Attachment I - STD Payment Details.xlsx

XLSX spreadsheet 218 KB Posted

Attached to
State of Nebraska Short-Term Disability (STD) and Long-Term Disability (LTD) Insurance
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.

View the file

Other files

File Type Posted
120084 O5 SOLICITATION ADDENDUM ONE final.docx DOCX document
Attachment I - STD Payment Details.xlsx XLSX spreadsheet
120084 O5- Addendum Two- Revised Schedule of Events.pdf PDF
120084 O5 RFP STD LTD Insurance.docx DOCX document
Attachment P Claim details for SAE from 07.01.2019.pdf PDF
Attachment A Requirements Matrix.docx DOCX document
Attachment C Current Short Term Disability Benefits.pdf PDF
UnitedHealthCare BAFO cost.pdf PDF
120084 O5 Cost Proposal.xlsx XLSX spreadsheet
BAFO 120084 O5 FinalEvaluationDocument.pdf PDF
Attachment F - LTD Group Paid by month.pdf PDF
Attachment J - LTD Claims Status.pdf PDF
List of Respondents.pdf PDF
Attachment G- STD Group Paid by month.pdf PDF
120084 O5 RFP STD LTD Insurance.pdf PDF
Attachment K - STD Claims Status.pdf PDF
UnitedHealthCare (stacked).pdf PDF
120084 O5- Addendum Three - Revised Schedule of Events.pdf PDF
Metlife Response (stacked).pdf PDF
Addendum 4 - Revised Schedule of Events.pdf PDF
120084 O5 Intent to Award.pdf PDF
Attachment N Historical LTD and STD Premium Payments.xlsx XLSX spreadsheet
Attachment O October 2024 STD LTD Monthly Invoice.pdf PDF
Attachment E - STD open and closed paid claim summary.pdf PDF
120084 O5 SolicitationEvaluationCriteria.pdf PDF
Metlife Response BAFO cost.pdf PDF
Attachment D - LTD open and closed paid claim summary.pdf PDF
120084 O5 BAFO Cost Proposal.xlsx XLSX spreadsheet
Attachment H - LTD Payment Details.xlsx XLSX spreadsheet
Attachment M EligibilityCensus.xlsx XLSX spreadsheet
Attachment L Census LTD STD.xlsx XLSX spreadsheet
Attachment B Current Long Term Disability Benefits.pdf PDF
120084 O5 RFP STD LTD Insurance.docx DOCX document
Attachment L Census LTD STD.xlsx XLSX spreadsheet
Attachment G- STD Group Paid by month.pdf PDF
120084 O5 SOLICITATION ADDENDUM ONE final.docx DOCX document
Attachment B Current Long Term Disability Benefits.pdf PDF
120084 O5 Cost Proposal.xlsx XLSX spreadsheet
Attachment O October 2024 STD LTD Monthly Invoice.pdf PDF
Attachment J - LTD Claims Status.pdf PDF
Metlife Response (stacked).pdf PDF
Attachment H - LTD Payment Details.xlsx XLSX spreadsheet
Attachment K - STD Claims Status.pdf PDF
Metlife Response BAFO cost.pdf PDF
120084 O5 Intent to Award.pdf PDF
Attachment E - STD open and closed paid claim summary.pdf PDF
120084 O5- Addendum Three - Revised Schedule of Events.pdf PDF
Attachment D - LTD open and closed paid claim summary.pdf PDF
Attachment C Current Short Term Disability Benefits.pdf PDF
Attachment M EligibilityCensus.xlsx XLSX spreadsheet
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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 IDSubgroup NameClaim NumberBenefitGenderDate of BirthAge at Incurred DateCurrent Claim StatusIncurred DateEnter DatePaid IndicatorPayment DateMax Payment DatePayment Cover From DatePayment Cover To DateNet Benefit AmountClaim Total Net Benefit Amount To DateCurent Claim Status DescriptionExpected RTW FullTime DateRTW FullTime Date
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y09/13/201904/09/202008/15/201908/29/2019$834.76$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y09/20/201904/09/202008/29/201909/12/2019$834.76$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y01/06/202004/09/202012/02/201912/09/2019$343.47$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y01/22/202004/09/202012/09/201912/16/2019$1,595.61$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y04/09/202004/09/202002/03/202002/10/2020$159.00$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y04/09/202004/09/202002/10/202002/13/2020$347.82$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y03/03/202004/09/202001/06/202001/13/2020$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y03/03/202004/09/202001/13/202001/20/2020$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y03/03/202004/09/202001/20/202001/27/2020$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y03/03/202004/09/202001/27/202002/03/2020$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y11/11/201904/09/202011/07/201911/14/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y11/18/201904/09/202011/14/201911/21/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y11/25/201904/09/202011/21/201912/02/2019$655.88$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y10/07/201904/09/202010/03/201910/10/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y10/14/201904/09/202010/10/201