Copy of 06-2019 Loss Run - SNA.xlsx
XLSX spreadsheet 20 KB Posted
- Solicitation number
- 74BAI-S1476
- Issued by
- Churchill County, Nevada
About this file
This document appears to be a state and local contract opportunity for Workers' Compensation Uninsured Claims Administration services for Clark County and the City of Las Vegas in Nevada. The contract includes providing claims handling, medical management, and administrative services for the agencies' workers' compensation uninsured claims. The contract term is not specified, but may include renewal options.
The pricing terms, set asides, incumbents, funding sources, and other financial details are not provided in the document. However, the summary indicates this is an ongoing program to handle workers' compensation claims for the two jurisdictions in Nevada.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment D - Insurance Schedule.docx | DOCX document | |
| RFP 74BAI-S1476 Final 1~1.docx | DOCX document | |
| DIR CLAIMS ACTIVITY REDACTED.xlsx | XLSX spreadsheet | |
| LetterOfIntent - RFP 74BAI-S1476.pdf | ||
| Proposed Staff Resume - 04-05-17.doc | DOC document | |
| Standard Form Contract .docx | DOCX document | |
| Open Claims Cost Detail.pdf | ||
| Reference Questionnaire - 01-24-20.doc | DOC document | |
| Attachment G - Cost Schedule.docx | DOCX document | |
| Closed Claims Cost Detail.pdf | ||
| Quote Instructions.pdf |
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Text version
Report 1
| Company | Claim No | Loss Date | Claim Status | Loss Descr | Loss Cause Descr | Med Paid Period | Med Paid To Date | Med Incurred | Ind Paid Period | Ind Paid To Date | Ind Incurred | Rhb Paid Period | Rhb Paid To Date | Rhb Incurred | Oth Paid Period | Oth Paid To Date | Oth Incurred | Tot Paid | Tot Incr | Tot Rsv | |
| DIR UNINSURED CLAIMS | 077050000062 | 9/20/2004 | O | IW was lifting plyboard and injured lower back. **QUARTERLY VISITS, RXS ONLY.** | Strain; lifting | $86,415.10 | $86,415.10 | $212,934.88 | $73,428.72 | $73,428.72 | $73,428.72 | $930.00 | $930.00 | $3,000.00 | $19,443.05 | $19,443.05 | $19,646.21 | $180,216.87 | $309,009.81 | $128,792.94 | |
| DIR UNINSURED CLAIMS | 117050000191 | 3/17/1999 | R | On 3/17/99, IW was carrying lumbar upstairs when fell injuring his thoracic spine -T12/L1 fracture/paralysis- | Fall; from different level/elevation | $67,574.95 | $67,574.95 | $67,574.95 | $110,130.20 | $110,130.20 | $110,130.20 | $7.90 | $7.90 | $7.90 | $177,713.05 | $177,713.05 | $0.00 | ||||
| DIR UNINSURED CLAIMS | 127050000038 | 8/2/2011 | P | IW was lowering a car down, a frame machine and it slammed down crushing his left hand and amputating left index finger. **PAYING MONTHLY PPD INSTALLMENTS TO 12/11/2027 ONLY** | Caught; in, under, between, | $19,148.91 | $19,148.91 | $19,148.91 | $67,914.95 | $67,914.95 | $80,609.40 | $2,289.92 | $2,289.92 | $2,289.92 | $8.25 | $8.25 | $8.25 | $89,362.03 | $102,056.48 | $12,694.45 | |
