Attachment I - STD Payment Details.xlsx
XLSX spreadsheet 218 KB Posted
- Solicitation number
- 120084 O5
- Issued by
- Lancaster County, Nebraska
About this file
This document is an Attachment I - STD Payment Details for the State of Nebraska related to a Short-Term Disability (STD) claim summary. The document provides detailed information on STD claims submitted and processed, including the claimant's group, claim number, demographic details, claim status, dates of incurred injury/illness, payment dates, and net benefit amounts. The claims were processed through various source systems on behalf of the State of Nebraska for the time period of July 1, 2019 to October 28, 2024.
The document outlines the STD claim processing and payment details for numerous closed claims, including those categorized as "Return to Own Occ (with policyholder)", "Maximum Benefit Reached (T65, RBD, etc.)", and "End of Pregnancy Recovery Period". The summary provides insights into the nature of the STD claims, their durations, and the associated benefit payments made to the claimants.
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Text version
OFCR-16_x
| Attachment I |
| OFCR-16_x; Claim Summary by Claim ID, Paid Date, From & To Dates, Enter Date for all Status v5.4 |
| Selection Parameters >>> Group/Customer: 306147; Subgroup: ALL; Business Segment: STD; Paid Date Range: 07/01/2019 to 12/31/2999; Incurred Date Range: 07/01/2019 to 10/28/2024; Enter Date Range: 07/01/2019 to 10/28/2024; Source System: ACIS, FACETS, ONBASE, PRIME, UHOPS, USP; Hide or Show Claims with Closed Status and no Payment: S |
Run Datetime: 10/28/2024 10:03:07 PM; Page: 1 of 1
| Group ID | Subgroup Name | Claim Number | Benefit | Gender | Date of Birth | Age at Incurred Date | Current Claim Status | Incurred Date | Enter Date | Paid Indicator | Payment Date | Max Payment Date | Payment Cover From Date | Payment Cover To Date | Net Benefit Amount | Claim Total Net Benefit Amount To Date | Curent Claim Status Description | Expected RTW FullTime Date | RTW FullTime Date |
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 09/13/2019 | 04/09/2020 | 08/15/2019 | 08/29/2019 | $834.76 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 09/20/2019 | 04/09/2020 | 08/29/2019 | 09/12/2019 | $834.76 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 01/06/2020 | 04/09/2020 | 12/02/2019 | 12/09/2019 | $343.47 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 01/22/2020 | 04/09/2020 | 12/09/2019 | 12/16/2019 | $1,595.61 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 04/09/2020 | 04/09/2020 | 02/03/2020 | 02/10/2020 | $159.00 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 04/09/2020 | 04/09/2020 | 02/10/2020 | 02/13/2020 | $347.82 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 03/03/2020 | 04/09/2020 | 01/06/2020 | 01/13/2020 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 03/03/2020 | 04/09/2020 | 01/13/2020 | 01/20/2020 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 03/03/2020 | 04/09/2020 | 01/20/2020 | 01/27/2020 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 03/03/2020 | 04/09/2020 | 01/27/2020 | 02/03/2020 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 11/11/2019 | 04/09/2020 | 11/07/2019 | 11/14/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 11/18/2019 | 04/09/2020 | 11/14/2019 | 11/21/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 11/25/2019 | 04/09/2020 | 11/21/2019 | 12/02/2019 | $655.88 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 10/07/2019 | 04/09/2020 | 10/03/2019 | 10/10/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 10/14/2019 | 04/09/2020 | 10/10/2019 | 10/17/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 10/21/2019 | 04/09/2020 | 10/17/2019 | 10/24/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 10/28/2019 | 04/09/2020 | 10/24/2019 | 10/31/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 11/04/2019 | 04/09/2020 | 10/31/2019 | 11/07/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 09/25/2019 | 04/09/2020 | 09/12/2019 | 09/19/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 09/26/2019 | 04/09/2020 | 09/19/2019 | 09/26/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769070 | STD | F | 03/03/1958 | 60 | Closed | 08/08/2019 | 08/11/2019 | Y | 09/30/2019 | 04/09/2020 | 09/26/2019 | 10/03/2019 | $417.38 | $10,614.62 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200769883 | STD | F | 12/12/1977 | 41 | Closed | 07/30/2019 | 08/21/2019 | Y | 01/15/2020 | 01/15/2020 | 08/06/2019 | 09/26/2019 | $2,491.57 | $2,491.57 | CLOSED - Not TD Any Occ | ||
| 00306147 | STATE OF NEBRASKA | 200770222 | STD | F | 12/11/1975 | 43 | Closed | 08/12/2019 | 08/28/2019 | Y | 09/13/2019 | 09/13/2019 | 08/19/2019 | 09/04/2019 | $1,107.13 | $1,107.13 | CLOSED - Failure to Provide Proof | ||
| 00306147 | STATE OF NEBRASKA | 200770226 | STD | F | 05/25/1960 | 58 | Closed | 08/08/2019 | 08/28/2019 | Y | 09/13/2019 | 10/02/2019 | 08/15/2019 | 09/12/2019 | $1,662.76 | $3,147.37 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200770226 | STD | F | 05/25/1960 | 58 | Closed | 08/08/2019 | 08/28/2019 | Y | 09/24/2019 | 10/02/2019 | 09/12/2019 | 09/19/2019 | $415.69 | $3,147.37 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200770226 | STD | F | 05/25/1960 | 58 | Closed | 08/08/2019 | 08/28/2019 | Y | 10/02/2019 | 10/02/2019 | 09/19/2019 | 10/07/2019 | $1,068.92 | $3,147.37 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200770392 | STD | F | 11/26/1967 | 51 | Closed | 10/02/2019 | 08/30/2019 | Y | 12/12/2019 | 12/12/2019 | 10/09/2019 | 11/18/2019 | $2,090.34 | $2,090.34 | CLOSED - Return to Own Occ (with policyholder) | 11/18/2019 | |