910/17/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y10/21/201904/09/202010/17/201910/24/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y10/28/201904/09/202010/24/201910/31/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y11/04/201904/09/202010/31/201911/07/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y09/25/201904/09/202009/12/201909/19/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y09/26/201904/09/202009/19/201909/26/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769070STDF03/03/195860Closed08/08/201908/11/2019Y09/30/201904/09/202009/26/201910/03/2019$417.38$10,614.62CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200769883STDF12/12/197741Closed07/30/201908/21/2019Y01/15/202001/15/202008/06/201909/26/2019$2,491.57$2,491.57CLOSED - Not TD Any Occ
00306147STATE OF NEBRASKA200770222STDF12/11/197543Closed08/12/201908/28/2019Y09/13/201909/13/201908/19/201909/04/2019$1,107.13$1,107.13CLOSED - Failure to Provide Proof
00306147STATE OF NEBRASKA200770226STDF05/25/196058Closed08/08/201908/28/2019Y09/13/201910/02/201908/15/201909/12/2019$1,662.76$3,147.37CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200770226STDF05/25/196058Closed08/08/201908/28/2019Y09/24/201910/02/201909/12/201909/19/2019$415.69$3,147.37CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200770226STDF05/25/196058Closed08/08/201908/28/2019Y10/02/201910/02/201909/19/201910/07/2019$1,068.92$3,147.37CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200770392STDF11/26/196751Closed10/02/201908/30/2019Y12/12/201912/12/201910/09/201911/18/2019$2,090.34$2,090.34CLOSED - Return to Own Occ (with policyholder)11/18/2019
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y10/01/201902/10/202008/15/201908/22/2019$1,067.60$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y12/09/201902/10/202012/05/201912/12/2019$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y12/16/201902/10/202012/12/201912/19/2019$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y12/23/201902/10/202012/19/201912/26/2019$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y12/30/201902/10/202012/26/201901/02/2020$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y02/10/202002/10/202002/06/202002/13/2020$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y01/06/202002/10/202001/02/202001/09/2020$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y01/13/202002/10/202001/09/202001/16/2020$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y01/21/202002/10/202001/16/202001/23/2020$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y01/27/202002/10/202001/23/202001/30/2020$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y02/03/202002/10/202001/30/202002/06/2020$269.40$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y12/03/201902/10/202010/18/201912/05/2019$1,847.31$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770414STDF05/04/196058Closed08/08/201908/30/2019Y10/21/201902/10/202009/12/201910/18/2019$1,385.49$6,994.40CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200770873STDF11/04/195860Closed09/01/201909/09/2019Y12/23/201912/23/201910/08/201910/29/2019$2,136.30$5,188.16CLOSED - Death
00306147STATE OF NEBRASKA200770873STDF11/04/195860Closed09/01/201909/09/2019Y12/23/201912/23/201909/08/201910/08/2019$3,051.86$5,188.16CLOSED - Death
00306147STATE OF NEBRASKA200771070STDF11/05/196652Closed08/20/201909/11/2019Y10/11/201910/11/201908/27/201909/12/2019$1,044.91$1,044.91CLOSED - Return to Own Occ (with policyholder)09/12/2019
00306147STATE OF NEBRASKA200771392STDF01/07/199622Closed09/09/201909/17/2019Y11/25/201911/25/201910/07/201910/28/2019$1,255.83$2,511.66CLOSED - Return to Own Occ (with policyholder)10/28/2019
00306147STATE OF NEBRASKA200771392STDF01/07/199622Closed09/09/201909/17/2019Y10/11/201911/25/201909/16/201910/07/2019$1,255.83$2,511.66CLOSED - Return to Own Occ (with policyholder)10/28/2019
00306147STATE OF NEBRASKA200771392STDF01/07/199622Closed09/09/201909/17/2019Y11/07/201911/25/201909/16/201910/07/2019($1,255.83)$2,511.66CLOSED - Return to Own Occ (with policyholder)10/28/2019
00306147STATE OF NEBRASKA200771392STDF01/07/199622Closed09/09/201909/17/2019Y11/11/201911/25/201909/16/201910/07/2019$1,255.83$2,511.66CLOSED - Return to Own Occ (with policyholder)10/28/2019
00306147STATE OF NEBRASKA200771851STDF09/13/196652Closed09/07/201909/24/2019Y10/11/201910/11/201909/07/201909/24/2019$617.00$617.00CLOSED - Return to Own Occ (with policyholder)09/24/2019