| DIR UNINSURED CLAIMS | 127050000221 | 3/6/2012 | O | On 03/06/2012 iw was sweeping trash on 1st floor of building (with shovel), had debris go in R eye lacerating it. **OVS & EYE DROPS ONLY** | Misc; foreign matter (body) in eye(s) | $14,774.72 | $14,774.72 | $38,163.10 | $14,835.33 | $14,835.33 | $14,835.33 | $0.00 | $0.00 | $0.00 | $1,040.50 | $1,040.50 | $1,158.90 | $30,650.55 | $54,157.33 | $23,506.78 | |
| DIR UNINSURED CLAIMS | 137050000227 | 10/15/2013 | O | Slipped while pushing a car out of the shop. | Fall, slip or trip, | $22,430.48 | $22,430.48 | $27,029.66 | $62,676.44 | $62,676.44 | $62,900.67 | $1,700.70 | $1,700.70 | $4,387.00 | $8,358.40 | $8,358.40 | $12,510.00 | $95,166.02 | $106,827.33 | $11,661.31 | |
| DIR UNINSURED CLAIMS | 147050000066 | 12/17/2013 | R | IW WAS UNLOADING MOBILE HOME AXLES OFF A TRAILER AND HURT HIS LOW BACK. | Strain; lifting | $111,774.83 | $111,774.83 | $139,620.06 | $76,316.35 | $76,316.35 | $97,544.24 | $17,523.38 | $17,523.38 | $17,523.38 | $2,557.15 | $2,557.15 | $4,019.00 | $208,171.71 | $258,706.68 | $50,534.97 | |
| DIR UNINSURED CLAIMS | 147050000180 | 6/30/2014 | O | IW WAS SETTING CONCRETE WALL AND THE BACKHOE BUCKE PINCHED HIS RIGHT ARM AGAINST THE CONCRETE WALL | |||||||||||||||||
| RN assigned 02/05/18 - MM | Caught; in, under, between, | $52,252.93 | $52,252.93 | $108,450.00 | $97,689.80 | $97,689.80 | $164,176.68 | $0.00 | $0.00 | $4,000.00 | $3,850.00 | $3,850.00 | $19,000.00 | $153,792.73 | $295,626.68 | $141,833.95 | |||||
| DIR UNINSURED CLAIMS | 157050000002 | 8/23/2014 | O | WHILE CLEANING FLOOR WITH MACHINE, STOPPED TO LOOK AT MACHINE AND HIT HIS HEAD **PPD PROCESS** | Injured by; struck or injured | $42,356.76 | $42,356.76 | $46,200.00 | $38,150.69 | $38,150.69 | $38,304.86 | $80.80 | $80.80 | $82.00 | $80,588.25 | $84,586.86 | $3,998.61 | ||||
| DIR UNINSURED CLAIMS | 157050000021 | 6/1/2015 | O | SHE WAS PREPARING TO EXIT HER EMPLOYER VAN WHEN ANOTHER MOTORIST BACKED INTO HER VEHICLE. | Vehicle; collide with other vehicle | $11,912.55 | $11,912.55 | $13,150.00 | $0.00 | $0.00 | $14,915.34 | $2,662.50 | $2,662.50 | $4,100.00 | $14,575.05 | $32,165.34 | $17,590.29 | ||||
| DIR UNINSURED CLAIMS | 157050000025 | 7/31/2014 | O | GETTING OFF ROOF OF A DOUBLE WIDE MOBILE HOME. | Fall, slip or trip, | $48,610.60 | $48,610.60 | $57,300.00 | $20,821.65 | $20,821.65 | $28,738.47 | $6,618.44 | $6,618.44 | $16,732.68 | $8,441.72 | $8,441.72 | $10,600.00 | $84,492.41 | $113,371.15 | $28,878.74 | |
| DIR UNINSURED CLAIMS | 167050000003 | 11/4/2015 | O | HE FELL ON THE RAMP WHEN HE WAS WALKING AND PUT HIS RIGHT HAND ON THE FLOOR. | Fall, slip or trip, | $9,488.36 | $9,488.36 | $12,250.00 | $6,699.54 | $6,699.54 | $8,677.68 | $9.55 | $9.55 | $9.55 | $16,197.45 | $20,937.23 | $4,739.78 | ||||
