47411393-E3B2-7F55-0865EAB909BEF818.xlsx

XLSX spreadsheet 42 KB Posted

Attached to
Professional Engineering Services S. Grener Avenue, Emmit Avenue, Mix Avenue, and Sullivant Avenue (
Solicitation number
RFQ No. 2025-09-03
Issued by
Franklin County, Ohio

About this file

Summary

This is a Short Term Disability Claims Status Detail report prepared for the Franklin County Cooperative Health Improvement Program (Customer 0157775) covering the period from January 1, 2022, through July 31, 2025, with data current as of July 30, 2025. The report documents 493 total disability claims processed during this timeframe, detailing claim status, claimant demographics (gender and age), disability classification (sick or accident-related, occupational or non-occupational), disability dates, benefit start dates, claim end dates, base benefit amounts, and cumulative gross benefit payments. Claims are categorized by status including Closed, Denied, Open, Pending, and Suspended, with the underlying benefit structure providing weekly or bi-weekly payments to eligible participants during periods of disability.

The total cumulative gross benefit payments issued for Customer 0157775 amount to $2,234,179.52 across all 493 claims. Base benefits vary by claimant, ranging from $25.00 to $1,500.00 per benefit period, with cumulative gross benefits ranging from $0.00 (for denied or immediately terminated claims) to $35,071.12 for extended claim periods. The report reflects a mature disability program with consistent claim volume and benefit administration, demonstrating ongoing benefit distribution throughout the four-year reporting period with no apparent set-asides, incumbency considerations, or funding source specifications detailed in this administrative data summary.

View the file

Other files

File Type Posted
4764BD72-A4C9-CB3B-C1392F63B1D7AA28.pdf PDF
CCC737E4-C815-7DA9-BAFDD4D8BCA83EAE.pdf PDF
47647B12-EF69-CBAE-3877E615229CE346.pdf PDF
FAFB33F1-A49E-7354-6799AC07E5D29DA0.pdf PDF
600B193E-A6DE-E459-0374B7046DEB49BE.xlsx XLSX spreadsheet
48C51FFE-B1BA-D9DA-11337A7B04016CA4.pdf PDF
4ADC54F2-C74F-3F02-B4900398FFBEE5A5.xlsx XLSX spreadsheet
48FFC2CD-AEC5-7A21-3B4F6E3270F0429B.pdf PDF
E9905CF7-C973-40FC-678D5FD85143E735.pdf PDF
36771012-968A-47BA-49FB1CC4DFFFEC63.pdf PDF
44F2E64B-E391-5EAC-DD33927813E7BE98.xlsx XLSX spreadsheet
44B739A8-A554-F8F5-C38D97EF8EFBF991.xlsx XLSX spreadsheet
9124AC45-D403-5860-A4635A70C618C298.pdf PDF
8F3A405E-0241-7E43-C0DC0A6106AC42BB.pdf PDF
44F28715-E1AF-A884-828CBEAF47CBA5D7.xlsx XLSX spreadsheet
E990A518-E8F3-4318-3125803AC770B0DD.pdf PDF
1FF70774-E56E-EAC8-88A7694DAF5EB82C.pdf PDF
A46910BC-E967-DD22-10B71BADEA153824.docx DOCX document
DDA0BDC2-FA19-ADB6-FAD2DEA5AE6B4AEE.pdf PDF
8D7E2732-E2EF-8808-10498B0343D0DB6B.pdf PDF
47039A14-CC1D-3979-F8226F8E1E768343.pdf PDF
E93EE438-A2D2-AF8E-6F5941F303D00F6A.pdf PDF
A468D9BE-C742-A53B-A0E51044FC47530E.pdf PDF
96EE5830-0F4F-104B-FF1246192320CF51.pdf PDF
600B382B-92C2-EE01-36E3171A1CE23381.pdf PDF
ED338BF8-FCF8-7E6B-4327CDB3236D9A0A.pdf PDF
441C7CE8-FE79-FFAD-86876E5C9E330E9F.pdf PDF
56D1E25C-D6F7-A070-782594700401C348.docx DOCX document
D19B3093-A699-8107-EE175100DAB2A969.pdf PDF
39A8A9E3-F569-C6B6-B9E7BF50CFDC4F51.pdf PDF
1FF76D77-0146-31BD-B70AC2B9310C078F.pdf PDF
3CA5BBE9-A618-9D6F-45A1FE1B6F58F0BF.pdf PDF
4ADC244E-B24C-BEC2-4654E43F7ACFB8A4.xlsx XLSX spreadsheet
455CC78D-B78A-EC66-F7D6D71B8AF36042.pdf PDF
BEA8B132-08B9-5848-83E1018BFD8D09C5.xlsx XLSX spreadsheet
1FF8629C-E097-4138-B3B7BE56C0FCD3F5.pdf PDF
58DCD716-9EAC-9E14-6719EE5FDA607EE3.pdf PDF
600ACEFD-D8A4-EF86-6746123A35214FBD.pdf PDF
45745F40-E0BA-1577-1AE1A9CC2179CA13.pdf PDF
490005E7-0009-0FD7-0E92BD0F4BF1B987.xlsx XLSX spreadsheet
340E518F-B0A2-92CD-5CE67BE8C5C74ADC.pdf PDF
A4692B9C-E659-F33F-532C87A025A11AC2.pdf PDF
C0135AC1-FF9D-F3AC-BDB7FB4697056E65.pdf PDF
56D21EF1-090E-9236-DC87D4ABB226948A.pdf PDF
9188FC82-07E6-2A24-E7927A56369C067A.pdf PDF
5FEA932D-A443-F834-C369AEC7AD13A552.pdf PDF
F388F0B8-095B-81FD-4AB0A90CB30AE31F.pdf PDF
4703BAFF-A637-A4BC-D31224A6D85981B6.pdf PDF
379F0AFD-BC67-5833-47CED9B9F8A77644.pdf PDF
365FC443-9C1D-6871-4B183773D28A5AB9.pdf PDF
Show 40 more

Latest 50 of 148 listed here. See the rest on GovTribe.