00306147STATE OF NEBRASKA200772098STDF04/11/196454Closed10/15/201909/27/2019Y12/11/201901/15/202012/03/201912/10/2019$311.04$3,554.74CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200772098STDF04/11/196454Closed10/15/201909/27/2019Y12/16/201901/15/202012/10/201912/17/2019$311.04$3,554.74CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200772098STDF04/11/196454Closed10/15/201909/27/2019Y12/23/201901/15/202012/17/201912/24/2019$311.04$3,554.74CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200772098STDF04/11/196454Closed10/15/201909/27/2019Y12/30/201901/15/202012/24/201912/31/2019$311.04$3,554.74CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200772098STDF04/11/196454Closed10/15/201909/27/2019Y01/06/202001/15/202012/31/201901/07/2020$311.04$3,554.74CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200772098STDF04/11/196454Closed10/15/201909/27/2019Y01/15/202001/15/202001/07/202001/10/2020$133.30$3,554.74CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200772098STDF04/11/196454Closed10/15/201909/27/2019Y12/03/201901/15/202010/22/201912/03/2019$1,866.24$3,554.74CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200773130STDF05/30/197939Closed09/24/201910/07/2019Y10/28/201910/28/201910/01/201910/28/2019$1,390.04$1,390.04CLOSED - Return to Own Occ (with policyholder)10/28/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y12/23/201912/23/201912/02/201912/16/2019$813.87$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y12/23/201912/23/201912/09/201912/16/2019($73.99)$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y11/06/201912/23/201911/02/201911/09/2019$443.93$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y11/13/201912/23/201911/09/201911/16/2019$443.93$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y11/20/201912/23/201911/16/201911/23/2019$443.93$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y11/27/201912/23/201911/23/201911/30/2019$443.93$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y12/20/201912/23/201911/23/201911/30/2019$0.00$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y12/20/201912/23/201911/30/201912/02/2019$126.84$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y12/23/201912/23/201911/30/201912/07/2019$0.00$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y10/25/201912/23/201910/05/201910/26/2019$1,331.79$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200773262STDF07/11/195365Closed09/28/201910/08/2019Y10/30/201912/23/201910/26/201911/02/2019$443.93$4,418.16CLOSED - Maximum Benefit Reached (T65, RBD, etc.)12/16/2019
00306147STATE OF NEBRASKA200774363STDF05/08/197444Closed10/16/201910/21/2019Y11/12/201911/12/201910/23/201911/04/2019$775.13$775.13CLOSED - Failure to Provide Proof
00306147STATE OF NEBRASKA200774464STDM12/31/196553Closed10/02/201910/22/2019Y11/22/201906/15/202011/18/201911/25/2019$408.00$3,205.72CLOSED - Return to Own Occ (with policyholder)11/26/2019
00306147STATE OF NEBRASKA200774464STDM12/31/196553Closed10/02/201910/22/2019Y12/02/201906/15/202011/25/201911/26/2019$58.29$3,205.72CLOSED - Return to Own Occ (with policyholder)11/26/2019
00306147STATE OF NEBRASKA200774464STDM12/31/196553Closed10/02/201910/22/2019Y06/10/202006/15/202011/25/201911/26/2019($58.29)$3,205.72CLOSED - Return to Own Occ (with policyholder)11/26/2019
00306147STATE OF NEBRASKA200774464STDM12/31/196553Closed10/02/201910/22/2019Y06/15/202006/15/202011/25/201911/26/2019$58.29$3,205.72CLOSED - Return to Own Occ (with policyholder)11/26/2019
00306147STATE OF NEBRASKA200774464STDM12/31/196553Closed10/02/201910/22/2019Y11/19/201906/15/202010/02/201911/18/2019$2,739.43$3,205.72CLOSED - Return to Own Occ (with policyholder)11/26/2019
00306147STATE OF NEBRASKA200775054STDF03/23/197642Closed09/20/201910/29/2019Y11/19/201911/19/201909/20/201910/17/2019$982.84$982.84CLOSED - Return to Own Occ (with policyholder)10/17/2019
00306147STATE OF NEBRASKA200775190STDF12/07/199127Closed10/14/201910/30/2019Y11/13/201911/13/201910/21/201910/28/2019$359.08$359.08CLOSED - Return to Own Occ (with policyholder)10/28/2019
00306147STATE OF NEBRASKA200775545STDM06/14/196553Closed10/14/201911/01/2019Y02/18/202002/18/202011/18/201912/02/2019$997.92$2,993.76CLOSED - Return to Own Occ (with policyholder)12/28/2019
00306147STATE OF NEBRASKA200775545STDM06/14/196553Closed10/14/201911/01/2019Y01/16/202002/18/202010/21/201911/18/2019$1,995.84$2,993.76CLOSED - Return to Own Occ (with policyholder)12/28/2019
