Attachment I - STD Payment Details.xlsx
XLSX spreadsheet 218 KB Posted
- Solicitation number
- 120084 O5
- Issued by
- Lancaster County, Nebraska
About this file
The file is a detailed payment record spreadsheet from the State of Nebraska's Short Term Disability (STD) program, showing claim payments made between July 2019 and March 2021. The document tracks individual STD claims for state employees, including claim numbers, benefit types, claimant demographics, claim status, payment dates, benefit amounts, and reasons for claim closure. Each entry includes information such as the employee's gender, date of birth, age at incurred date, claim status, payment periods, and net benefit amounts.
The data shows payments ranging from as low as $25.00 to over $16,000 per claim, with various closure reasons including return to work, maximum benefit reached, failure to provide proof, death, and end of pregnancy recovery period. The majority of claimants were female employees, with ages ranging from early 20s to late 60s. Claims were typically closed due to either return to work or reaching maximum benefit duration, with payment periods generally lasting between a few weeks to several months. The spreadsheet demonstrates that this is an active STD program with regular claim activity and consistent benefit payments made to state employees during medical leave periods.
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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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