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

Text version

Sheet1

FRANKLIN COUNTY COOPERATIVE HEALTH IMPROVEMENT PRO
Claim Status Detail
Short Term Disability
Data as of: 07/30/2025From: 01/01/2022To: 07/31/2025
Customer: 0157775
Claim StatusGenderClaimant Age - YearsAcc/SickOcc/Non-OccDisability DateBenefit Start DateClaim End DateBase BenefitCumulative Gross Benefit
DeniedM61SN11/26/201912/10/201911/26/2019$372.00$0.00
ClosedM60SN10/5/202110/19/20212/6/2022$633.36$10,043.28
ClosedF31SN12/27/20211/10/20222/20/2022$529.68$1,801.32
DeniedF42SN12/28/20211/11/20221/6/2022$483.36$0.00
DeniedF49SN3/17/20223/31/20223/17/2022$476.16$0.00
ClosedF65SN6/22/20227/6/202211/6/2022$635.75$11,261.86
ClosedF53SN7/25/20228/8/20228/21/2022$750.24$1,500.48
ClosedM64SN7/27/20228/10/20229/3/2022$396.24$1,867.99
DeniedM31SN8/5/20228/19/20228/5/2022$571.68$0.00
ClosedF65SN8/29/20229/12/202210/31/2022$574.32$4,102.29
DeniedM66SN1/4/20231/18/20231/4/2023$678.00$0.00
ClosedM58SN3/22/20234/5/20236/14/2023$762.92$5,353.80
ClosedM39AN6/25/20237/9/20239/10/2023$840.25$6,867.04
DeniedM51SN8/15/20238/29/20238/15/2023$488.88$0.00
ClosedF30SN10/4/202310/18/202311/14/2023$609.60$267.03
ClosedF25SN10/11/202310/25/20231/1/2024$547.44$5,396.20
ClosedF48SN11/8/202311/22/20232/8/2024$684.00$7,719.43
ClosedM53SN1/3/20241/17/20243/27/2024$1,482.85$6,709.77
DeniedF67SN1/4/20241/18/20241/4/2024$531.12$0.00
ClosedM65SN12/15/202312/29/20232/11/2024$675.36$3,809.95
ClosedM71SN2/13/20242/27/20244/30/2024$752.40$6,879.08
ClosedF34SN3/15/20243/29/20244/24/2024$565.44$2,180.98
ClosedF43SN3/20/20244/3/202410/4/2024$553.44$14,331.79
ClosedF48SN3/26/20244/9/20248/13/2024$928.32$15,164.79
DeniedF59SN6/4/20246/18/20246/4/2024$725.76$0.00
ClosedF34SN5/8/20245/22/20245/27/2024$565.44$1,292.44
ClosedF26SN7/1/20247/15/20248/4/2024$646.85$1,940.55
ClosedF45SN5/23/20246/6/20246/19/2024$559.44$1,118.88
ClosedF56SN6/12/20246/26/20247/18/2024$444.00$1,458.86
DeniedF22SN11/12/202411/26/202411/12/2024$25.00$0.00
ClosedF27SN10/10/202410/24/202412/4/2024$886.80$150.00
DeniedF62SN10/18/202411/1/202410/18/2024$955.43$0.00
ClosedM43SN10/3/202410/17/202411/17/2024$636.24$2,908.53
ClosedF50SN12/16/202412/30/20246/29/2025$595.68$14,917.00
ClosedM59SN12/28/20241/11/20257/11/2025$553.20$14,383.20
ClosedF48SN2/3/20252/17/20253/30/2025$655.92$3,935.52
OpenF60SN2/3/20252/17/20258/7/2025$678.72$13,574.40
ClosedF34SN2/3/20252/17/20252/24/2025$607.12$28.57
ClosedF49SN3/28/20254/11/20257/27/2025$552.00$8,437.71
DeniedM51SN3/10/20253/24/20253/10/2025$579.12$0.00
ClosedM22SN4/9/20254/23/20255/14/2025$458.31$1,440.40
ClosedF61SN4/27/20255/11/20256/25/2025$500.64$3,289.92
PendingF67SN7/18/20258/1/20257/18/2025$698.40$0.00
ClosedF31SN5/26/20256/9/20257/6/2025$782.88$3,131.52
OpenF45SN6/25/20257/9/20258/19/2025$647.76$1,758.21
ClosedF49AN4/10/20254/24/20256/29/2025$599.28$4,933.39
PendingF55SN6/16/20256/30/20257/27/2025$692.16$0.00
ClosedF66SN12/9/202112/23/20213/6/2022$512.16$3,879.71
ClosedF60SN3/21/20224/4/20226/12/2022$481.68$3,903.44
ClosedM31SN4/21/20225/5/20228/29/2022$571.68$7,848.69
ClosedF31SN4/2/20224/16/20225/16/2022$597.84$1,053.34
ClosedF52SN5/31/20226/14/202212/12/2022$699.60$16,840.41
ClosedF39SN11/21/202212/5/20221/20/2023$1,157.09$4,733.45
ClosedM55SN9/14/20229/28/20221/1/2023$614.40$8,426.06
DeniedF25SN10/6/202210/20/202210/6/2022$372.72$0.00
ClosedF58SN1/3/20231/17/20232/21/2023$414.00$2,129.15
ClosedF60SN2/13/20232/27/20238/27/2023$522.96$8,314.37
ClosedF35SN5/1/20235/15/20236/25/2023$622.08$1,244.16
ClosedF62SN2/10/20232/24/20234/18/2023$570.24$4,398.99
DeniedF66SN1/9/20231/10/2023$0.00
DeniedF29SN3/26/20234/9/20233/26/2023$576.24$0.00
ClosedF41SN5/26/20236/9/20237/9/2023$525.60$2,327.66
ClosedF44SN6/5/20236/22/202310/6/2023$535.44$8,184.59
ClosedF37AN4/26/20235/10/202311/3/2023$444.00$5,185.37
ClosedF45SN6/12/20236/26/20237/23/2023$563.76$1,528.36