00306147STATE OF NEBRASKA200776430STDF02/09/197246Closed11/25/201911/11/2019Y12/11/201902/24/202012/02/201912/09/2019$450.02$6,107.41CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200776430STDF02/09/197246Closed11/25/201911/11/2019Y12/13/201902/24/202012/09/201912/16/2019$450.02$6,107.41CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200776430STDF02/09/197246Closed11/25/201911/11/2019Y12/20/201902/24/202012/16/201912/23/2019$450.02$6,107.41CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200776430STDF02/09/197246Closed11/25/201911/11/2019Y12/27/201902/24/202012/23/201912/30/2019$450.02$6,107.41CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200776430STDF02/09/197246Closed11/25/201911/11/2019Y02/06/202002/24/202012/30/201902/07/2020$2,507.25$6,107.41CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200776430STDF02/09/197246Closed11/25/201911/11/2019Y02/24/202002/24/202002/07/202003/06/2020$1,800.08$6,107.41CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200777141STDF07/21/199523Closed11/17/201911/20/2019Y01/15/202001/15/202011/24/201912/06/2019$615.22$615.22CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200777176STDF01/17/196157Closed10/29/201911/20/2019Y12/19/201912/19/201911/05/201911/12/2019$472.51$472.51CLOSED - Return to Own Occ (with policyholder)11/12/2019
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y12/23/201903/09/202012/17/201912/24/2019$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y12/30/201903/09/202012/24/201912/31/2019$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y01/06/202003/09/202012/31/201901/07/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y02/10/202003/09/202002/04/202002/11/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y02/12/202003/09/202002/11/202002/18/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y02/24/202003/09/202002/18/202002/25/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y03/02/202003/09/202002/25/202003/03/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y01/13/202003/09/202001/07/202001/14/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y01/21/202003/09/202001/14/202001/21/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y01/27/202003/09/202001/21/202001/28/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y02/03/202003/09/202001/28/202002/04/2020$461.04$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778759STDF02/20/199028Closed12/10/201912/12/2019Y03/09/202003/09/202003/03/202004/02/2020$1,975.89$7,047.33CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200778936STDM01/17/195563Closed12/10/201912/13/2019Y02/13/202003/05/202012/17/201902/15/2020$4,183.20$5,298.72CLOSED - Return to Own Occ (with policyholder)03/02/2020
00306147STATE OF NEBRASKA200778936STDM01/17/195563Closed12/10/201912/13/2019Y02/19/202003/05/202002/15/202002/22/2020$488.04$5,298.72CLOSED - Return to Own Occ (with policyholder)03/02/2020
00306147STATE OF NEBRASKA200778936STDM01/17/195563Closed12/10/201912/13/2019Y02/26/202003/05/202002/22/202002/29/2020$488.04$5,298.72CLOSED - Return to Own Occ (with policyholder)03/02/2020
00306147STATE OF NEBRASKA200778936STDM01/17/195563Closed12/10/201912/13/2019Y03/05/202003/05/202002/29/202003/02/2020$139.44$5,298.72CLOSED - Return to Own Occ (with policyholder)03/02/2020
00306147STATE OF NEBRASKA200779473STDF10/15/196157Closed12/12/201912/20/2019Y01/15/202001/15/202012/19/201901/13/2020$1,690.54$1,690.54CLOSED - Return to Own Occ (with policyholder)01/13/2020
00306147STATE OF NEBRASKA200780458STDF06/06/198831Closed01/06/202001/06/2020Y02/07/202003/06/202002/03/202002/10/2020$733.54$9,421.23CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200780458STDF06/06/198831Closed01/06/202001/06/2020Y02/14/202003/06/202002/10/202002/17/2020$733.54$9,421.23CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200780458STDF06/06/198831Closed01/06/202001/06/2020Y02/21/202003/06/202002/17/202002/24/2020$733.54$9,421.23CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200780458STDF06/06/198831Closed01/06/202001/06/2020Y02/28/202003/06/202002/24/202003/02/2020$733.54$9,421.23CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200780458STDF06/06/198831Closed01/06/202001/06/2020Y01/24/202003/06/202001/13/202001/20/2020$723.54$9,421.23CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200780458STDF06/06/198831Closed01/06/202001/06/2020Y02/03/202003/06/202001/20/202001/27/2020$733.54$9,421.23CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200780458STDF06/06/198831Closed01/06/202001/06/2020Y02/04/202003/06/202001/27/202002/03/2020$733.54$9,421.23CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200780458STDF06/06/198831Closed01/06/202001/06/2020Y03/06/202003/06/202003/02/202004/12/2020$4,296.45$9,421.23CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200780567STDF03/01/198434Closed12/31/201901/08/2020Y01/29/202001/29/202001/07/202001/16/2020$687.16$687.16CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200780880STDF11/19/198930Closed03/14/202001/10/2020Y03/26/202003/26/202003/21/202003/28/2020$1,872.80$1,872.80CLOSED - Maximum Benefit Reached (T65, RBD, etc.)