| DIR UNINSURED CLAIMS | 167050000011 | 7/15/2015 | O | A CO-WORKER HIT ME. I WAS BENT GRABBING A BOX WHEN SHE FELT A CO-WORKER HIT HER. | Injured by; Another Person | $1,458.59 | $1,458.59 | $2,555.00 | $22,430.83 | $22,430.83 | $22,430.83 | $224.55 | $224.55 | $254.55 | $24,113.97 | $25,240.38 | $1,126.41 | ||||
| DIR UNINSURED CLAIMS | 167050000029 | 8/8/2016 | O | WALKED TO FRIDGE TO PUT LUNCH IN AND SLIPPED ON WATER DUE TO WATER LEAK IN SINK. HIT HEAD. | Fall; from liquid or grease spills | $32,309.36 | $32,309.36 | $70,310.00 | $11,417.76 | $11,417.76 | $63,069.39 | $2,542.11 | $2,542.11 | $3,060.00 | $46,269.23 | $136,439.39 | $90,170.16 | ||||
| DIR UNINSURED CLAIMS | 167050000030 | 9/19/2016 | O | WHILE UNLOADING ITEMS INTO AN AREA THERE WERE 2 FORK LIFTS PRESENT AND THEY LIFTED A LOAD & ACCIDENTALLY DROPPED IT ON ME. | Injured by; struck or injured | $16,041.82 | $16,041.82 | $18,930.00 | $75,628.96 | $75,628.96 | $76,090.59 | $9.55 | $9.55 | $10.00 | $91,680.33 | $95,030.59 | $3,350.26 | ||||
| DIR UNINSURED CLAIMS | 177050000005 | 9/4/2014 | O | FELL 20 FT WHEN PART OF RIGGING FELL WHILE BEING DISASSEMBLED. IW at fault due to his miss-use of safety harness. | Fall; from different level/elevation | $126,169.71 | $126,169.71 | $177,400.00 | $140,324.03 | $140,324.03 | $232,585.37 | $20,258.08 | $20,258.08 | $106,834.40 | $9.50 | $9.50 | $6,800.00 | $286,761.32 | $523,619.77 | $236,858.45 | |
| DIR UNINSURED CLAIMS | 177050000012 | 11/2/2016 | O | TEARING DOWN A PALAPA COVER (GAZEBO OVER A SPA) IN A CLIENT'S BACKYARD WHEN IT COLLAPSED ON TOP OF HIM. | |||||||||||||||||
| CLOSED TO TCM 05/09/18 - RN MM | Strike; object being lifted or handled | $14,892.44 | $14,892.44 | $23,050.00 | $18,805.54 | $18,805.54 | $52,285.03 | $29,394.40 | $29,394.40 | $32,277.56 | $3,376.10 | $3,376.10 | $9,210.00 | $66,468.48 | $116,822.59 | $50,354.11 | |||||
| DIR UNINSURED CLAIMS | 177050000015 | 3/9/2017 | O | HE WAS CUTTING SOME WOOD WITH A SAW AND CUT HIS FINGERS. | Cut; powered hand tool, appliance | $6,363.33 | $6,363.33 | $7,960.00 | $1,602.93 | $1,602.93 | $8,083.10 | $9.50 | $9.50 | $10.00 | $7,975.76 | $16,053.10 | $8,077.34 | ||||
| DIR UNINSURED CLAIMS | 177050000020 | 4/27/2017 | O | RETURNING FROM DELIVERING A LOAD, HE WAS PUNCHED, SHOVED AND KICKED BY THE CO-OWNER. | Injured by; Another Person | $2,124.31 | $2,124.31 | $15,600.00 | $81,075.71 | $81,075.71 | $82,576.09 | $9.50 | $9.50 | $510.00 | $83,209.52 | $98,686.09 | $15,476.57 | ||||
| DIR UNINSURED CLAIMS | 177050000023 | 5/16/2017 | O | CLIMBED LADDER TO RELEASE SNAGGED WIRE. WAS AT TOP OF LADDER FOR A FEW MINUTES WHEN LADDER SLIPPED AND HE FELL WITH THE LADDER AND LANDED ON IT. | Fall; from ladder or scaffolding | $33,764.86 | $33,764.86 | $39,330.00 | $29,936.47 | $29,936.47 | $55,296.29 | $45.60 | $45.60 | $200.00 | $63,746.93 | $94,826.29 | $31,079.36 | ||||