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 10/01/2019 | 02/10/2020 | 08/15/2019 | 08/22/2019 | $1,067.60 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 12/09/2019 | 02/10/2020 | 12/05/2019 | 12/12/2019 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 12/16/2019 | 02/10/2020 | 12/12/2019 | 12/19/2019 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 12/23/2019 | 02/10/2020 | 12/19/2019 | 12/26/2019 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 12/30/2019 | 02/10/2020 | 12/26/2019 | 01/02/2020 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 02/10/2020 | 02/10/2020 | 02/06/2020 | 02/13/2020 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 01/06/2020 | 02/10/2020 | 01/02/2020 | 01/09/2020 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 01/13/2020 | 02/10/2020 | 01/09/2020 | 01/16/2020 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 01/21/2020 | 02/10/2020 | 01/16/2020 | 01/23/2020 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 01/27/2020 | 02/10/2020 | 01/23/2020 | 01/30/2020 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 02/03/2020 | 02/10/2020 | 01/30/2020 | 02/06/2020 | $269.40 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 12/03/2019 | 02/10/2020 | 10/18/2019 | 12/05/2019 | $1,847.31 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770414 | STD | F | 05/04/1960 | 58 | Closed | 08/08/2019 | 08/30/2019 | Y | 10/21/2019 | 02/10/2020 | 09/12/2019 | 10/18/2019 | $1,385.49 | $6,994.40 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200770873 | STD | F | 11/04/1958 | 60 | Closed | 09/01/2019 | 09/09/2019 | Y | 12/23/2019 | 12/23/2019 | 10/08/2019 | 10/29/2019 | $2,136.30 | $5,188.16 | CLOSED - Death | ||
| 00306147 | STATE OF NEBRASKA | 200770873 | STD | F | 11/04/1958 | 60 | Closed | 09/01/2019 | 09/09/2019 | Y | 12/23/2019 | 12/23/2019 | 09/08/2019 | 10/08/2019 | $3,051.86 | $5,188.16 | CLOSED - Death | ||
| 00306147 | STATE OF NEBRASKA | 200771070 | STD | F | 11/05/1966 | 52 | Closed | 08/20/2019 | 09/11/2019 | Y | 10/11/2019 | 10/11/2019 | 08/27/2019 | 09/12/2019 | $1,044.91 | $1,044.91 | CLOSED - Return to Own Occ (with policyholder) | 09/12/2019 | |
| 00306147 | STATE OF NEBRASKA | 200771392 | STD | F | 01/07/1996 | 22 | Closed | 09/09/2019 | 09/17/2019 | Y | 11/25/2019 | 11/25/2019 | 10/07/2019 | 10/28/2019 | $1,255.83 | $2,511.66 | CLOSED - Return to Own Occ (with policyholder) | 10/28/2019 | |
| 00306147 | STATE OF NEBRASKA | 200771392 | STD | F | 01/07/1996 | 22 | Closed | 09/09/2019 | 09/17/2019 | Y | 10/11/2019 | 11/25/2019 | 09/16/2019 | 10/07/2019 | $1,255.83 | $2,511.66 | CLOSED - Return to Own Occ (with policyholder) | 10/28/2019 | |
| 00306147 | STATE OF NEBRASKA | 200771392 | STD | F | 01/07/1996 | 22 | Closed | 09/09/2019 | 09/17/2019 | Y | 11/07/2019 | 11/25/2019 | 09/16/2019 | 10/07/2019 | ($1,255.83) | $2,511.66 | CLOSED - Return to Own Occ (with policyholder) | 10/28/2019 | |
| 00306147 | STATE OF NEBRASKA | 200771392 | STD | F | 01/07/1996 | 22 | Closed | 09/09/2019 | 09/17/2019 | Y | 11/11/2019 | 11/25/2019 | 09/16/2019 | 10/07/2019 | $1,255.83 | $2,511.66 | CLOSED - Return to Own Occ (with policyholder) | 10/28/2019 | |
| 00306147 | STATE OF NEBRASKA | 200771851 | STD | F | 09/13/1966 | 52 | Closed | 09/07/2019 | 09/24/2019 | Y | 10/11/2019 | 10/11/2019 | 09/07/2019 | 09/24/2019 | $617.00 | $617.00 | CLOSED - Return to Own Occ (with policyholder) | 09/24/2019 | |
| 00306147 | STATE OF NEBRASKA | 200772098 | STD | F | 04/11/1964 | 54 | Closed | 10/15/2019 | 09/27/2019 | Y | 12/11/2019 | 01/15/2020 | 12/03/2019 | 12/10/2019 | $311.04 | $3,554.74 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200772098 | STD | F | 04/11/1964 | 54 | Closed | 10/15/2019 | 09/27/2019 | Y | 12/16/2019 | 01/15/2020 | 12/10/2019 | 12/17/2019 | $311.04 | $3,554.74 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200772098 | STD | F | 04/11/1964 | 54 | Closed | 10/15/2019 | 09/27/2019 | Y | 12/23/2019 | 01/15/2020 | 12/17/2019 | 12/24/2019 | $311.04 | $3,554.74 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200772098 | STD | F | 04/11/1964 | 54 | Closed | 10/15/2019 | 09/27/2019 | Y | 12/30/2019 | 01/15/2020 | 12/24/2019 | 12/31/2019 | $311.04 | $3,554.74 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200772098 | STD | F | 04/11/1964 | 54 | Closed | 10/15/2019 | 09/27/2019 | Y | 01/06/2020 | 01/15/2020 | 12/31/2019 | 01/07/2020 | $311.04 | $3,554.74 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200772098 | STD | F | 04/11/1964 | 54 | Closed | 10/15/2019 | 09/27/2019 | Y | 01/15/2020 | 01/15/2020 | 01/07/2020 | 01/10/2020 | $133.30 | $3,554.74 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200772098 | STD | F | 04/11/1964 | 54 | Closed | 10/15/2019 | 09/27/2019 | Y | 12/03/2019 | 01/15/2020 | 10/22/2019 | 12/03/2019 | $1,866.24 | $3,554.74 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200773130 | STD | F | 05/30/1979 | 39 | Closed | 09/24/2019 | 10/07/2019 | Y | 10/28/2019 | 10/28/2019 | 10/01/2019 | 10/28/2019 | $1,390.04 | $1,390.04 | CLOSED - Return to Own Occ (with policyholder) | 10/28/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 12/23/2019 | 12/23/2019 | 12/02/2019 | 12/16/2019 | $813.87 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 12/23/2019 | 12/23/2019 | 12/09/2019 | 12/16/2019 | ($73.99) | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 11/06/2019 | 12/23/2019 | 11/02/2019 | 11/09/2019 | $443.93 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 11/13/2019 | 12/23/2019 | 11/09/2019 | 11/16/2019 | $443.93 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 11/20/2019 | 12/23/2019 | 11/16/2019 | 11/23/2019 | $443.93 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 11/27/2019 | 12/23/2019 | 11/23/2019 | 11/30/2019 | $443.93 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 12/20/2019 | 12/23/2019 | 11/23/2019 | 11/30/2019 | $0.00 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 12/20/2019 | 12/23/2019 | 11/30/2019 | 12/02/2019 | $126.84 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 12/23/2019 | 12/23/2019 | 11/30/2019 | 12/07/2019 | $0.00 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 10/25/2019 | 12/23/2019 | 10/05/2019 | 10/26/2019 | $1,331.79 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200773262 | STD | F | 07/11/1953 | 65 | Closed | 09/28/2019 | 10/08/2019 | Y | 10/30/2019 | 12/23/2019 | 10/26/2019 | 11/02/2019 | $443.93 | $4,418.16 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | 12/16/2019 | |