00306147STATE OF NEBRASKA200781254STDM09/26/197841Closed01/07/202001/15/2020Y02/27/202002/27/202001/14/202001/21/2020$2,033.25$2,033.25CLOSED - Return to Own Occ (with policyholder)02/17/2020
00306147STATE OF NEBRASKA200781256STDF05/02/196950Closed01/07/202001/15/2020Y01/29/202002/05/202001/14/202001/17/2020$188.53$565.59CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200781256STDF05/02/196950Closed01/07/202001/15/2020Y02/05/202002/05/202001/17/202001/23/2020$377.06$565.59CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200781299STDF01/28/196157Closed12/24/201901/15/2020Y01/28/202001/28/202012/31/201901/02/2020$90.47$90.47CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200781482STDF01/03/196751Closed12/24/201901/21/2020Y04/15/202009/01/202004/09/202004/23/2020$715.10$7,834.30CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200781482STDF01/03/196751Closed12/24/201901/21/2020Y04/27/202009/01/202004/23/202004/30/2020$357.55$7,834.30CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200781482STDF01/03/196751Closed12/24/201901/21/2020Y05/04/202009/01/202004/30/202005/07/2020$357.55$7,834.30CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200781482STDF01/03/196751Closed12/24/201901/21/2020Y09/01/202009/01/202012/27/201912/30/2019$153.24$7,834.30CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200781482STDF01/03/196751Closed12/24/201901/21/2020Y02/27/202009/01/202012/31/201901/21/2020$75.00$7,834.30CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200781482STDF01/03/196751Closed12/24/201901/21/2020Y04/08/202009/01/202001/21/202002/03/2020$3,417.62$7,834.30CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200781482STDF01/03/196751Closed12/24/201901/21/2020Y06/19/202009/01/202005/07/202006/30/2020$2,758.24$7,834.30CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200782412STDF04/12/198930Closed02/19/202002/04/2020Y03/04/202003/04/202002/26/202004/01/2020$2,600.30$2,600.30CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200783855STDF04/03/198930Closed02/21/202002/23/2020Y03/25/202003/25/202002/28/202003/01/2020$2,302.91$2,302.91CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200784642STDF11/02/198831Closed03/06/202003/03/2020Y03/26/202003/26/202003/13/202004/18/2020$2,340.31$2,340.31CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200784710STDF10/18/197544Closed02/18/202003/04/2020Y07/02/202007/02/202002/25/202003/11/2020$723.39$723.39CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200784909STDF11/07/198831Closed03/18/202003/05/2020Y04/22/202004/22/202003/25/202004/29/2020$2,672.25$2,672.25CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200785910STDF08/05/198237Closed03/18/202003/19/2020Y04/24/202004/24/202003/25/202005/13/2020$3,150.14$3,150.14CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200786436STDF01/20/199128Closed04/06/202003/25/2020Y05/13/202005/13/202004/13/202005/18/2020$3,161.65$3,161.65CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200786843STDF07/02/196158Closed03/15/202003/30/2020Y06/08/202006/08/202003/22/202004/22/2020$1,734.05$1,734.05CLOSED - Return to Own Occ (with policyholder)04/22/2020
00306147STATE OF NEBRASKA200787363STDF09/03/198633Closed04/24/202004/02/2020Y06/02/202006/02/202005/01/202006/06/2020$2,158.41$2,158.41CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200787370STDF10/27/198039Closed03/24/202004/02/2020Y05/27/202005/27/202003/31/202006/03/2020$4,388.57$4,388.57CLOSED -
00306147STATE OF NEBRASKA200787892STDF06/14/198732Closed04/01/202004/07/2020Y06/16/202006/16/202004/08/202005/27/2020$4,214.89$4,214.89CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200787915STDF03/04/199128Closed06/22/202004/08/2020Y08/13/202008/13/202006/29/202008/17/2020$3,124.80$3,124.80CLOSED - Miscellaneous
00306147STATE OF NEBRASKA200788209STDF03/07/196851Closed03/27/202004/14/2020Y02/03/202102/03/202104/03/202004/14/2020$691.27$691.27CLOSED - Return to Another Occ w Same Employer
00306147STATE OF NEBRASKA200789133STDF08/12/198732Closed05/13/202004/27/2020Y07/01/202007/01/202005/20/202007/08/2020$4,514.02$4,514.02CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200789337STDM10/21/196653Closed04/02/202004/30/2020Y02/09/202102/09/202104/09/202005/05/2020$1,757.32$1,757.32CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200789503STDM04/26/196158Closed04/29/202005/04/2020Y06/22/202006/22/202006/01/202007/27/2020$3,264.00$4,779.43CLOSED - Death
00306147STATE OF NEBRASKA200789503STDM04/26/196158Closed04/29/202005/04/2020Y06/17/202006/22/202005/06/202006/01/2020$1,515.43$4,779.43CLOSED - Death