ClosedF25SN7/8/20237/22/20238/20/2023$515.99$2,211.39
ClosedF28SN7/17/20237/31/20231/28/2024$646.08$13,513.84
ClosedF41SN8/14/20238/28/20239/9/2023$579.60$1,076.40
DeniedM41AN9/16/20239/30/20239/15/2023$408.00$0.00
ClosedF41SN10/13/202310/27/202311/27/2023$541.44$2,475.16
ClosedF61SN10/30/202311/13/20235/12/2024$493.68$12,835.68
ClosedF49SN10/9/202310/23/202311/12/2023$604.80$1,814.40
ClosedF30SN3/15/20243/29/20244/25/2024$857.23$0.00
DeniedF23SN10/14/202310/28/202310/14/2023$550.32$0.00
ClosedM61SN12/9/202312/23/20236/21/2024$1,124.75$23,941.11
ClosedF38SN1/4/20241/18/20243/21/2024$777.44$6,683.17
ClosedM55SN1/8/20241/22/20242/4/2024$667.20$692.20
ClosedF33SN3/16/20243/30/20246/2/2024$495.54$4,601.45
ClosedF24SN6/26/20247/10/20248/15/2024$450.96$2,383.64
DeniedF41SN9/30/202410/14/20249/30/2024$780.24$0.00
ClosedF57SN9/10/20249/24/20241/12/2025$613.20$9,723.60
ClosedF33SN10/8/202410/22/202411/18/2024$836.78$3,347.12
ClosedF26SN12/9/202412/23/20245/31/2025$535.92$11,892.32
ClosedM48SN1/9/20251/23/20253/2/2025$753.84$4,523.04
ClosedF27SN2/8/20252/22/20254/15/2025$550.08$4,164.90
DeniedF54SN11/16/202411/30/202411/16/2024$608.40$0.00
ClosedF46SN12/31/20241/14/20252/24/2025$559.44$3,356.64
DeniedF49SN1/27/20252/10/20251/27/2025$566.64$0.00
ClosedF50SN1/10/20251/24/20257/24/2025$463.92$11,863.10
OpenF61SN4/21/20255/5/20258/5/2025$1,001.52$11,590.51
ClosedF53SN5/29/20256/12/20257/6/2025$566.64$2,023.71
OpenF35SN5/19/20256/2/20258/15/2025$566.64$4,533.12
OpenF53SN4/24/20255/8/20258/14/2025$730.56$8,453.62
SuspendedF31SN7/1/20257/15/20257/28/2025$488.16$976.32
ClosedF59SN5/27/20256/10/20257/21/2025$754.80$3,903.26
PendingF0SN8/14/2025$0.00
ClosedM34SN5/21/20216/4/202112/2/2021$655.73$11,334.76
ClosedF29SN10/1/202110/15/202110/17/2021$476.16$204.07
ClosedM49AN10/23/202111/6/20215/6/2022$1,157.12$30,085.12
ClosedF54SN12/27/20211/10/20224/24/2022$559.44$8,391.60
ClosedF32SN12/6/202112/20/20211/30/2022$384.00$2,304.00
ClosedF41SN1/17/20221/31/20223/14/2022$715.44$4,394.85
ClosedF50SN3/30/20224/13/20225/4/2022$669.05$1,642.70
ClosedF53SN5/15/20225/29/202210/1/2022$498.96$8,981.28
DeniedF55SN5/20/20226/3/20226/1/2022$1,157.17$0.00
ClosedF40SN10/6/202210/20/202211/4/2022$629.04$1,282.31
ClosedF64SN9/29/202210/13/20224/12/2023$414.96$10,670.40
ClosedF57SN1/30/20232/13/20232/26/2023$582.24$413.16
ClosedF27SN8/8/20228/22/20222/19/2023$628.80$2,169.11
DeniedF52SN2/20/20233/6/20232/20/2023$949.28$0.00
ClosedF33SN3/17/20233/31/20235/11/2023$669.23$3,505.57
ClosedM61SN4/23/20235/7/20238/31/2023$1,088.75$18,197.68
ClosedF60SN5/10/20235/24/20236/13/2023$511.20$2,117.83
ClosedM43SN5/12/20235/26/20238/29/2023$704.16$9,657.05
DeniedF58SN7/25/20238/8/20237/25/2023$425.28$0.00
ClosedF59SN7/21/20238/4/202310/15/2023$633.60$6,607.54
ClosedF50SN7/27/20238/10/20232/12/2024$481.44$12,517.44
ClosedF60SN6/12/20236/26/202311/5/2023$463.20$7,471.92
DeniedF53SN8/25/20239/8/20238/25/2023$608.16$0.00
ClosedF47SN7/11/20237/25/202310/19/2023$574.08$7,027.35
ClosedM41AN9/16/20239/30/20233/11/2024$408.00$9,558.86
ClosedF33SN9/15/20239/29/202311/19/2023$408.00$3,030.86
ClosedF31SN10/9/202310/23/202312/1/2023$525.60$3,003.43
ClosedF38SN10/18/202311/1/202312/3/2023$535.44$2,159.62
ClosedF60SN11/22/202312/6/20235/8/2024$459.36$6,820.77
DeniedF23SN1/13/20241/27/20241/13/2024$450.00$0.00
ClosedF25SN4/11/20244/25/20245/22/2024$571.44$2,285.76
DeniedM60AY11/4/20232/23/202411/4/2023$1,256.89$0.00
ClosedF36SN3/21/20244/4/20249/16/2024$571.44$13,551.29
ClosedM52SN4/2/20244/16/20245/27/2024$829.92$4,979.52
ClosedF32SN2/13/20242/27/20244/19/2024$571.44$734.71
ClosedF61SN3/27/20244/10/20247/28/2024$918.24$14,352.97
ClosedF66SN5/9/20245/23/20248/7/2024$520.80$4,910.40
DeniedF47SN5/14/20245/28/20245/14/2024$450.00$0.00
ClosedF41SN7/29/20248/12/20249/15/2024$1,099.68$5,498.40
DeniedF30SN9/2/20249/16/20249/2/2024$547.44$0.00
DeniedF38SN10/16/202410/30/202410/16/2024$817.92$0.00