| 00306147 | STATE OF NEBRASKA | 200774363 | STD | F | 05/08/1974 | 44 | Closed | 10/16/2019 | 10/21/2019 | Y | 11/12/2019 | 11/12/2019 | 10/23/2019 | 11/04/2019 | $775.13 | $775.13 | CLOSED - Failure to Provide Proof | ||
| 00306147 | STATE OF NEBRASKA | 200774464 | STD | M | 12/31/1965 | 53 | Closed | 10/02/2019 | 10/22/2019 | Y | 11/22/2019 | 06/15/2020 | 11/18/2019 | 11/25/2019 | $408.00 | $3,205.72 | CLOSED - Return to Own Occ (with policyholder) | 11/26/2019 | |
| 00306147 | STATE OF NEBRASKA | 200774464 | STD | M | 12/31/1965 | 53 | Closed | 10/02/2019 | 10/22/2019 | Y | 12/02/2019 | 06/15/2020 | 11/25/2019 | 11/26/2019 | $58.29 | $3,205.72 | CLOSED - Return to Own Occ (with policyholder) | 11/26/2019 | |
| 00306147 | STATE OF NEBRASKA | 200774464 | STD | M | 12/31/1965 | 53 | Closed | 10/02/2019 | 10/22/2019 | Y | 06/10/2020 | 06/15/2020 | 11/25/2019 | 11/26/2019 | ($58.29) | $3,205.72 | CLOSED - Return to Own Occ (with policyholder) | 11/26/2019 | |
| 00306147 | STATE OF NEBRASKA | 200774464 | STD | M | 12/31/1965 | 53 | Closed | 10/02/2019 | 10/22/2019 | Y | 06/15/2020 | 06/15/2020 | 11/25/2019 | 11/26/2019 | $58.29 | $3,205.72 | CLOSED - Return to Own Occ (with policyholder) | 11/26/2019 | |
| 00306147 | STATE OF NEBRASKA | 200774464 | STD | M | 12/31/1965 | 53 | Closed | 10/02/2019 | 10/22/2019 | Y | 11/19/2019 | 06/15/2020 | 10/02/2019 | 11/18/2019 | $2,739.43 | $3,205.72 | CLOSED - Return to Own Occ (with policyholder) | 11/26/2019 | |
| 00306147 | STATE OF NEBRASKA | 200775054 | STD | F | 03/23/1976 | 42 | Closed | 09/20/2019 | 10/29/2019 | Y | 11/19/2019 | 11/19/2019 | 09/20/2019 | 10/17/2019 | $982.84 | $982.84 | CLOSED - Return to Own Occ (with policyholder) | 10/17/2019 | |
| 00306147 | STATE OF NEBRASKA | 200775190 | STD | F | 12/07/1991 | 27 | Closed | 10/14/2019 | 10/30/2019 | Y | 11/13/2019 | 11/13/2019 | 10/21/2019 | 10/28/2019 | $359.08 | $359.08 | CLOSED - Return to Own Occ (with policyholder) | 10/28/2019 | |
| 00306147 | STATE OF NEBRASKA | 200775545 | STD | M | 06/14/1965 | 53 | Closed | 10/14/2019 | 11/01/2019 | Y | 02/18/2020 | 02/18/2020 | 11/18/2019 | 12/02/2019 | $997.92 | $2,993.76 | CLOSED - Return to Own Occ (with policyholder) | 12/28/2019 | |
| 00306147 | STATE OF NEBRASKA | 200775545 | STD | M | 06/14/1965 | 53 | Closed | 10/14/2019 | 11/01/2019 | Y | 01/16/2020 | 02/18/2020 | 10/21/2019 | 11/18/2019 | $1,995.84 | $2,993.76 | CLOSED - Return to Own Occ (with policyholder) | 12/28/2019 | |
| 00306147 | STATE OF NEBRASKA | 200776430 | STD | F | 02/09/1972 | 46 | Closed | 11/25/2019 | 11/11/2019 | Y | 12/11/2019 | 02/24/2020 | 12/02/2019 | 12/09/2019 | $450.02 | $6,107.41 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200776430 | STD | F | 02/09/1972 | 46 | Closed | 11/25/2019 | 11/11/2019 | Y | 12/13/2019 | 02/24/2020 | 12/09/2019 | 12/16/2019 | $450.02 | $6,107.41 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200776430 | STD | F | 02/09/1972 | 46 | Closed | 11/25/2019 | 11/11/2019 | Y | 12/20/2019 | 02/24/2020 | 12/16/2019 | 12/23/2019 | $450.02 | $6,107.41 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200776430 | STD | F | 02/09/1972 | 46 | Closed | 11/25/2019 | 11/11/2019 | Y | 12/27/2019 | 02/24/2020 | 12/23/2019 | 12/30/2019 | $450.02 | $6,107.41 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200776430 | STD | F | 02/09/1972 | 46 | Closed | 11/25/2019 | 11/11/2019 | Y | 02/06/2020 | 02/24/2020 | 12/30/2019 | 02/07/2020 | $2,507.25 | $6,107.41 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200776430 | STD | F | 02/09/1972 | 46 | Closed | 11/25/2019 | 11/11/2019 | Y | 02/24/2020 | 02/24/2020 | 02/07/2020 | 03/06/2020 | $1,800.08 | $6,107.41 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200777141 | STD | F | 07/21/1995 | 23 | Closed | 11/17/2019 | 11/20/2019 | Y | 01/15/2020 | 01/15/2020 | 11/24/2019 | 12/06/2019 | $615.22 | $615.22 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200777176 | STD | F | 01/17/1961 | 57 | Closed | 10/29/2019 | 11/20/2019 | Y | 12/19/2019 | 12/19/2019 | 11/05/2019 | 11/12/2019 | $472.51 | $472.51 | CLOSED - Return to Own Occ (with policyholder) | 11/12/2019 | |
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 12/23/2019 | 03/09/2020 | 12/17/2019 | 12/24/2019 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 12/30/2019 | 03/09/2020 | 12/24/2019 | 12/31/2019 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 01/06/2020 | 03/09/2020 | 12/31/2019 | 01/07/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 02/10/2020 | 03/09/2020 | 02/04/2020 | 02/11/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 02/12/2020 | 03/09/2020 | 02/11/2020 | 02/18/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 02/24/2020 | 03/09/2020 | 02/18/2020 | 02/25/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 03/02/2020 | 03/09/2020 | 02/25/2020 | 03/03/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 01/13/2020 | 03/09/2020 | 01/07/2020 | 01/14/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 01/21/2020 | 03/09/2020 | 01/14/2020 | 01/21/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 01/27/2020 | 03/09/2020 | 01/21/2020 | 01/28/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 02/03/2020 | 03/09/2020 | 01/28/2020 | 02/04/2020 | $461.04 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778759 | STD | F | 02/20/1990 | 28 | Closed | 12/10/2019 | 12/12/2019 | Y | 03/09/2020 | 03/09/2020 | 03/03/2020 | 04/02/2020 | $1,975.89 | $7,047.33 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200778936 | STD | M | 01/17/1955 | 63 | Closed | 12/10/2019 | 12/13/2019 | Y | 02/13/2020 | 03/05/2020 | 12/17/2019 | 02/15/2020 | $4,183.20 | $5,298.72 | CLOSED - Return to Own Occ (with policyholder) | 03/02/2020 | |
