Attachment I - STD Payment Details.xlsx
XLSX spreadsheet 218 KB Posted
- Solicitation number
- 120084 O5
- Issued by
- Lancaster County, Nebraska
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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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