DeniedF52SN9/23/202410/7/20249/23/2024$596.88$0.00
DeniedF29SN10/29/202411/12/202410/29/2024$547.44$0.00
ClosedM63SN10/29/202411/12/20244/6/2025$778.80$16,243.54
ClosedF37SN11/27/202412/11/20243/2/2025$481.20$5,636.91
OpenF48SN1/17/20251/31/20257/31/2025$912.48$11,745.58
DeniedF42SN12/19/20241/2/202512/19/2024$817.20$0.00
ClosedF42SN3/20/20244/3/20245/28/2024$857.23$486.22
ClosedF62AN11/29/202412/13/20243/16/2025$586.32$7,873.44
DeniedF26SN1/14/20251/28/20251/14/2025$462.00$0.00
OpenF46SN6/30/20257/14/20258/10/2025$550.56$1,101.12
DeniedF25SY6/20/20257/4/20256/20/2025$715.92$0.00
PendingF0SN5/16/2025$0.00
ClosedM33SN8/12/20218/26/20212/23/2022$484.56$11,416.84
ClosedF34SN10/23/202111/6/20215/30/2022$599.28$15,581.28
ClosedF54SN12/9/202112/23/20213/6/2022$542.16$5,731.41
DeniedF36SN1/5/20221/19/20221/6/2022$476.64$0.00
ClosedF41SN1/9/20221/23/20222/21/2022$506.16$725.78
ClosedF48SN6/7/20216/21/202112/19/2021$528.24$6,613.06
DeniedM67SN9/15/20219/29/20219/15/2021$471.12$0.00
ClosedF42SN2/15/20223/1/20224/11/2022$593.28$508.53
ClosedM65SN3/23/20224/6/20225/15/2022$692.88$3,959.31
DeniedF36SN7/28/20228/11/20227/28/2022$525.12$0.00
DeniedM31SN6/22/20227/6/20226/22/2022$571.68$0.00
ClosedF66SN6/9/20226/23/20227/26/2022$330.00$1,048.40
ClosedF40SN9/26/202210/10/202210/23/2022$527.28$1,355.86
ClosedF34SN8/8/20228/22/20222/5/2023$451.44$8,562.94
ClosedF31SN9/8/20229/22/202210/21/2022$530.40$2,273.15
ClosedF51AN9/30/202210/14/20225/20/2023$760.56$12,767.35
ClosedF66SN10/21/202211/4/20224/11/2023$570.24$12,952.60
DeniedF30SN1/12/20231/26/20233/14/2023$421.68$0.00
ClosedF43SN2/1/20232/15/20237/31/2023$573.36$13,023.46
ClosedF56SN2/17/20233/3/20238/31/2023$729.36$17,450.45
ClosedF34SN5/18/20236/1/20236/28/2023$634.32$2,537.28
ClosedM60SN6/15/20236/29/20237/30/2023$600.72$2,746.15
ClosedF39SN5/30/20236/13/20237/1/2023$701.04$1,902.82
ClosedF31SN9/15/20239/29/202310/25/2023$646.56$1,662.58
ClosedF44SN6/29/20237/13/20237/26/2023$686.04$1,372.08
ClosedF59AN6/28/20237/12/202312/11/2023$673.44$13,807.35
ClosedF60SN9/6/20239/20/20233/19/2024$724.32$18,651.27
ClosedM57SN10/27/202311/10/20231/22/2024$607.68$2,841.15
ClosedF44SN9/26/202310/10/202312/25/2023$553.44$5,771.59
ClosedF59SN12/19/20231/2/20247/1/2024$425.28$11,057.28
ClosedF62SN9/20/202310/4/202310/8/2023$612.24$437.31
ClosedF44SN1/29/20242/12/20245/7/2024$857.23$10,670.45
DeniedF62SN2/8/20242/22/20242/8/2024$491.52$0.00
ClosedF32SN1/19/20242/2/20247/22/2024$535.44$13,156.52
ClosedF62SN2/23/20243/8/20249/5/2024$636.24$15,765.49
DeniedF35SN4/16/20244/30/20244/16/2024$716.64$0.00
ClosedF51SN4/12/20244/26/20247/7/2024$636.24$6,635.08
ClosedM59SN6/19/20247/3/20249/10/2024$809.30$5,896.34
ClosedF43SN7/1/20247/15/20248/11/2024$587.04$2,348.16
ClosedF64SN5/7/20245/21/20247/14/2024$622.80$4,893.43
ClosedF32SN8/16/20248/30/20249/30/2024$588.96$2,692.39
ClosedF61SN6/15/20246/29/202412/27/2024$762.96$19,618.97
ClosedM66SN6/14/20246/28/202412/17/2024$711.36$17,580.76
ClosedM59SN6/26/20247/10/20247/28/2024$713.76$1,937.35
DeniedM56SN8/9/20248/23/20248/9/2024$778.56$0.00
ClosedF41SN10/25/202411/8/202412/18/2024$1,300.56$7,617.56
ClosedF50SN9/2/20249/16/20249/29/2024$583.20$1,749.60
ClosedF53SN8/31/20249/14/202410/20/2024$707.04$3,737.21
ClosedF58SN12/3/202412/17/20241/26/2025$834.28$2,661.86
ClosedF23SN9/26/202410/10/202411/10/2024$535.92$2,296.80
ClosedF53SN10/1/202410/15/202411/3/2024$545.52$1,558.63
ClosedF60SN9/16/20249/30/20243/30/2025$582.56$5,234.76
ClosedM54SN11/26/202412/10/202412/29/2024$700.80$2,002.29
DeniedF46SN10/18/202411/1/202410/27/2024$653.04$0.00
ClosedF33SN11/4/202411/18/20243/30/2025$674.16$11,310.15
ClosedM59SN10/31/202411/14/202412/16/2024$547.44$1,984.47
DeniedF28SN4/2/20254/16/20254/2/2025$696.24$0.00
SuspendedF36SN3/18/20254/1/20257/18/2025$566.64$8,823.39
ClosedF50SN3/31/20254/14/20255/11/2025$728.16$2,912.64
ClosedM66SN3/21/20254/4/20255/11/2025$601.20$711.91