| 00306147 | STATE OF NEBRASKA | 200778936 | STD | M | 01/17/1955 | 63 | Closed | 12/10/2019 | 12/13/2019 | Y | 02/19/2020 | 03/05/2020 | 02/15/2020 | 02/22/2020 | $488.04 | $5,298.72 | CLOSED - Return to Own Occ (with policyholder) | 03/02/2020 | |
| 00306147 | STATE OF NEBRASKA | 200778936 | STD | M | 01/17/1955 | 63 | Closed | 12/10/2019 | 12/13/2019 | Y | 02/26/2020 | 03/05/2020 | 02/22/2020 | 02/29/2020 | $488.04 | $5,298.72 | CLOSED - Return to Own Occ (with policyholder) | 03/02/2020 | |
| 00306147 | STATE OF NEBRASKA | 200778936 | STD | M | 01/17/1955 | 63 | Closed | 12/10/2019 | 12/13/2019 | Y | 03/05/2020 | 03/05/2020 | 02/29/2020 | 03/02/2020 | $139.44 | $5,298.72 | CLOSED - Return to Own Occ (with policyholder) | 03/02/2020 | |
| 00306147 | STATE OF NEBRASKA | 200779473 | STD | F | 10/15/1961 | 57 | Closed | 12/12/2019 | 12/20/2019 | Y | 01/15/2020 | 01/15/2020 | 12/19/2019 | 01/13/2020 | $1,690.54 | $1,690.54 | CLOSED - Return to Own Occ (with policyholder) | 01/13/2020 | |
| 00306147 | STATE OF NEBRASKA | 200780458 | STD | F | 06/06/1988 | 31 | Closed | 01/06/2020 | 01/06/2020 | Y | 02/07/2020 | 03/06/2020 | 02/03/2020 | 02/10/2020 | $733.54 | $9,421.23 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200780458 | STD | F | 06/06/1988 | 31 | Closed | 01/06/2020 | 01/06/2020 | Y | 02/14/2020 | 03/06/2020 | 02/10/2020 | 02/17/2020 | $733.54 | $9,421.23 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200780458 | STD | F | 06/06/1988 | 31 | Closed | 01/06/2020 | 01/06/2020 | Y | 02/21/2020 | 03/06/2020 | 02/17/2020 | 02/24/2020 | $733.54 | $9,421.23 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200780458 | STD | F | 06/06/1988 | 31 | Closed | 01/06/2020 | 01/06/2020 | Y | 02/28/2020 | 03/06/2020 | 02/24/2020 | 03/02/2020 | $733.54 | $9,421.23 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200780458 | STD | F | 06/06/1988 | 31 | Closed | 01/06/2020 | 01/06/2020 | Y | 01/24/2020 | 03/06/2020 | 01/13/2020 | 01/20/2020 | $723.54 | $9,421.23 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200780458 | STD | F | 06/06/1988 | 31 | Closed | 01/06/2020 | 01/06/2020 | Y | 02/03/2020 | 03/06/2020 | 01/20/2020 | 01/27/2020 | $733.54 | $9,421.23 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200780458 | STD | F | 06/06/1988 | 31 | Closed | 01/06/2020 | 01/06/2020 | Y | 02/04/2020 | 03/06/2020 | 01/27/2020 | 02/03/2020 | $733.54 | $9,421.23 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200780458 | STD | F | 06/06/1988 | 31 | Closed | 01/06/2020 | 01/06/2020 | Y | 03/06/2020 | 03/06/2020 | 03/02/2020 | 04/12/2020 | $4,296.45 | $9,421.23 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200780567 | STD | F | 03/01/1984 | 34 | Closed | 12/31/2019 | 01/08/2020 | Y | 01/29/2020 | 01/29/2020 | 01/07/2020 | 01/16/2020 | $687.16 | $687.16 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200780880 | STD | F | 11/19/1989 | 30 | Closed | 03/14/2020 | 01/10/2020 | Y | 03/26/2020 | 03/26/2020 | 03/21/2020 | 03/28/2020 | $1,872.80 | $1,872.80 | CLOSED - Maximum Benefit Reached (T65, RBD, etc.) | ||
| 00306147 | STATE OF NEBRASKA | 200781254 | STD | M | 09/26/1978 | 41 | Closed | 01/07/2020 | 01/15/2020 | Y | 02/27/2020 | 02/27/2020 | 01/14/2020 | 01/21/2020 | $2,033.25 | $2,033.25 | CLOSED - Return to Own Occ (with policyholder) | 02/17/2020 | |
| 00306147 | STATE OF NEBRASKA | 200781256 | STD | F | 05/02/1969 | 50 | Closed | 01/07/2020 | 01/15/2020 | Y | 01/29/2020 | 02/05/2020 | 01/14/2020 | 01/17/2020 | $188.53 | $565.59 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200781256 | STD | F | 05/02/1969 | 50 | Closed | 01/07/2020 | 01/15/2020 | Y | 02/05/2020 | 02/05/2020 | 01/17/2020 | 01/23/2020 | $377.06 | $565.59 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200781299 | STD | F | 01/28/1961 | 57 | Closed | 12/24/2019 | 01/15/2020 | Y | 01/28/2020 | 01/28/2020 | 12/31/2019 | 01/02/2020 | $90.47 | $90.47 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200781482 | STD | F | 01/03/1967 | 51 | Closed | 12/24/2019 | 01/21/2020 | Y | 04/15/2020 | 09/01/2020 | 04/09/2020 | 04/23/2020 | $715.10 | $7,834.30 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200781482 | STD | F | 01/03/1967 | 51 | Closed | 12/24/2019 | 01/21/2020 | Y | 04/27/2020 | 09/01/2020 | 04/23/2020 | 04/30/2020 | $357.55 | $7,834.30 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200781482 | STD | F | 01/03/1967 | 51 | Closed | 12/24/2019 | 01/21/2020 | Y | 05/04/2020 | 09/01/2020 | 04/30/2020 | 05/07/2020 | $357.55 | $7,834.30 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200781482 | STD | F | 01/03/1967 | 51 | Closed | 12/24/2019 | 01/21/2020 | Y | 09/01/2020 | 09/01/2020 | 12/27/2019 | 12/30/2019 | $153.24 | $7,834.30 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200781482 | STD | F | 01/03/1967 | 51 | Closed | 12/24/2019 | 01/21/2020 | Y | 02/27/2020 | 09/01/2020 | 12/31/2019 | 01/21/2020 | $75.00 | $7,834.30 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200781482 | STD | F | 01/03/1967 | 51 | Closed | 12/24/2019 | 01/21/2020 | Y | 04/08/2020 | 09/01/2020 | 01/21/2020 | 02/03/2020 | $3,417.62 | $7,834.30 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200781482 | STD | F | 01/03/1967 | 51 | Closed | 12/24/2019 | 01/21/2020 | Y | 06/19/2020 | 09/01/2020 | 05/07/2020 | 06/30/2020 | $2,758.24 | $7,834.30 