00306147STATE OF NEBRASKA200789531STDF11/01/196653Closed04/27/202005/04/2020Y06/08/202006/08/202005/04/202005/05/2020$60.40$60.40CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y06/24/202011/23/202004/27/202006/22/2020$4,419.44$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y08/11/202011/23/202008/03/202008/10/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y08/13/202011/23/202008/10/202008/17/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y08/20/202011/23/202008/17/202008/24/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y08/27/202011/23/202008/24/202008/31/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y09/03/202011/23/202008/31/202009/07/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y07/01/202011/23/202006/22/202006/29/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y07/14/202011/23/202006/29/202008/03/2020$2,762.15$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y11/02/202011/23/202011/02/202011/09/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y11/12/202011/23/202011/09/202011/16/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y11/19/202011/23/202011/16/202011/23/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y11/23/202011/23/202011/23/202011/25/2020$157.84$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y10/08/202011/23/202010/05/202010/12/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y10/15/202011/23/202010/12/202010/19/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y10/22/202011/23/202010/19/202010/26/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y10/26/202011/23/202010/26/202011/02/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y09/10/202011/23/202009/07/202009/14/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y09/17/202011/23/202009/14/202009/21/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y09/24/202011/23/202009/21/202009/28/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789627STDF03/08/196257Closed04/20/202005/05/2020Y09/28/202011/23/202009/28/202010/05/2020$552.43$16,730.74CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA200789712STDF02/13/197841Closed05/01/202005/07/2020Y06/23/202007/02/202006/01/202006/11/2020$596.26$3,322.75CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200789712STDF02/13/197841Closed05/01/202005/07/2020Y07/01/202007/02/202006/11/202006/15/2020$238.50$3,322.75CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200789712STDF02/13/197841Closed05/01/202005/07/2020Y07/01/202007/02/202006/15/202006/22/2020$347.82$3,322.75CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200789712STDF02/13/197841Closed05/01/202005/07/2020Y07/02/202007/02/202006/22/202006/29/2020$347.82$3,322.75CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200789712STDF02/13/197841Closed05/01/202005/07/2020Y06/08/202007/02/202005/01/202006/01/2020$1,792.35$3,322.75CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200789864STDF07/29/195861Closed03/24/202005/08/2020Y06/18/202006/18/202003/31/202005/06/2020$128.57$128.57CLOSED - Return to Own Occ (with policyholder)05/06/2020
00306147STATE OF NEBRASKA200789931STDF06/21/197841Closed04/08/202005/11/2020Y06/01/202006/01/202004/15/202005/21/2020$2,092.78$2,092.78CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA200790040STDF03/22/198435Closed05/06/202005/12/2020Y06/26/202006/26/202006/18/202007/02/2020$575.52$2,343.19CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200790040STDF03/22/198435Closed05/06/202005/12/2020Y06/09/202006/26/202005/06/202006/18/2020$1,767.67$2,343.19CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200790160STDM03/07/198633Closed05/27/202005/14/2020Y07/02/202007/02/202007/06/202007/20/2020$816.00$2,356.43CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200790160STDM03/07/198633Closed05/27/202005/14/2020Y06/15/202007/02/202006/03/202006/10/2020$1,132.43$2,356.43CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200790160STDM03/07/198633Closed05/27/202005/14/2020Y07/01/202007/02/202006/29/202007/06/2020$408.00$2,356.43CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200790208STDF07/24/199029Closed04/30/202005/14/2020Y06/18/202006/18/202005/07/202006/13/2020$2,212.76$1,537.96CLOSED - Failure to Provide Proof
00306147STATE OF NEBRASKA200790208STDF07/24/199029Closed04/30/202005/14/2020Y06/18/202006/18/202005/20/202005/22/2020($562.33)$1,537.96CLOSED - Failure to Provide Proof
00306147STATE OF NEBRASKA200790208STDF07/24/199029Closed04/30/202005/14/2020Y06/18/202006/18/202005/27/202006/06/2020($112.47)$1,537.96CLOSED - Failure to Provide Proof
00306147STATE OF NEBRASKA200790330STDF07/26/196752Closed05/04/202005/18/2020Y06/18/202006/18/202005/04/202005/13/2020$631.36$631.36CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200790370STDF07/24/195663Closed03/20/202005/19/2020Y07/01/202007/01/202003/27/202005/19/2020$2,737.30$2,737.30CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200790968STDF03/05/198336Closed05/17/202005/27/2020Y06/16/202006/16/202005/24/202005/26/2020$119.59$119.59CLOSED - Return to Own Occ (with policyholder)
00306147STATE OF NEBRASKA200790978STDF04/17/195366Closed03/16/202005/27/2020Y07/14/202007/14/202003/23/202003/30/2020$25.00$25.00CLOSED - Miscellaneous
00306147STATE OF NEBRASKA200791196STDF02/07/198534Closed07/24/202005/29/2020Y08/03/202008/03/202007/31/202009/18/2020$2,766.61$2,766.61CLOSED - Miscellaneous
00306147STATE OF NEBRASKA200792011STDF04/22/197544Closed06/16/202006/09/2020Y07/15/202007/15/202007/01/202007/28/2020$1,918.58$1,947.15CLOSED - Miscellaneous
00306147STATE OF NEBRASKA200792011STDF04/22/197544Closed06/16/202006/09/2020Y06/23/202007/15/202006/23/202007/01/2020$28.57$1,947.15CLOSED - Miscellaneous