OpenF32AN3/29/20254/12/20258/24/2025$507.36$7,755.36
ClosedF70SN4/14/20254/28/20257/13/2025$546.96$6,016.56
ClosedF42SN5/16/20255/30/20256/29/2025$1,129.92$5,003.93
ClosedF32SN1/23/20252/6/20255/9/2025$566.64$1,518.20
PendingF42SN7/8/20257/22/20257/8/2025$897.12$0.00
PendingF40SN7/16/20257/30/2025$627.36$0.00
ClosedF52SN11/1/202111/15/20211/23/2022$485.52$250.00
ClosedF38SN11/11/202111/25/20213/9/2022$506.16$6,941.62
ClosedM70SN10/25/202111/8/202111/28/2021$385.68$991.75
ClosedF51SN1/24/20222/7/20224/17/2022$566.88$5,668.80
ClosedF37SN5/22/20226/5/20226/18/2022$557.52$1,115.03
ClosedM31SN9/29/202210/13/20224/12/2023$571.68$14,863.68
ClosedM49SN10/17/202210/31/202211/20/2022$607.44$1,822.32
DeniedF29SN2/7/20232/21/202312/6/2022$409.44$0.00
ClosedF51SN1/11/20231/25/20232/12/2023$468.96$1,272.89
DeniedF29SN1/17/20231/31/20231/17/2023$601.92$0.00
ClosedM61SN1/26/20232/9/20238/13/2023$740.88$6,925.67
ClosedF42SN2/13/20232/27/20235/15/2023$723.36$5,266.86
ClosedF24SN5/7/20235/21/20236/25/2023$547.44$177.14
ClosedM58SN2/24/20233/10/20234/16/2023$1,500.00$8,142.85
ClosedF61SN4/18/20235/2/20237/16/2023$454.85$4,938.37
ClosedM48SN2/10/20232/24/20235/18/2023$526.32$4,287.13
ClosedF59SN3/9/20233/23/20237/4/2023$443.76$5,388.51
ClosedF58AN4/22/20235/6/202311/3/2023$547.44$11,073.80
ClosedF64SN4/18/20235/2/202310/30/2023$480.96$7,554.54
DeniedM45SN5/22/20236/5/20235/22/2023$733.92$0.00
ClosedM33SN6/26/20237/10/202310/1/2023$711.60$9,962.40
ClosedF44SN7/3/20237/17/20239/26/2023$564.72$5,808.55
ClosedF38SN7/1/20237/15/20238/26/2023$952.13$5,214.08
ClosedF57SN8/14/20238/28/20239/24/2023$419.22$1,676.88
ClosedF56SN9/28/202310/12/202311/5/2023$585.84$3,529.33
ClosedF60SN11/30/202312/14/20231/17/2024$612.24$3,061.20
ClosedF47SN10/13/202310/27/202311/26/2023$541.44$2,397.81
ClosedF63SN10/14/202310/28/20231/18/2024$489.36$5,802.42
DeniedF34SN2/5/20242/19/20242/5/2024$716.64$0.00
ClosedF63SN4/18/20235/2/202310/30/2023$846.72$650.00
DeniedF29SN11/30/202312/14/202311/30/2023$420.00$0.00
ClosedF64SN12/24/20231/7/20244/7/2024$572.88$6,519.92
ClosedF46SN1/17/20241/31/20244/9/2024$591.36$5,913.60
ClosedF37SN4/12/20244/26/20245/27/2024$597.36$2,730.79
ClosedF47SN1/24/20242/7/20247/22/2024$805.44$19,215.49
ClosedF41SN7/13/20247/27/202410/8/2024$855.84$9,047.46
ClosedF34SN2/29/20243/14/20243/28/2024$636.24$1,363.37
ClosedF51SN5/10/20245/24/202411/21/2024$677.76$17,621.76
ClosedF47SN5/7/20245/21/20247/21/2024$636.24$5,635.27
DeniedF66SN7/16/20247/30/20247/16/2024$642.72$0.00
ClosedM52SN6/10/20246/24/20247/22/2024$1,122.48$4,650.27
DeniedF31SN7/26/20248/9/20247/26/2024$547.44$0.00
ClosedM53SN10/21/202411/4/20241/3/2025$685.20$5,971.03
ClosedF46SN10/16/202410/30/20244/29/2025$547.44$14,233.44
ClosedF38SN1/18/20252/1/20252/28/2025$480.00$1,920.00
ClosedF52AN2/15/20253/1/20255/15/2025$677.04$7,350.72
PendingF32SN7/16/20257/30/20257/16/2025$585.12$0.00
DeniedF54SN6/9/20256/23/20256/9/2025$826.08$0.00
PendingF45SN7/22/20258/5/20257/22/2025$655.44$0.00
DeniedM61SN6/7/20206/21/20206/5/2020$25.00$0.00
ClosedF60SN7/31/20218/14/20212/11/2022$1,157.42$28,936.88
ClosedF57SN2/2/20222/16/20223/15/2022$581.52$1,354.19
ClosedF35SN3/5/20223/19/20227/24/2022$902.17$8,351.67
DeniedF49SN4/25/20225/9/20224/25/2022$546.24$0.00
ClosedM49SN6/2/20226/16/202212/15/2022$582.57$14,536.52
ClosedF31SN7/4/20227/18/20228/14/2022$671.09$2,460.67
ClosedF46SN8/1/20228/15/20222/12/2023$591.36$14,981.12
ClosedF54SN9/13/20229/27/202210/26/2022$562.56$2,410.97
ClosedF50SN1/18/20232/1/20234/2/2023$1,011.73$8,485.24
ClosedF46SN12/9/202112/23/20215/12/2022$379.92$6,006.60
ClosedM56SN2/28/20233/14/20239/11/2023$872.88$15,777.10
ClosedF43SN5/1/20235/15/20236/21/2023$672.59$3,410.99
ClosedF55SN6/5/20236/19/20237/31/2023$652.56$4,008.58
ClosedF46SN10/25/202311/8/20231/21/2024$589.68$6,318.00
DeniedF41SN9/25/202310/9/202310/8/2023$709.20$0.00