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200782412 | STD | F | 04/12/1989 | 30 | Closed | 02/19/2020 | 02/04/2020 | Y | 03/04/2020 | 03/04/2020 | 02/26/2020 | 04/01/2020 | $2,600.30 | $2,600.30 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200783855 | STD | F | 04/03/1989 | 30 | Closed | 02/21/2020 | 02/23/2020 | Y | 03/25/2020 | 03/25/2020 | 02/28/2020 | 03/01/2020 | $2,302.91 | $2,302.91 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200784642 | STD | F | 11/02/1988 | 31 | Closed | 03/06/2020 | 03/03/2020 | Y | 03/26/2020 | 03/26/2020 | 03/13/2020 | 04/18/2020 | $2,340.31 | $2,340.31 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200784710 | STD | F | 10/18/1975 | 44 | Closed | 02/18/2020 | 03/04/2020 | Y | 07/02/2020 | 07/02/2020 | 02/25/2020 | 03/11/2020 | $723.39 | $723.39 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200784909 | STD | F | 11/07/1988 | 31 | Closed | 03/18/2020 | 03/05/2020 | Y | 04/22/2020 | 04/22/2020 | 03/25/2020 | 04/29/2020 | $2,672.25 | $2,672.25 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200785910 | STD | F | 08/05/1982 | 37 | Closed | 03/18/2020 | 03/19/2020 | Y | 04/24/2020 | 04/24/2020 | 03/25/2020 | 05/13/2020 | $3,150.14 | $3,150.14 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200786436 | STD | F | 01/20/1991 | 28 | Closed | 04/06/2020 | 03/25/2020 | Y | 05/13/2020 | 05/13/2020 | 04/13/2020 | 05/18/2020 | $3,161.65 | $3,161.65 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200786843 | STD | F | 07/02/1961 | 58 | Closed | 03/15/2020 | 03/30/2020 | Y | 06/08/2020 | 06/08/2020 | 03/22/2020 | 04/22/2020 | $1,734.05 | $1,734.05 | CLOSED - Return to Own Occ (with policyholder) | 04/22/2020 | |
| 00306147 | STATE OF NEBRASKA | 200787363 | STD | F | 09/03/1986 | 33 | Closed | 04/24/2020 | 04/02/2020 | Y | 06/02/2020 | 06/02/2020 | 05/01/2020 | 06/06/2020 | $2,158.41 | $2,158.41 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200787370 | STD | F | 10/27/1980 | 39 | Closed | 03/24/2020 | 04/02/2020 | Y | 05/27/2020 | 05/27/2020 | 03/31/2020 | 06/03/2020 | $4,388.57 | $4,388.57 | CLOSED - | ||
| 00306147 | STATE OF NEBRASKA | 200787892 | STD | F | 06/14/1987 | 32 | Closed | 04/01/2020 | 04/07/2020 | Y | 06/16/2020 | 06/16/2020 | 04/08/2020 | 05/27/2020 | $4,214.89 | $4,214.89 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200787915 | STD | F | 03/04/1991 | 28 | Closed | 06/22/2020 | 04/08/2020 | Y | 08/13/2020 | 08/13/2020 | 06/29/2020 | 08/17/2020 | $3,124.80 | $3,124.80 | CLOSED - Miscellaneous | ||
| 00306147 | STATE OF NEBRASKA | 200788209 | STD | F | 03/07/1968 | 51 | Closed | 03/27/2020 | 04/14/2020 | Y | 02/03/2021 | 02/03/2021 | 04/03/2020 | 04/14/2020 | $691.27 | $691.27 | CLOSED - Return to Another Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200789133 | STD | F | 08/12/1987 | 32 | Closed | 05/13/2020 | 04/27/2020 | Y | 07/01/2020 | 07/01/2020 | 05/20/2020 | 07/08/2020 | $4,514.02 | $4,514.02 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200789337 | STD | M | 10/21/1966 | 53 | Closed | 04/02/2020 | 04/30/2020 | Y | 02/09/2021 | 02/09/2021 | 04/09/2020 | 05/05/2020 | $1,757.32 | $1,757.32 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200789503 | STD | M | 04/26/1961 | 58 | Closed | 04/29/2020 | 05/04/2020 | Y | 06/22/2020 | 06/22/2020 | 06/01/2020 | 07/27/2020 | $3,264.00 | $4,779.43 | CLOSED - Death | ||
| 00306147 | STATE OF NEBRASKA | 200789503 | STD | M | 04/26/1961 | 58 | Closed | 04/29/2020 | 05/04/2020 | Y | 06/17/2020 | 06/22/2020 | 05/06/2020 | 06/01/2020 | $1,515.43 | $4,779.43 | CLOSED - Death | ||
| 00306147 | STATE OF NEBRASKA | 200789531 | STD | F | 11/01/1966 | 53 | Closed | 04/27/2020 | 05/04/2020 | Y | 06/08/2020 | 06/08/2020 | 05/04/2020 | 05/05/2020 | $60.40 | $60.40 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 06/24/2020 | 11/23/2020 | 04/27/2020 | 06/22/2020 | $4,419.44 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 08/11/2020 | 11/23/2020 | 08/03/2020 | 08/10/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 08/13/2020 | 11/23/2020 | 08/10/2020 | 08/17/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 08/20/2020 | 11/23/2020 | 08/17/2020 | 08/24/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 08/27/2020 | 11/23/2020 | 08/24/2020 | 08/31/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 09/03/2020 | 11/23/2020 | 08/31/2020 | 09/07/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 07/01/2020 | 11/23/2020 | 06/22/2020 | 06/29/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 07/14/2020 | 11/23/2020 | 06/29/2020 | 08/03/2020 | $2,762.15 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 11/02/2020 | 11/23/2020 | 11/02/2020 | 11/09/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 11/12/2020 | 11/23/2020 | 11/09/2020 | 11/16/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 11/19/2020 | 11/23/2020 | 11/16/2020 | 11/23/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 11/23/2020 | 11/23/2020 | 11/23/2020 | 11/25/2020 | $157.84 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 10/08/2020 | 11/23/2020 | 10/05/2020 | 10/12/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 10/15/2020 | 11/23/2020 | 10/12/2020 | 10/19/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 10/22/2020 | 11/23/2020 | 10/19/2020 | 10/26/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 10/26/2020 | 11/23/2020 | 10/26/2020 | 11/02/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 09/10/2020 | 11/23/2020 | 09/07/2020 | 09/14/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 09/17/2020 | 11/23/2020 | 09/14/2020 | 09/21/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 09/24/2020 | 11/23/2020 | 09/21/2020 | 09/28/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789627 | STD | F | 03/08/1962 | 57 | Closed | 04/20/2020 | 05/05/2020 | Y | 09/28/2020 | 11/23/2020 | 