| DIR UNINSURED CLAIMS | 177050000027 | 9/17/2016 | O | SLIPPED AND FELL ON A WET FLOOR AT THE NAIL SALON. | Fall; from liquid or grease spills | $2,658.65 | $2,658.65 | $17,640.00 | $11,424.04 | $11,424.04 | $14,337.31 | $9.50 | $9.50 | $10.00 | $14,092.19 | $31,987.31 | $17,895.12 | ||||
| DIR UNINSURED CLAIMS | 177050000029 | 7/29/2017 | R | GOT INTO FIGHT WITH INTOXICATED CUSTOMER. | Injured by; Another Person | $8,977.34 | $8,977.34 | $8,977.34 | $0.00 | $0.00 | $0.00 | $8,977.34 | $8,977.34 | $0.00 | |||||||
| DIR UNINSURED CLAIMS | 177050000031 | 7/24/2017 | O | DRIVING ON FREEWAY, TRACTOR/TRAILER COMBO HE WAS DRIVING HAD A LEFT FRONT TIRE BLOWOUT RESULTING IN THE VEHICLE ROLLING OVER ONTO ITS LEFT SIDE. | Vehicle; motor vehicle | $10,957.27 | $10,957.27 | $19,380.00 | $81,705.47 | $81,705.47 | $90,922.72 | $13,567.40 | $13,567.40 | $59,672.15 | $10.15 | $10.15 | $10.15 | $106,240.29 | $169,985.02 | $63,744.73 | |
| DIR UNINSURED CLAIMS | 187050000003 | 7/19/2017 | O | HE WAS INJURED IN AN AUTO ACCIDENT ON HIGHWAY I-90 IN SILVER BOW, MONTANA. | Vehicle; motor vehicle | $0.00 | $0.00 | $5,200.00 | $0.00 | $0.00 | $11.00 | $0.00 | $5,211.00 | $5,211.00 | |||||||
| DIR UNINSURED CLAIMS | 187050000004 | 2/9/2018 | O | LOADING STEEL FRAME SLIPPED AND CRUSHED BOTH ARM/HANDS. | Injured by; struck or injured | $14,147.31 | $14,147.31 | $24,920.00 | $17,676.08 | $17,676.08 | $49,916.15 | $10.15 | $10.15 | $10.50 | $31,833.54 | $74,846.65 | $43,013.11 | ||||
| DIR UNINSURED CLAIMS | 187050000008 | 3/7/2018 | R | WENT TO GO THROW TRASH CAN AND HE SLIPPED BECAUSE HE STEPPED ON OIL. HE SLIPPED AND FELL ON BACK. | Fall, slip or trip, | $0.00 | $0.00 | $0.00 | $10.15 | $10.15 | $10.15 | $10.15 | $10.15 | $0.00 | |||||||
| DIR UNINSURED CLAIMS | 187050000012 | 12/23/2017 | O | THERE WAS A FIGHT NEXT DOOR TO WHERE HE WAS WORKING WITH OTHER SECURITY GUARDS. MEN CAME BACK AND FIRED SHOTS. | Misc; person in act of crime | $17,743.82 | $17,743.82 | $80,160.00 | $10,219.94 | $10,219.94 | $22,989.50 | $0.00 | $0.00 | $11.00 | $27,963.76 | $103,160.50 | $75,196.74 | ||||
| DIR UNINSURED CLAIMS | 187050000013 | 7/28/2018 | O | FELL ON AN UNEVEN WALKWAY OF A HOUSE. | Fall, slip or trip, | $4,018.36 | $4,018.36 | $21,170.00 | $5,297.10 | $5,297.10 | $30,408.45 | $2,637.55 | $2,637.55 | $7,400.00 | $11,953.01 | $58,978.45 | $47,025.44 | ||||
| DIR UNINSURED CLAIMS | 187050000014 | 6/13/2018 | O | HE WAS SLEEPING AT THE SLEEPER. THE DRIVER SAID THE RIGHT PASSENGER TIRE BLEW-OUT & HE CAN NOT CONTROL IT. | Injured by; motor vehicle | $71,966.25 | $71,966.25 | $132,320.00 | $0.00 | $0.00 | $55,876.49 | $0.00 | $0.00 | $12.00 | $71,966.25 | $188,208.49 | $116,242.24 | ||||
| DIR UNINSURED CLAIMS | 187050000015 | 7/24/2018 | O | HOLDING KNIFE WHILE CLEANING SHRIMP-RAIN FROM CEILING DRIPPED INTO ELECTRICAL SWITCH, SHOCKED HAPPENED CAME UP HER RIGHT ARM FROM THE KNIFE. | Injured by; struck or injured | $1,542.64 | $1,542.64 | $5,200.00 | $0.00 | $0.00 | $11.00 | $1,542.64 | $5,211.00 | $3,668.36 | |||||||