ClosedM57SN10/26/202311/9/202312/17/2023$1,023.84$5,704.25
ClosedM59SN11/30/202312/14/20231/11/2024$438.00$1,814.58
ClosedM58SN1/5/20241/19/20243/16/2024$612.00$4,980.69
ClosedF63SN2/7/20242/21/20244/30/2024$636.24$6,362.40
ClosedF44SN2/26/20243/11/20244/21/2024$500.16$3,000.96
ClosedM34SN6/17/20247/1/20247/28/2024$638.16$1,326.32
ClosedF52SN9/27/202410/11/202412/22/2024$1,148.88$10,449.34
ClosedF39SN8/16/20248/30/202410/14/2024$716.88$2,355.46
ClosedF46SN10/1/202410/15/20244/14/2025$1,253.04$29,063.22
DeniedM27SN9/4/20249/18/20249/17/2024$492.48$0.00
ClosedF51SN10/16/202410/30/202411/10/2024$591.84$1,014.59
ClosedF39SN10/22/202411/5/202412/22/2024$565.44$3,877.30
ClosedF22SN12/2/202412/16/20241/14/2025$485.04$698.62
ClosedF62SN9/24/202410/8/202412/1/2024$506.40$917.20
ClosedF46SN1/30/20252/13/20254/9/2025$583.20$1,616.34
ClosedM59AN11/23/202412/7/20246/6/2025$754.56$19,618.56
ClosedF36SN2/19/20253/5/20254/3/2025$566.64$944.00
ClosedF31SN6/3/20256/17/20257/20/2025$832.56$4,043.86
ClosedM48SN4/27/20255/11/20257/22/2025$734.40$7,658.74
ClosedF50SN5/19/20256/2/20256/11/2025$566.64$809.49
DeniedF45SN4/15/20254/29/20254/29/2025$581.52$0.00
OpenF45AN5/23/20256/6/20258/17/2025$745.44$3,990.18
DeniedF38SY7/8/20257/22/20257/8/2025$27.00$0.00
DeniedF57SN7/6/20257/20/20257/6/2025$681.84$0.00
PendingF32SN7/21/20258/4/20257/21/2025$717.12$0.00
ClosedF49SN4/1/20214/15/20217/1/2021$411.48$2,104.03
ClosedF64SN10/13/202110/27/20212/6/2022$759.36$6,850.76
ClosedF50SN10/29/202111/12/20211/31/2022$526.32$5,739.40
ClosedF62SN10/26/202111/9/20211/27/2022$432.24$1,736.58
ClosedF32SN12/17/202112/31/20216/13/2022$397.44$8,647.99
ClosedF57SN12/15/202112/29/20212/25/2022$428.68$2,773.41
ClosedF46SN1/26/20222/9/20228/9/2022$458.64$11,924.64
ClosedF34SN1/31/20222/14/20223/4/2022$489.36$1,328.26
ClosedF36SN4/28/20225/12/20226/22/2022$601.92$3,582.86
DeniedF26SN5/7/20225/21/20225/8/2022$496.32$0.00
ClosedM31SN3/29/20224/12/20225/10/2022$611.52$2,970.24
ClosedF30SN4/30/20225/14/20226/7/2022$546.24$1,950.86
ClosedF59SN4/26/20225/10/20228/7/2022$414.24$5,325.95
DeniedF38SN8/13/20228/27/202210/11/2022$546.24$0.00
DeniedF37SN8/8/20228/22/20228/8/2022$662.40$0.00
ClosedF33SN8/22/20229/5/202210/9/2022$530.40$2,563.60
ClosedF28SN9/7/20229/21/202211/3/2022$754.08$4,739.93
ClosedF54AN9/8/20229/22/202212/1/2022$394.08$3,997.10
ClosedF29SN8/24/20229/7/202210/2/2022$576.48$2,022.01
ClosedM42SN11/8/202211/22/20225/22/2023$959.03$20,667.72
ClosedF24SN12/1/202212/15/20222/14/2023$573.36$4,313.85
ClosedF32SN1/10/20232/1/20233/16/2023$451.44$2,837.63
ClosedF45SN1/27/20232/10/20232/23/2023$441.60$883.20
DeniedM24SN5/23/20236/6/20235/23/2023$535.44$0.00
ClosedF49SN1/17/20231/31/20232/9/2023$574.80$711.65
ClosedF31SN12/24/20221/7/20236/4/2023$763.10$6,934.82
DeniedF41SN5/22/20236/5/20235/22/2023$520.80$0.00
DeniedF38SN3/1/20233/15/20233/1/2023$878.16$0.00
DeniedF33SN7/10/20237/24/20238/6/2023$547.44$0.00
ClosedF53SN10/5/202310/19/202312/3/2023$448.80$2,949.26
ClosedF24SN9/19/202310/3/202310/30/2023$566.40$1,801.54
ClosedM37SN9/7/20239/21/202312/1/2023$447.84$4,606.36
DeniedM41AN9/16/20239/30/20239/16/2023$408.00$0.00
ClosedF51SN11/16/202311/30/20232/12/2024$525.60$5,631.43
ClosedM65SN11/3/202311/17/20231/1/2024$1,050.24$2,525.79
ClosedF51SN4/29/20245/13/20247/21/2024$918.72$9,187.20
ClosedF66SN3/15/20243/29/20249/26/2024$688.56$17,902.56
ClosedF36SN5/14/20245/28/20246/24/2024$1,168.32$4,673.28
ClosedM49SN7/9/20247/23/20248/1/2024$1,300.56$35.71
ClosedM50SN7/18/20248/1/202410/27/2024$603.12$3,016.54
DeniedM65AN9/20/202410/4/20249/20/2024$686.40$0.00
ClosedF60SN10/22/202411/5/20241/20/2025$657.84$7,236.24
ClosedF43SN3/13/20253/27/20253/30/2025$617.52$617.52
ClosedF58SN4/4/20254/18/20255/9/2025$828.24$2,563.60
OpenF41SN6/6/20256/20/20258/3/2025$529.20$996.49
PendingM50SN5/10/20255/24/20255/10/2025$578.16$0.00
PendingF0SN6/16/2025$0.00
ClosedF53SN7/28/20218/11/20212/8/2022$506.16$10,918.60