09/28/2020 | 10/05/2020 | $552.43 | $16,730.74 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 200789712 | STD | F | 02/13/1978 | 41 | Closed | 05/01/2020 | 05/07/2020 | Y | 06/23/2020 | 07/02/2020 | 06/01/2020 | 06/11/2020 | $596.26 | $3,322.75 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200789712 | STD | F | 02/13/1978 | 41 | Closed | 05/01/2020 | 05/07/2020 | Y | 07/01/2020 | 07/02/2020 | 06/11/2020 | 06/15/2020 | $238.50 | $3,322.75 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200789712 | STD | F | 02/13/1978 | 41 | Closed | 05/01/2020 | 05/07/2020 | Y | 07/01/2020 | 07/02/2020 | 06/15/2020 | 06/22/2020 | $347.82 | $3,322.75 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200789712 | STD | F | 02/13/1978 | 41 | Closed | 05/01/2020 | 05/07/2020 | Y | 07/02/2020 | 07/02/2020 | 06/22/2020 | 06/29/2020 | $347.82 | $3,322.75 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200789712 | STD | F | 02/13/1978 | 41 | Closed | 05/01/2020 | 05/07/2020 | Y | 06/08/2020 | 07/02/2020 | 05/01/2020 | 06/01/2020 | $1,792.35 | $3,322.75 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200789864 | STD | F | 07/29/1958 | 61 | Closed | 03/24/2020 | 05/08/2020 | Y | 06/18/2020 | 06/18/2020 | 03/31/2020 | 05/06/2020 | $128.57 | $128.57 | CLOSED - Return to Own Occ (with policyholder) | 05/06/2020 | |
| 00306147 | STATE OF NEBRASKA | 200789931 | STD | F | 06/21/1978 | 41 | Closed | 04/08/2020 | 05/11/2020 | Y | 06/01/2020 | 06/01/2020 | 04/15/2020 | 05/21/2020 | $2,092.78 | $2,092.78 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 200790040 | STD | F | 03/22/1984 | 35 | Closed | 05/06/2020 | 05/12/2020 | Y | 06/26/2020 | 06/26/2020 | 06/18/2020 | 07/02/2020 | $575.52 | $2,343.19 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200790040 | STD | F | 03/22/1984 | 35 | Closed | 05/06/2020 | 05/12/2020 | Y | 06/09/2020 | 06/26/2020 | 05/06/2020 | 06/18/2020 | $1,767.67 | $2,343.19 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200790160 | STD | M | 03/07/1986 | 33 | Closed | 05/27/2020 | 05/14/2020 | Y | 07/02/2020 | 07/02/2020 | 07/06/2020 | 07/20/2020 | $816.00 | $2,356.43 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200790160 | STD | M | 03/07/1986 | 33 | Closed | 05/27/2020 | 05/14/2020 | Y | 06/15/2020 | 07/02/2020 | 06/03/2020 | 06/10/2020 | $1,132.43 | $2,356.43 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200790160 | STD | M | 03/07/1986 | 33 | Closed | 05/27/2020 | 05/14/2020 | Y | 07/01/2020 | 07/02/2020 | 06/29/2020 | 07/06/2020 | $408.00 | $2,356.43 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200790208 | STD | F | 07/24/1990 | 29 | Closed | 04/30/2020 | 05/14/2020 | Y | 06/18/2020 | 06/18/2020 | 05/07/2020 | 06/13/2020 | $2,212.76 | $1,537.96 | CLOSED - Failure to Provide Proof | ||
| 00306147 | STATE OF NEBRASKA | 200790208 | STD | F | 07/24/1990 | 29 | Closed | 04/30/2020 | 05/14/2020 | Y | 06/18/2020 | 06/18/2020 | 05/20/2020 | 05/22/2020 | ($562.33) | $1,537.96 | CLOSED - Failure to Provide Proof | ||
| 00306147 | STATE OF NEBRASKA | 200790208 | STD | F | 07/24/1990 | 29 | Closed | 04/30/2020 | 05/14/2020 | Y | 06/18/2020 | 06/18/2020 | 05/27/2020 | 06/06/2020 | ($112.47) | $1,537.96 | CLOSED - Failure to Provide Proof | ||
| 00306147 | STATE OF NEBRASKA | 200790330 | STD | F | 07/26/1967 | 52 | Closed | 05/04/2020 | 05/18/2020 | Y | 06/18/2020 | 06/18/2020 | 05/04/2020 | 05/13/2020 | $631.36 | $631.36 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200790370 | STD | F | 07/24/1956 | 63 | Closed | 03/20/2020 | 05/19/2020 | Y | 07/01/2020 | 07/01/2020 | 03/27/2020 | 05/19/2020 | $2,737.30 | $2,737.30 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200790968 | STD | F | 03/05/1983 | 36 | Closed | 05/17/2020 | 05/27/2020 | Y | 06/16/2020 | 06/16/2020 | 05/24/2020 | 05/26/2020 | $119.59 | $119.59 | CLOSED - Return to Own Occ (with policyholder) | ||
| 00306147 | STATE OF NEBRASKA | 200790978 | STD | F | 04/17/1953 | 66 | Closed | 03/16/2020 | 05/27/2020 | Y | 07/14/2020 | 07/14/2020 | 03/23/2020 | 03/30/2020 | $25.00 | $25.00 | CLOSED - Miscellaneous | ||
| 00306147 | STATE OF NEBRASKA | 200791196 | STD | F | 02/07/1985 | 34 | Closed | 07/24/2020 | 05/29/2020 | Y | 08/03/2020 | 08/03/2020 | 07/31/2020 | 09/18/2020 | $2,766.61 | $2,766.61 | CLOSED - Miscellaneous | ||
| 00306147 | STATE OF NEBRASKA | 200792011 | STD | F | 04/22/1975 | 44 | Closed | 06/16/2020 | 06/09/2020 | Y | 07/15/2020 | 07/15/2020 | 07/01/2020 | 07/28/2020 | $1,918.58 | $1,947.15 | CLOSED - Miscellaneous | ||
| 00306147 | STATE OF NEBRASKA | 200792011 | STD | F | 04/22/1975 | 44 | Closed | 06/16/2020 | 06/09/2020 | Y | 06/23/2020 | 07/15/2020 | 06/23/2020 | 07/01/2020 | $28.57 | $1,947.15 | CLOSED - Miscellaneous | ||
| 00306147 | STATE OF NEBRASKA | 200792633 | STD | F | 01/31/1963 | 56 | Closed | 07/06/2020 | 06/17/2020 | Y | 08/18/2020 | 10/12/2020 | 08/03/2020 | 08/24/2020 | $1,726.56 | $5,179.68 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200792633 | STD | F | 01/31/1963 | 56 | Closed | 07/06/2020 | 06/17/2020 | Y | 08/27/2020 | 10/12/2020 | 08/24/2020 | 08/31/2020 | $575.52 | $5,179.68 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200792633 | STD | F | 01/31/1963 | 56 | Closed | 07/06/2020 | 06/17/2020 | Y | 09/03/2020 | 10/12/2020 | 08/31/2020 | 09/07/2020 | $575.52 | $5,179.68 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200792633 | STD | F | 01/31/1963 | 56 | Closed | 07/06/2020 | 06/17/2020 | Y | 07/30/2020 | 10/12/2020 | 07/13/2020 | 08/03/2020 | $863.28 | $5,179.68 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200792633 | STD | F | 01/31/1963 | 56 | Closed | 07/06/2020 | 06/17/2020 | Y | 09/10/2020 | 10/12/2020 | 09/07/2020 | 09/14/2020 | $575.52 | $5,179.68 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200792633 | STD | F | 01/31/1963 | 56 | Closed | 07/06/2020 | 06/17/2020 | Y | 09/14/2020 | 10/12/2020 | 09/14/2020 | 09/30/2020 | $657.74 | $5,179.68 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200792633 | STD | F | 01/31/1963 | 56 | Closed | 07/06/2020 | 06/17/2020 | Y | 10/12/2020 | 10/12/2020 | 09/30/2020 | 10/05/2020 | $205.54 | $5,179.68 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200792854 | STD | F | 07/16/1988 | 31 | Closed | 06/13/2020 | 06/22/2020 | Y | 07/30/2020 | 07/30/2020 | 06/20/2020 | 07/25/2020 | $3,944.46 | $3,944.46 | CLOSED - Miscellaneous | ||