| DIR UNINSURED CLAIMS | 187050000016 | 9/1/2018 | O | SHE ARRIVED AT WORK 2PM, SHE WAS ASKED BY A CO-WORKER TO SHARPEN A KNIFE SHE NEEDED, THE KNIFE SLIPPED FROM THE SHARPENER. | Cut; hand tool, utensil, not powered | $344.72 | $344.72 | $6,440.00 | $1,130.65 | $1,130.65 | $1,610.28 | $1,475.37 | $8,050.28 | $6,574.91 | |||||||
| DIR UNINSURED CLAIMS | 190394UEF | 9/17/2001 | O | Death Claim. **BENEFICIARY BENEFITS** | Burn; contact | $44,874.05 | $44,874.05 | $44,877.05 | $213,714.88 | $213,714.88 | $229,880.16 | $548.56 | $548.56 | $551.56 | $259,137.49 | $275,308.77 | $16,171.28 | ||||
| DIR UNINSURED CLAIMS | 190485UEF | 9/17/2001 | O | Emergency ph # 775-782-5363 Alicia Rubio (cousin.) **PPD MONTHLY INSTALLMENTS UP TO 9/19/2045** | Misc; other - miscellaneous, | $137,881.49 | $137,881.49 | $137,881.49 | $117,549.12 | $117,549.12 | $163,630.47 | $2,283.53 | $2,283.53 | $2,283.53 | $4,409.58 | $4,409.58 | $4,409.58 | $262,123.72 | $308,205.07 | $46,081.35 | |
| DIR UNINSURED CLAIMS | 197050000002 | 10/24/2018 | O | LOADING TRUCK WITH GRASS. HE FELL FROM THE TRUCK ON HIS BOTTOM AND HIT HIS HEAD ON THE FLOOR. | Fall, slip or trip, | $0.00 | $0.00 | $5,800.00 | $10.50 | $10.50 | $211.00 | $10.50 | $6,011.00 | $6,000.50 | |||||||
| DIR UNINSURED CLAIMS | 197050000003 | 10/21/2017 | O | HE WAS LOOKING THROUGH A PLASTIC TANK CHECKING TEST RESULTS WHEN THE TANK EXPLODED. | Burn; Chemicals | $0.00 | $0.00 | $0.00 | $10.50 | $10.50 | $11.00 | $10.50 | $11.00 | $0.50 | |||||||
| DIR UNINSURED CLAIMS | 197050000004 | 12/17/2018 | O | ON THE SECOND FLOOR WHEN THE LADDER SLID OFF THE ROOF AND HE FELL OFF. HITTING HIS FACE ON THE LADDER THEN HIS FOOT AND BACK HURT. | Fall; from ladder or scaffolding | $0.00 | $0.00 | $200.00 | $0.00 | $200.00 | $200.00 | ||||||||||
| DIR UNINSURED CLAIMS | 197050000005 | 1/12/2019 | O | SHE WAS TOLD TO GET THE DOG FROM HIS KENNEL FOR A PICTURE OF HIM. OUT NOWHERE HE MAULED HER, KNOCKED HER DOWN 4 TIMES CONTINUOUSLY ATTACKING HER. | Injured by; animal or insect | $0.00 | $0.00 | $4,200.00 | $0.00 | $0.00 | $11.50 | $0.00 | $4,211.50 | $4,211.50 | |||||||
| DIR UNINSURED CLAIMS | 197050000006 | 1/24/2019 | O | HE WAS WELDING WHEN THE METAL HIT HIS LEFT EYE | Misc; foreign matter (body) in eye(s) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $11.00 | $0.00 | $11.00 | $11.00 | |||||||
| DIR UNINSURED CLAIMS | 197050000007 | 12/8/2018 | O | HE WAS PUSHING A REFRIGERATOR FROM THE TRUCK TO UNLOAD IT WHEN IT CAME BACK DOWN ON HIS ANKLE | Caught; in, under, between, | $0.00 | $0.00 | $11,960.00 | $7,679.28 | $7,679.28 | $15,358.56 | $0.00 | $0.00 | $11.00 | $7,679.28 | $27,329.56 | $19,650.28 | ||||