00306147STATE OF NEBRASKA200792633STDF01/31/196356Closed07/06/202006/17/2020Y08/18/202010/12/202008/03/202008/24/2020$1,726.56$5,179.68CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200792633STDF01/31/196356Closed07/06/202006/17/2020Y08/27/202010/12/202008/24/202008/31/2020$575.52$5,179.68CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200792633STDF01/31/196356Closed07/06/202006/17/2020Y09/03/202010/12/202008/31/202009/07/2020$575.52$5,179.68CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200792633STDF01/31/196356Closed07/06/202006/17/2020Y07/30/202010/12/202007/13/202008/03/2020$863.28$5,179.68CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200792633STDF01/31/196356Closed07/06/202006/17/2020Y09/10/202010/12/202009/07/202009/14/2020$575.52$5,179.68CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200792633STDF01/31/196356Closed07/06/202006/17/2020Y09/14/202010/12/202009/14/202009/30/2020$657.74$5,179.68CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200792633STDF01/31/196356Closed07/06/202006/17/2020Y10/12/202010/12/202009/30/202010/05/2020$205.54$5,179.68CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200792854STDF07/16/198831Closed06/13/202006/22/2020Y07/30/202007/30/202006/20/202007/25/2020$3,944.46$3,944.46CLOSED - Miscellaneous
00306147STATE OF NEBRASKA200792997STDM12/25/196851Closed06/25/202006/22/2020Y09/03/202009/03/202007/02/202008/24/2020$3,089.14$3,089.14CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200793508STDF09/13/196653Closed07/02/202006/26/2020Y09/01/202011/16/202007/02/202009/10/2020$2,599.20$3,787.41CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200793508STDF09/13/196653Closed07/02/202006/26/2020Y10/05/202011/16/202010/01/202010/07/2020$222.79$3,787.41CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200793508STDF09/13/196653Closed07/02/202006/26/2020Y11/16/202011/16/202010/07/202010/12/2020$185.66$3,787.41CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200793508STDF09/13/196653Closed07/02/202006/26/2020Y09/14/202011/16/202009/10/202009/17/2020$259.92$3,787.41CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200793508STDF09/13/196653Closed07/02/202006/26/2020Y09/16/202011/16/202009/17/202009/24/2020$259.92$3,787.41CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200793508STDF09/13/196653Closed07/02/202006/26/2020Y09/28/202011/16/202009/24/202010/01/2020$259.92$3,787.41CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA200793561STDF03/11/197940Closed05/06/202006/26/2020Y07/20/202007/20/202005/13/202005/25/2020$734.11$734.11CLOSED - Miscellaneous
00306147STATE OF NEBRASKA200793710STDF04/17/195366Closed05/29/202006/29/2020Y07/14/202007/14/202006/05/202006/15/2020$35.72$35.72CLOSED - Miscellaneous
00306147STATE OF NEBRASKA200793736STDF09/13/196653Closed06/19/202006/29/2020Y10/15/202010/15/202006/26/202007/06/2020$803.51$803.51CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202003375STDF07/20/198138Closed06/17/202007/08/2020Y08/13/202008/13/202006/24/202009/01/2020$3,585.87$3,585.87CLOSED - Claim Withdrawn
00306147STATE OF NEBRASKA202003712STDU04/05/197148Closed06/23/202007/14/2020Y08/17/202008/20/202006/23/202008/19/2020$2,233.59$2,635.83CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202003712STDU04/05/197148Closed06/23/202007/14/2020Y08/19/202008/20/202006/23/202008/26/2020$2,635.83$2,635.83CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202003712STDU04/05/197148Closed06/23/202007/14/2020Y08/20/202008/20/202006/23/202008/19/2020($2,233.59)$2,635.83CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202003786STDM08/22/196950Closed06/02/202007/14/2020Y09/16/202009/16/202007/06/202007/16/2020$535.34$1,820.16CLOSED - Return to Another Occ w Same Employer
00306147STATE OF NEBRASKA202003786STDM08/22/196950Closed06/02/202007/14/2020Y09/16/202009/16/202006/09/202007/03/2020$1,284.82$1,820.16CLOSED - Return to Another Occ w Same Employer
00306147STATE OF NEBRASKA202004172STDF05/29/198930Closed10/13/202007/21/2020Y11/19/202011/19/202010/20/202011/23/2020$3,097.66$3,097.66CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA202004226STDF04/03/198930Closed05/13/202007/22/2020Y08/27/202008/27/202005/20/202006/01/2020$834.82$834.82CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202004244STDF12/12/196059Closed08/07/202007/22/2020Y09/08/202011/02/202008/14/202009/21/2020$3,241.69$8,286.05CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202004244STDF12/12/196059Closed08/07/202007/22/2020Y10/12/202011/02/202010/08/202010/16/2020$877.28$8,286.05CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202004244STDF12/12/196059Closed08/07/202007/22/2020Y10/19/202011/02/202010/16/202010/23/2020$767.62$8,286.05CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202004244STDF12/12/196059Closed08/07/202007/22/2020Y10/26/202011/02/202010/23/202010/30/2020$767.62$8,286.05CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202004244STDF12/12/196059Closed08/07/202007/22/2020Y11/02/202011/02/202010/30/202011/06/2020$767.62$8,286.05CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202004244STDF12/12/196059Closed08/07/202007/22/2020Y09/28/202011/02/202009/21/202010/08/2020$1,864.22$8,286.05CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202004475STDF10/10/196356Closed07/24/202007/27/2020Y11/04/202011/04/202007/31/202008/11/2020$230.93$230.93CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202004891STDF03/28/198435Closed07/21/202007/31/2020Y08/17/202008/17/202007/21/202009/21/2020$2,442.20$2,442.20CLOSED - Failure to Provide Proof