| 00306147 | STATE OF NEBRASKA | 200792997 | STD | M | 12/25/1968 | 51 | Closed | 06/25/2020 | 06/22/2020 | Y | 09/03/2020 | 09/03/2020 | 07/02/2020 | 08/24/2020 | $3,089.14 | $3,089.14 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200793508 | STD | F | 09/13/1966 | 53 | Closed | 07/02/2020 | 06/26/2020 | Y | 09/01/2020 | 11/16/2020 | 07/02/2020 | 09/10/2020 | $2,599.20 | $3,787.41 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200793508 | STD | F | 09/13/1966 | 53 | Closed | 07/02/2020 | 06/26/2020 | Y | 10/05/2020 | 11/16/2020 | 10/01/2020 | 10/07/2020 | $222.79 | $3,787.41 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200793508 | STD | F | 09/13/1966 | 53 | Closed | 07/02/2020 | 06/26/2020 | Y | 11/16/2020 | 11/16/2020 | 10/07/2020 | 10/12/2020 | $185.66 | $3,787.41 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200793508 | STD | F | 09/13/1966 | 53 | Closed | 07/02/2020 | 06/26/2020 | Y | 09/14/2020 | 11/16/2020 | 09/10/2020 | 09/17/2020 | $259.92 | $3,787.41 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200793508 | STD | F | 09/13/1966 | 53 | Closed | 07/02/2020 | 06/26/2020 | Y | 09/16/2020 | 11/16/2020 | 09/17/2020 | 09/24/2020 | $259.92 | $3,787.41 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200793508 | STD | F | 09/13/1966 | 53 | Closed | 07/02/2020 | 06/26/2020 | Y | 09/28/2020 | 11/16/2020 | 09/24/2020 | 10/01/2020 | $259.92 | $3,787.41 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 200793561 | STD | F | 03/11/1979 | 40 | Closed | 05/06/2020 | 06/26/2020 | Y | 07/20/2020 | 07/20/2020 | 05/13/2020 | 05/25/2020 | $734.11 | $734.11 | CLOSED - Miscellaneous | ||
| 00306147 | STATE OF NEBRASKA | 200793710 | STD | F | 04/17/1953 | 66 | Closed | 05/29/2020 | 06/29/2020 | Y | 07/14/2020 | 07/14/2020 | 06/05/2020 | 06/15/2020 | $35.72 | $35.72 | CLOSED - Miscellaneous | ||
| 00306147 | STATE OF NEBRASKA | 200793736 | STD | F | 09/13/1966 | 53 | Closed | 06/19/2020 | 06/29/2020 | Y | 10/15/2020 | 10/15/2020 | 06/26/2020 | 07/06/2020 | $803.51 | $803.51 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202003375 | STD | F | 07/20/1981 | 38 | Closed | 06/17/2020 | 07/08/2020 | Y | 08/13/2020 | 08/13/2020 | 06/24/2020 | 09/01/2020 | $3,585.87 | $3,585.87 | CLOSED - Claim Withdrawn | ||
| 00306147 | STATE OF NEBRASKA | 202003712 | STD | U | 04/05/1971 | 48 | Closed | 06/23/2020 | 07/14/2020 | Y | 08/17/2020 | 08/20/2020 | 06/23/2020 | 08/19/2020 | $2,233.59 | $2,635.83 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202003712 | STD | U | 04/05/1971 | 48 | Closed | 06/23/2020 | 07/14/2020 | Y | 08/19/2020 | 08/20/2020 | 06/23/2020 | 08/26/2020 | $2,635.83 | $2,635.83 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202003712 | STD | U | 04/05/1971 | 48 | Closed | 06/23/2020 | 07/14/2020 | Y | 08/20/2020 | 08/20/2020 | 06/23/2020 | 08/19/2020 | ($2,233.59) | $2,635.83 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202003786 | STD | M | 08/22/1969 | 50 | Closed | 06/02/2020 | 07/14/2020 | Y | 09/16/2020 | 09/16/2020 | 07/06/2020 | 07/16/2020 | $535.34 | $1,820.16 | CLOSED - Return to Another Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202003786 | STD | M | 08/22/1969 | 50 | Closed | 06/02/2020 | 07/14/2020 | Y | 09/16/2020 | 09/16/2020 | 06/09/2020 | 07/03/2020 | $1,284.82 | $1,820.16 | CLOSED - Return to Another Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004172 | STD | F | 05/29/1989 | 30 | Closed | 10/13/2020 | 07/21/2020 | Y | 11/19/2020 | 11/19/2020 | 10/20/2020 | 11/23/2020 | $3,097.66 | $3,097.66 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 202004226 | STD | F | 04/03/1989 | 30 | Closed | 05/13/2020 | 07/22/2020 | Y | 08/27/2020 | 08/27/2020 | 05/20/2020 | 06/01/2020 | $834.82 | $834.82 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004244 | STD | F | 12/12/1960 | 59 | Closed | 08/07/2020 | 07/22/2020 | Y | 09/08/2020 | 11/02/2020 | 08/14/2020 | 09/21/2020 | $3,241.69 | $8,286.05 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004244 | STD | F | 12/12/1960 | 59 | Closed | 08/07/2020 | 07/22/2020 | Y | 10/12/2020 | 11/02/2020 | 10/08/2020 | 10/16/2020 | $877.28 | $8,286.05 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004244 | STD | F | 12/12/1960 | 59 | Closed | 08/07/2020 | 07/22/2020 | Y | 10/19/2020 | 11/02/2020 | 10/16/2020 | 10/23/2020 | $767.62 | $8,286.05 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004244 | STD | F | 12/12/1960 | 59 | Closed | 08/07/2020 | 07/22/2020 | Y | 10/26/2020 | 11/02/2020 | 10/23/2020 | 10/30/2020 | $767.62 | $8,286.05 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004244 | STD | F | 12/12/1960 | 59 | Closed | 08/07/2020 | 07/22/2020 | Y | 11/02/2020 | 11/02/2020 | 10/30/2020 | 11/06/2020 | $767.62 | $8,286.05 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004244 | STD | F | 12/12/1960 | 59 | Closed | 08/07/2020 | 07/22/2020 | Y | 09/28/2020 | 11/02/2020 | 09/21/2020 | 10/08/2020 | $1,864.22 | $8,286.05 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004475 | STD | F | 10/10/1963 | 56 | Closed | 07/24/2020 | 07/27/2020 | Y | 11/04/2020 | 11/04/2020 | 07/31/2020 | 08/11/2020 | $230.93 | $230.93 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202004891 | STD | F | 03/28/1984 | 35 | Closed | 07/21/2020 | 07/31/2020 | Y | 08/17/2020 | 08/17/2020 | 07/21/2020 | 09/21/2020 | $2,442.20 | $2,442.20 | CLOSED - Failure to Provide Proof | ||