| DIR UNINSURED CLAIMS | 197050000008 | 2/16/2019 | O | VIOLENT ATTACK BY UNKNOWN PERSON | Injured by; Another Person | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $12.00 | $0.00 | $12.00 | $12.00 | |||||||
| DIR UNINSURED CLAIMS | 197050000009 | 1/1/2019 | O | HE WAS CARRYING BOXES THAT CONTAINED APPLIANCES | Strain; lifting | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $12.00 | $0.00 | $12.00 | $12.00 | |||||||
| DIR UNINSURED CLAIMS | 197050000010 | 2/12/2019 | P | DRIVING RUNNING ERRANDS FOR COMPANY. SHE WAS GOING WESTWARD ON SAHARA WHEN A TOYOTA TUNDRA TURNED LEFT IN FRONT OF HER AND CRASHED HEAD ON. | Vehicle; collide with other vehicle | $0.00 | $0.00 | $0.00 | |||||||||||||
| DIR UNINSURED CLAIMS | 197050000011 | 3/28/2019 | P | PATROLLING PARKING LOT, STEPPED OFF WALKWAY, TOOK A BAD STEP AND SLIPPED OFF PARKING CURB. | Fall, slip or trip, | $0.00 | $0.00 | $0.00 | |||||||||||||
| DIR UNINSURED CLAIMS | 810168814UEF | 1/27/1981 | O | HEAD INJURY, DEATH CLAIM. **WIDOW/BENEFICIARY BENEFITS - JOYCE NEWTON** | Misc; person in act of crime | $30,799.89 | $30,799.89 | $30,799.89 | $183,865.68 | $183,865.68 | $342,665.55 | $214,665.57 | $373,465.44 | $158,799.87 | |||||||
| DIR UNINSURED CLAIMS | 830227787UEF | 6/21/1983 | O | Amputation. **PPD ANNUAL INSTALLMENTS UP TO 04/25/2031** | Caught; in, under, between, | $17,841.60 | $17,841.60 | $28,546.56 | $17,841.60 | $28,546.56 | $10,704.96 | ||||||||||
| DIR UNINSURED CLAIMS | 860690102UEF | 1/1/1986 | O | Injured lower back | Injured by; moving parts of machine | $10,895.12 | $10,895.12 | $27,056.03 | $260,427.03 | $260,427.03 | $276,544.27 | $2,586.15 | $2,586.15 | $9,385.50 | $273,908.30 | $312,985.80 | $39,077.50 | ||||
| DIR UNINSURED CLAIMS | 880913150UEF | 6/27/1988 | R | Amputation. **ANNUAL PPD INSTALLMENTS UNTIL 2/13/2037** | Caught; in, under, between, | $4,270.44 | $4,270.44 | $8,268.00 | $0.00 | $0.00 | $0.00 | $4,270.44 | $8,268.00 | $3,997.56 | |||||||
| DIR UNINSURED CLAIMS | 890673873UEF | 11/11/1988 | O | fall | Passed Out | $21,586.44 | $21,586.44 | $57,500.00 | $302,780.98 | $302,780.98 | $463,337.55 | $1,957.22 | $1,957.22 | $3,800.00 | $326,324.64 | $524,637.55 | $198,312.91 | ||||
| DIR UNINSURED CLAIMS | 900735816UEF | 10/15/1989 | O | **MONTHLY PPD INSTALLMENTS TO 10/14/2035** | Caught; in, under, between, | $25,620.75 | $25,620.75 | $43,726.08 | $25,620.75 | $43,726.08 | $18,105.33 | ||||||||||
| DIR UNINSURED CLAIMS | 910971060UEF | 5/26/1991 | O | **PPD MONTHLY INSTALLMENTS UNTIL 4/22/2029** | Burn; fire or flame | $0.00 | $0.00 | $0.00 | $53,467.20 | $53,467.20 | $73,015.04 | $0.00 | $0.00 | $0.00 | $4.75 | $4.75 | $9.50 | $53,471.95 | $73,024.54 | $19,552.59 | |
| DIR UNINSURED CLAIMS | 920724285UE | 12/22/1991 | O | GUN SHOT WOUND TO BRAIN IW'S HOME PHONE NUMBER: 702-413-1281 | Misc; person in act of crime | $809,435.42 | $809,435.42 | $986,062.66 | $106,824.24 | $106,824.24 | $174,871.45 | $350.00 | $350.00 | $350.00 | $1,369.94 | $1,369.94 | $11,066.67 | $917,979.60 | $1,172,350.78 | $254,371.18 | |