ClosedF45SN11/20/202112/4/20211/23/2022$506.16$3,687.74
ClosedF22SN12/12/202112/26/20212/5/2022$371.28$2,227.68
ClosedF61SN4/4/20224/18/20227/3/2022$526.32$5,789.52
ClosedF52SN1/18/20222/1/20228/1/2022$739.92$19,237.92
ClosedF63SN12/20/20211/3/20227/12/2022$409.44$9,807.05
ClosedF52SN11/30/202112/14/20212/13/2022$649.92$1,981.10
DeniedM37SN3/4/20223/18/20223/4/2022$369.84$0.00
ClosedF61AN4/26/20225/10/20227/31/2022$915.12$5,615.72
ClosedF43SN6/14/20226/28/20229/13/2022$783.80$6,856.10
ClosedF43SN7/20/20228/3/202210/10/2022$568.56$5,604.37
ClosedF27SN6/29/20227/13/202212/14/2022$601.92$12,239.04
ClosedF37SN7/1/20227/15/20228/2/2022$591.36$387.92
ClosedF40SN7/26/20228/9/20229/4/2022$581.28$2,408.16
ClosedF59SN8/8/20228/22/202211/2/2022$435.12$4,289.04
ClosedF58SN9/9/20229/23/202210/20/2022$599.89$2,399.56
ClosedF39SN10/12/202210/26/20221/4/2023$793.92$5,391.32
ClosedF24SN10/22/202211/5/202212/4/2022$491.52$2,106.51
ClosedF26SN12/20/20221/3/20232/13/2023$677.76$2,854.29
ClosedF50SN12/8/202212/22/20222/12/2023$636.00$907.14
DeniedF38SN3/2/20233/16/20233/2/2023$570.24$0.00
ClosedF56SN3/27/20234/10/20235/14/2023$585.84$2,929.20
ClosedF53SN12/13/202212/27/20226/11/2023$1,157.17$15,314.64
ClosedF32SN4/5/20234/19/20234/30/2023$470.40$806.40
ClosedF57SN5/3/20235/17/20235/21/2023$419.22$299.44
DeniedF20SN6/20/20237/4/20236/20/2023$25.00$0.00
DeniedF45SN7/18/20238/1/20237/18/2023$597.60$0.00
ClosedF35SN8/6/20238/20/20239/16/2023$883.97$5,303.82
ClosedF49SN7/19/20238/2/20231/30/2024$728.88$18,950.88
DeniedM41AN9/16/20239/30/20239/16/2023$408.00$0.00
ClosedF33SN10/2/202310/16/202312/10/2023$535.44$4,360.01
DeniedM44AY5/22/20236/5/202310/26/2023$1,482.78$0.00
ClosedM30SN11/14/202311/28/202312/3/2023$605.04$518.61
ClosedF62SN2/8/20242/22/20248/22/2024$591.84$13,133.21
ClosedF41SN4/29/20245/13/20245/19/2024$571.44$1,142.88
ClosedF52SN5/1/20245/15/20246/9/2024$687.60$2,553.94
DeniedF30SN3/21/20244/4/20243/21/2024$647.76$0.00
ClosedF26SN4/9/20244/23/20246/4/2024$535.92$2,832.72
DeniedF59SN6/4/20246/18/20246/4/2024$580.32$0.00
DeniedF64SN4/23/20245/7/20244/23/2024$637.44$0.00
ClosedF35SN8/5/20248/19/202411/3/2024$691.92$7,149.84
DeniedF38SN10/16/202410/30/202410/16/2024$817.92$0.00
ClosedM61SN10/22/202411/5/20245/5/2025$796.08$20,698.08
ClosedM46AN11/1/202411/15/20245/15/2025$552.00$10,964.14
ClosedF53SN12/30/20241/13/20253/23/2025$687.60$6,876.00
ClosedF51SN11/20/202412/4/202412/22/2024$878.16$2,093.47
ClosedF47SN4/4/20254/18/20255/18/2025$468.00$2,072.57
ClosedF30SN1/30/20252/13/20257/30/2025$520.38$2,973.60
ClosedF59SN6/9/20216/23/202112/12/2021$688.80$13,421.06
ClosedF41SN10/13/202110/27/20214/26/2022$510.96$11,922.41
ClosedF51SN11/29/202112/13/20211/10/2022$566.40$2,346.51
ClosedF53SN12/29/20211/11/20221/30/2022$752.62$5,235.10
DeniedF31SN2/1/20222/15/20222/1/2022$536.40$0.00
ClosedF31SN2/3/20222/17/20223/27/2022$442.34$2,464.47
DeniedF35SN3/12/20223/26/20223/12/2022$902.17$0.00
ClosedF36SN4/7/20224/21/20226/1/2022$599.28$2,682.49
ClosedF46SN5/26/20226/9/202211/13/2022$520.08$11,738.95
ClosedM66SN8/31/20229/14/202212/18/2022$692.88$10,888.11
ClosedM58SN8/31/20229/14/202210/12/2022$752.88$2,760.56
ClosedF25SN6/15/20226/29/20228/11/2022$551.76$1,737.42
ClosedF36AN9/2/20229/16/202210/2/2022$546.24$727.31
ClosedF45SN11/9/202211/23/20225/23/2023$642.96$16,410.79
ClosedF47SN11/9/202211/23/20221/8/2023$630.00$3,690.00
ClosedM47SN11/21/202212/5/202212/25/2022$696.72$2,786.88
ClosedF50SN10/24/202211/7/202211/15/2022$513.60$660.34
ClosedF29SN1/25/20232/8/20233/26/2023$409.44$2,749.10
ClosedF37SN1/25/20232/8/20233/22/2023$808.08$4,963.92
ClosedF31SN1/12/20231/26/20232/22/2023$601.92$1,314.83
ClosedM58SN3/22/20234/5/20234/23/2023$620.88$1,685.25
ClosedF65SN3/17/20233/31/20234/16/2023$487.68$1,184.37
DeniedF59SN6/29/20237/13/20236/29/2023$473.52$0.00
ClosedF34SN4/26/20235/10/20236/11/2023$554.40$2,613.60