00306147STATE OF NEBRASKA202005101STDF10/01/196950Closed08/05/202008/04/2020Y01/20/202101/20/202108/12/202008/13/2020$51.09$51.09CLOSED - Return to Another Occ w Same Employer
00306147STATE OF NEBRASKA202005660STDM06/22/198237Closed08/11/202008/10/2020Y11/16/202011/16/202008/18/202010/01/2020$2,367.14$2,367.14CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202005748STDM10/24/198138Closed07/14/202008/11/2020Y12/02/202012/02/202007/14/202008/24/2020$2,678.29$2,678.29CLOSED - Return to Another Occ w Same Employer
00306147STATE OF NEBRASKA202005957STDF08/30/198732Closed07/03/202008/13/2020Y09/15/202009/15/202007/10/202008/14/2020$1,619.51$1,619.51CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA202005968STDU09/03/198831Closed08/24/202008/13/2020Y10/05/202010/05/202008/31/202010/19/2020$2,930.41$2,930.41CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA202006006STDF10/29/199029Closed08/02/202008/13/2020Y09/16/202009/16/202008/09/202009/13/2020$2,316.60$2,316.60CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/19/202002/22/202108/15/202010/26/2020$4,868.74$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/25/202002/22/202108/15/202011/23/2020$6,897.29$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/30/202002/22/202108/15/202010/26/2020($4,868.74)$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y12/22/202002/22/202112/07/202012/15/2020$551.78$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y01/06/202102/22/202112/15/202001/05/2021$1,448.43$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y01/20/202102/22/202101/05/202101/18/2021$896.65$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y02/22/202102/22/202101/18/202102/13/2021$1,793.29$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/19/202002/22/202111/02/202011/09/2020$473.35$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/30/202002/22/202111/02/202011/09/2020($473.35)$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/19/202002/22/202111/09/202011/16/2020$473.35$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/30/202002/22/202111/09/202011/16/2020($473.35)$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/19/202002/22/202111/16/202011/23/2020$473.35$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/30/202002/22/202111/16/202011/23/2020($473.35)$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/30/202002/22/202111/23/202011/30/2020$482.81$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y12/03/202002/22/202111/30/202012/07/2020$482.81$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/19/202002/22/202110/26/202011/02/2020$473.35$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006226STDF10/15/196158Closed08/07/202008/17/2020Y11/30/202002/22/202110/26/202011/02/2020($473.35)$12,553.06CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006408STDU03/06/197940Closed09/17/202008/19/2020Y10/22/202010/22/202010/20/202010/30/2020$563.21$2,027.57CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202006408STDU03/06/197940Closed09/17/202008/19/2020Y10/08/202010/22/202009/24/202010/20/2020$1,464.36$2,027.57CLOSED - Return to Own Occ w Same Employer
00306147STATE OF NEBRASKA202006575STDU04/09/199128Closed09/02/202008/20/2020Y10/20/202010/20/202009/09/202010/29/2020$3,471.07$3,471.07CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA202006739STDF05/13/198534Closed08/28/202008/24/2020Y10/05/202010/05/202009/04/202010/23/2020$3,563.14$3,563.14CLOSED - End of Pregnancy Recovery Period
00306147STATE OF NEBRASKA202006898STDF09/24/196950Closed08/18/202008/26/2020Y09/11/202002/19/202108/25/202009/22/2020$1,691.12$10,921.81CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006898STDF09/24/196950Closed08/18/202008/26/2020Y02/05/202102/19/202102/02/202102/09/2021$422.78$10,921.81CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006898STDF09/24/196950Closed08/18/202008/26/2020Y02/12/202102/19/202102/09/202102/16/2021$422.78$10,921.81CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006898STDF09/24/196950Closed08/18/202008/26/2020Y02/19/202102/19/202102/16/202102/23/2021$422.78$10,921.81CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006898STDF09/24/196950Closed08/18/202008/26/2020Y01/15/202102/19/202101/12/202101/19/2021$422.78$10,921.81CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006898STDF09/24/196950Closed08/18/202008/26/2020Y01/22/202102/19/202101/19/202101/26/2021$422.78$10,921.81CLOSED - Max Benefit Duration Reached
00306147STATE OF NEBRASKA202006898STDF09/24/196950Closed08/18/202008/26/2020Y01/29/202102/19/202101/26/202102/02/2021$422.78$10,921.81CLOSED - Max Benefit Duration Reached

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