| DIR UNINSURED CLAIMS | 930794094UEF | 2/16/1993 | O | MVA multiple injuries. 26%PPD. **PPD ANNUAL INSTALLMENTS UNTIL 3/30/2034** | Misc; other - miscellaneous, | $3,884.16 | $3,884.16 | $5,894.88 | $3,884.16 | $5,894.88 | $2,010.72 | ||||||||||
| DIR UNINSURED CLAIMS | 960255353UEF | 12/1/1995 | R | Paralysis - | |||||||||||||||||
| Misc; other - miscellaneous, | $1,295,944.25 | $1,295,944.25 | $1,301,697.59 | $336,264.51 | $336,264.51 | $336,264.51 | $0.00 | $0.00 | $0.00 | $40,472.16 | $40,472.16 | $42,272.16 | $1,672,680.92 | $1,680,234.26 | $7,553.34 | ||||||
| DIR UNINSURED CLAIMS | 970379193UEF | 2/27/1997 | O | Death. **WIDOW/BENEFICIARY BENEFITS - ANNA HOLLAND** | Passed Out | $23,093.44 | $23,093.44 | $23,093.44 | $142,890.66 | $142,890.66 | $319,301.40 | $165,984.10 | $342,394.84 | $176,410.74 | |||||||
| DIR UNINSURED CLAIMS | 980346970UEF | 12/2/1997 | O | POST OP X 4 FUSIONS TO LUMBAR SPINE. **PTD, OFFICE VISITS, RXS, IN ARIZONA** | Injured by; object being lifted/handled | $411,663.64 | $411,663.64 | $412,717.72 | $508,195.08 | $508,195.08 | $834,647.70 | $5,388.64 | $5,388.64 | $5,388.64 | $8,025.70 | $8,025.70 | $8,652.02 | $933,273.06 | $1,261,406.08 | $328,133.02 | |
| DIR UNINSURED CLAIMS | UE01-90388 | 9/17/2001 | O | **PPD MONTHLY INSTALLMENTS UNTIL 8/9/2043.** | Injured by; explosion or flare back | $303,212.19 | $303,212.19 | $303,212.19 | $167,844.51 | $167,844.51 | $303,712.24 | $701.93 | $701.93 | $701.93 | $5,982.02 | $5,982.02 | $5,982.02 | $477,740.65 | $613,608.38 | $135,867.73 | |
| DIR UNINSURED CLAIMS | UE03-00022 | 7/29/2003 | O | A 10-12LB TARP APPARATIS CAM LOOSE FELL 10 FEET HIT EMPLOYEE IN HEAD. | Injured by; falling or flying object | $43,553.69 | $43,553.69 | $43,553.69 | $422,590.69 | $422,590.69 | $1,115,236.51 | $17,344.77 | $17,344.77 | $17,344.77 | $12,678.33 | $12,678.33 | $12,678.33 | $496,167.48 | $1,188,813.30 | $692,645.82 | |
| DIR UNINSURED CLAIMS | UE05-00014 | 1/30/2005 | O | Moving office furniture. **ANNUAL PPD INSTALLMENTS TO 11/23/2037** | Injured by; moving parts of machine | $82,810.32 | $82,810.32 | $82,810.32 | $72,365.68 | $72,365.68 | $78,085.55 | $1,918.56 | $1,918.56 | $1,918.56 | $157,094.56 | $162,814.43 | $5,719.87 | ||||
| DIR UNINSURED CLAIMS | UE06-00002 | 12/12/2005 | R | Driving a truck.While driving a truck Mr. Posada lost control of the truck and it rolled over. Diagnosis; multiple fractures to the legs/arms. **ANNUAL PPD INSTALLMENTS UNTIL 6/5/2042.** | Vehicle; motor vehicle | $85,812.30 | $85,812.30 | $85,812.30 | $156,037.32 | $156,037.32 | $176,213.88 | $3,559.92 | $3,559.92 | $3,559.92 | $1,611.14 | $1,611.14 | $1,611.14 | $247,020.68 | $267,197.24 | $20,176.56 |
File details come from the government source that posted it. Updated .