ClosedF33SN4/25/20235/9/20236/8/2023$456.84$1,238.61
DeniedF29SN5/12/20235/26/20235/12/2023$418.56$0.00
ClosedF50SN6/30/20237/14/202311/5/2023$653.76$10,740.34
ClosedM63SN6/26/20237/10/20231/7/2024$581.76$7,862.88
ClosedF38SN8/7/20238/21/202310/1/2023$612.72$2,884.36
DeniedM41AN9/16/20239/30/20239/16/2023$408.00$0.00
DeniedF30SN7/26/20238/9/20237/26/2023$511.44$0.00
ClosedM34SN1/16/20241/30/20247/29/2024$716.88$18,638.88
ClosedF69SN2/5/20242/19/20243/3/2024$496.56$993.12
ClosedF32SN3/1/20243/15/20245/29/2024$565.44$2,896.42
ClosedF36AN3/26/20244/9/20246/25/2024$652.80$4,798.85
ClosedF56SN1/25/20242/8/20246/9/2024$737.14$2,168.77
ClosedF34SN5/2/20245/16/20246/12/2024$571.44$100.00
ClosedM39SN6/14/20246/28/202412/26/2024$693.84$17,742.48
DeniedF31SN8/16/20248/30/20248/16/2024$608.16$0.00
ClosedF48SN8/28/20249/11/202411/10/2024$631.92$5,506.73
ClosedM35AN9/22/202410/6/202411/3/2024$730.32$3,025.61
DeniedF43SN10/30/202411/13/202410/30/2024$565.44$0.00
ClosedF64SN12/6/202412/20/20246/19/2025$557.28$14,489.28
DeniedM56SN11/13/202411/27/202411/13/2024$1,300.56$0.00
ClosedF42SN2/24/20253/10/20254/6/2025$810.48$2,971.76
ClosedF61SN1/13/20251/27/20252/2/2025$621.36$621.36
ClosedF47SN2/12/20252/26/20253/23/2025$1,134.48$92.86
ClosedF46SN3/28/20254/11/20254/24/2025$720.48$1,440.96
OpenF44SN4/3/20254/17/20258/29/2025$1,116.00$15,064.43
OpenM64SN5/12/20255/26/20259/25/2025$879.60$7,916.40
OpenF57SN5/29/20256/12/20259/8/2025$612.00$4,021.71
PendingM67SN8/19/20259/2/2025$576.00$0.00
PendingF34SN6/24/20257/10/2025$563.04$0.00
ClosedF32SN9/10/20219/24/20213/24/2022$516.24$13,422.24
ClosedM56AN11/19/202112/3/20212/13/2022$502.80$5,099.83
ClosedM45SN11/19/202112/3/20216/3/2022$1,157.10$30,084.60
ClosedF57SN11/11/202111/25/20211/9/2022$429.60$2,013.89
DeniedM35SN1/10/20221/24/20221/30/2022$379.92$0.00
ClosedF28SN1/26/20222/9/20222/22/2022$364.80$689.46
ClosedF57SN2/15/20223/1/20223/6/2022$544.80$466.97
ClosedF51SN4/18/20225/2/20225/18/2022$595.68$1,446.65
ClosedF53SN4/5/20224/19/202210/17/2022$388.32$8,694.94
DeniedF30SN8/3/20228/17/20228/3/2022$482.14$0.00
ClosedF63SN6/2/20226/16/20226/27/2022$628.38$1,077.22
DeniedF43SN7/5/20227/19/20227/5/2022$594.72$0.00
ClosedF25SN6/28/20227/12/20228/8/2022$601.92$594.50
DeniedF58SN10/15/202210/29/202210/23/2022$544.80$0.00
DeniedF31SN12/15/202212/29/202212/15/2022$763.10$0.00
DeniedF29SN1/25/20232/8/202311/29/2022$409.44$0.00
ClosedF22SN2/4/20232/18/20233/26/2023$494.40$2,448.46
ClosedF31SN5/28/20236/11/20237/9/2023$772.56$3,200.61
DeniedM41AN9/16/20239/30/20239/16/2023$408.00$0.00
ClosedF50SN12/29/20231/12/20242/11/2024$477.84$2,116.15
ClosedF56SN1/10/20241/24/20245/15/2024$583.44$9,418.39
DeniedM37AY1/24/20242/7/20241/24/2024$694.56$0.00
DeniedF50SN3/28/20244/11/20244/8/2024$669.36$0.00
DeniedF23SN3/28/20244/11/20244/1/2024$535.92$0.00
ClosedM47SN5/21/20246/4/20246/30/2024$753.84$2,907.67
ClosedF39AN6/1/20246/15/20247/21/2024$565.44$2,827.20
ClosedF47SN7/15/20247/29/202412/13/2024$491.40$9,687.60
DeniedF41SN11/13/202411/27/202411/13/2024$503.04$0.00
ClosedF52SN12/3/202412/17/20241/1/2025$555.60$1,587.43
ClosedF65SN12/16/202412/30/20244/6/2025$615.12$745.46
ClosedF51SN1/15/20251/29/20255/4/2025$673.68$9,239.04
DeniedF45SN2/5/20252/19/20252/5/2025$581.52$0.00
SuspendedM54SN4/23/20255/7/20257/18/2025$791.10$7,873.35
DeniedF67SN4/2/20254/16/20254/2/2025$698.40$0.00
DeniedF28SN3/18/20254/1/20253/18/2025$601.20$0.00
SuspendedM67SN5/29/20256/12/20257/23/2025$747.36$4,484.16
SuspendedF33SN5/29/20256/12/20257/28/2025$579.12$3,888.38
OpenF54SN7/9/20257/23/20258/19/2025$566.64$404.74
OpenM61SN7/8/20257/22/20258/21/2025$553.20$474.17
SuspendedM56SN6/25/20257/9/20257/22/2025$741.60$1,483.20
Total Claims for Customer 0157775 : 493Sum of Gross Benefit for Customer 0157775 : $2,234,179.52
8/13/2025 11:20:51 AMPage 2 of 2

File details come from the government source that posted it. Updated .