| 00306147 | STATE OF NEBRASKA | 202005101 | STD | F | 10/01/1969 | 50 | Closed | 08/05/2020 | 08/04/2020 | Y | 01/20/2021 | 01/20/2021 | 08/12/2020 | 08/13/2020 | $51.09 | $51.09 | CLOSED - Return to Another Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202005660 | STD | M | 06/22/1982 | 37 | Closed | 08/11/2020 | 08/10/2020 | Y | 11/16/2020 | 11/16/2020 | 08/18/2020 | 10/01/2020 | $2,367.14 | $2,367.14 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202005748 | STD | M | 10/24/1981 | 38 | Closed | 07/14/2020 | 08/11/2020 | Y | 12/02/2020 | 12/02/2020 | 07/14/2020 | 08/24/2020 | $2,678.29 | $2,678.29 | CLOSED - Return to Another Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202005957 | STD | F | 08/30/1987 | 32 | Closed | 07/03/2020 | 08/13/2020 | Y | 09/15/2020 | 09/15/2020 | 07/10/2020 | 08/14/2020 | $1,619.51 | $1,619.51 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 202005968 | STD | U | 09/03/1988 | 31 | Closed | 08/24/2020 | 08/13/2020 | Y | 10/05/2020 | 10/05/2020 | 08/31/2020 | 10/19/2020 | $2,930.41 | $2,930.41 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 202006006 | STD | F | 10/29/1990 | 29 | Closed | 08/02/2020 | 08/13/2020 | Y | 09/16/2020 | 09/16/2020 | 08/09/2020 | 09/13/2020 | $2,316.60 | $2,316.60 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/19/2020 | 02/22/2021 | 08/15/2020 | 10/26/2020 | $4,868.74 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/25/2020 | 02/22/2021 | 08/15/2020 | 11/23/2020 | $6,897.29 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/30/2020 | 02/22/2021 | 08/15/2020 | 10/26/2020 | ($4,868.74) | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 12/22/2020 | 02/22/2021 | 12/07/2020 | 12/15/2020 | $551.78 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 01/06/2021 | 02/22/2021 | 12/15/2020 | 01/05/2021 | $1,448.43 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 01/20/2021 | 02/22/2021 | 01/05/2021 | 01/18/2021 | $896.65 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 02/22/2021 | 02/22/2021 | 01/18/2021 | 02/13/2021 | $1,793.29 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/19/2020 | 02/22/2021 | 11/02/2020 | 11/09/2020 | $473.35 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/30/2020 | 02/22/2021 | 11/02/2020 | 11/09/2020 | ($473.35) | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/19/2020 | 02/22/2021 | 11/09/2020 | 11/16/2020 | $473.35 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/30/2020 | 02/22/2021 | 11/09/2020 | 11/16/2020 | ($473.35) | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/19/2020 | 02/22/2021 | 11/16/2020 | 11/23/2020 | $473.35 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/30/2020 | 02/22/2021 | 11/16/2020 | 11/23/2020 | ($473.35) | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/30/2020 | 02/22/2021 | 11/23/2020 | 11/30/2020 | $482.81 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 12/03/2020 | 02/22/2021 | 11/30/2020 | 12/07/2020 | $482.81 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/19/2020 | 02/22/2021 | 10/26/2020 | 11/02/2020 | $473.35 | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006226 | STD | F | 10/15/1961 | 58 | Closed | 08/07/2020 | 08/17/2020 | Y | 11/30/2020 | 02/22/2021 | 10/26/2020 | 11/02/2020 | ($473.35) | $12,553.06 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006408 | STD | U | 03/06/1979 | 40 | Closed | 09/17/2020 | 08/19/2020 | Y | 10/22/2020 | 10/22/2020 | 10/20/2020 | 10/30/2020 | $563.21 | $2,027.57 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202006408 | STD | U | 03/06/1979 | 40 | Closed | 09/17/2020 | 08/19/2020 | Y | 10/08/2020 | 10/22/2020 | 09/24/2020 | 10/20/2020 | $1,464.36 | $2,027.57 | CLOSED - Return to Own Occ w Same Employer | ||
| 00306147 | STATE OF NEBRASKA | 202006575 | STD | U | 04/09/1991 | 28 | Closed | 09/02/2020 | 08/20/2020 | Y | 10/20/2020 | 10/20/2020 | 09/09/2020 | 10/29/2020 | $3,471.07 | $3,471.07 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 202006739 | STD | F | 05/13/1985 | 34 | Closed | 08/28/2020 | 08/24/2020 | Y | 10/05/2020 | 10/05/2020 | 09/04/2020 | 10/23/2020 | $3,563.14 | $3,563.14 | CLOSED - End of Pregnancy Recovery Period | ||
| 00306147 | STATE OF NEBRASKA | 202006898 | STD | F | 09/24/1969 | 50 | Closed | 08/18/2020 | 08/26/2020 | Y | 09/11/2020 | 02/19/2021 | 08/25/2020 | 09/22/2020 | $1,691.12 | $10,921.81 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006898 | STD | F | 09/24/1969 | 50 | Closed | 08/18/2020 | 08/26/2020 | Y | 02/05/2021 | 02/19/2021 | 02/02/2021 | 02/09/2021 | $422.78 | $10,921.81 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006898 | STD | F | 09/24/1969 | 50 | Closed | 08/18/2020 | 08/26/2020 | Y | 02/12/2021 | 02/19/2021 | 02/09/2021 | 02/16/2021 | $422.78 | $10,921.81 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006898 | STD | F | 09/24/1969 | 50 | Closed | 08/18/2020 | 08/26/2020 | Y | 02/19/2021 | 02/19/2021 | 02/16/2021 | 02/23/2021 | $422.78 | $10,921.81 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006898 | STD | F | 09/24/1969 | 50 | Closed | 08/18/2020 | 08/26/2020 | Y | 01/15/2021 | 02/19/2021 | 01/12/2021 | 01/19/2021 | $422.78 | $10,921.81 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006898 | STD | F | 09/24/1969 | 50 | Closed | 08/18/2020 | 08/26/2020 | Y | 01/22/2021 | 02/19/2021 | 01/19/2021 | 01/26/2021 | $422.78 | $10,921.81 | CLOSED - Max Benefit Duration Reached | ||
| 00306147 | STATE OF NEBRASKA | 202006898 | STD | F | 09/24/1969 | 50 | Closed | 08/18/2020 | 08/26/2020 | Y | 01/29/2021 | 02/19/2021 | 01/26/2021 | 02/02/2021 | $422.78 | $10,921.81 | CLOSED - Max Benefit Duration Reached |
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