DIR CLAIMS ACTIVITY REDACTED.xlsx
XLSX spreadsheet 240 KB Posted
- Solicitation number
- 74BAI-S1476
- Issued by
- Churchill County, Nevada
About this file
This document appears to be a spreadsheet containing information about open workers' compensation claims or those that were open during the period of July 1, 2011 to December 31, 2011 for the State of Nevada. The contract opportunity referenced is for Workers' Compensation Uninsured Claims Administration services for Clark County and the City of Las Vegas. The contract term and any renewal options are not specified. The spreadsheet provides details on each claim, including the loss date, claim status, loss type, cause of loss, body part affected, nature of loss, and amounts paid and incurred for medical, indemnity, rehabilitation, legal, and other costs. The total paid and total incurred amounts, as well as the total remaining reserve for each claim, are also included. No additional details are provided about the specific services requested, response dates, award dates, or pricing terms for the state and local contract opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| Open Claims Cost Detail.pdf | ||
| Quote Instructions.pdf | ||
| Closed Claims Cost Detail.pdf | ||
| Copy of 06-2019 Loss Run - SNA.xlsx | XLSX spreadsheet | |
| Proposed Staff Resume - 04-05-17.doc | DOC document | |
| RFP 74BAI-S1476 Final 1~1.docx | DOCX document | |
| Reference Questionnaire - 01-24-20.doc | DOC document | |
| Attachment G - Cost Schedule.docx | DOCX document | |
| LetterOfIntent - RFP 74BAI-S1476.pdf | ||
| Standard Form Contract .docx | DOCX document | |
| Attachment D - Insurance Schedule.docx | DOCX document |
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Text version
| OPEN CLAIMS OR CLOSED BUT WERE OPEN IN THE PERIOD OF 7/1/2011 - 12/31/2011 | ||||||||||||||||||||||
| Claim No | Loss Date | Claim Status | Last Closed | Loss Type Descr | Loss Cause Descr | Body Part Descr | Loss Nature Descr | Med Paid | Med Incurred | Ind Paid | Ind Incurred | Rhb Paid | Rhb Incurred | Leg Paid | Leg Incurred | Oth Paid | Oth Incurred | Asof Paid | Tot Paid | Tot Incr | Tot Rsv | Asof Recovered |
| 810168814UEF | 1/27/1981 | O | Death Claim | Misc; person in act of crime | Multiple head injury | All Other NOS | $30,799.89 | $30,799.89 | $98,932.65 | $342,665.55 | $129,732.54 | $129,732.54 | $373,465.44 | $243,732.90 | $0.00 | |||||||
| UE01-69611 | 6/1/1983 | R | 6/6/2007 | Medical only | Passed Out | Multiple neck injury | Laceration | $6,411.47 | $9,176.30 | $217.00 | $217.00 | $6,628.47 | $6,628.47 | $9,393.30 | $2,764.83 | $0.00 | ||||||
| 830227787UEF | 6/21/1983 | O | Permanent Partial-Major >25% | Caught; in, under, between, | Hand(s) | Amputation | $11,597.04 | $28,546.56 | $11,597.04 | $11,597.04 | $28,546.56 | $16,949.52 | $0.00 | |||||||||
| 860690102UEF | 1/1/1986 | O | Permanent total disability | Injured by; moving parts of machine | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $7,256.03 | $7,256.03 | $155,441.45 | $276,544.27 | $1,206.50 | $6,800.00 | $1,292.75 | $2,585.50 | $165,196.73 | $165,196.73 | $293,185.80 | $127,989.07 | $0.00 | |||
| 870628331UEF | 1/21/1986 | O | Permanent total disability | Burn; electrical current | Upper arm(s) | Strain | $98,517.74 | $279,353.08 | $126,049.28 | $323,590.65 | $1,983.30 | $3,800.00 | $0.00 | $0.00 | $226,550.32 | $226,550.32 | $606,743.73 | $380,193.41 | $0.00 | |||
| 880307648UEF | 5/8/1988 | O | Death Claim | Strike; against or stepping on | Body system and Mult. Body systems | All Other NOS | $219,497.88 | $333,687.74 | $219,497.88 | $219,497.88 | $333,687.74 | $114,189.86 | $0.00 | |||||||||
| 880913150UEF | 6/27/1988 | R | 7/30/2004 | Permanent Partial-Major >25% | Caught; in, under, between, | Finger(s) | Amputation | $2,472.36 | $8,268.00 | $0.00 | $0.00 | $2,472.36 | $2,472.36 | $8,268.00 | $5,795.64 | $0.00 | ||||||
| 890673873UEF | 11/11/1988 | O | Permanent total disability | Passed Out | Multiple head injury | Multple injuries (incl phys and psych) | $18,204.26 | $57,500.00 | $163,201.62 | $463,337.55 | $1,957.22 | $3,800.00 | $183,363.10 | $183,363.10 | $524,637.55 | $341,274.45 | $0.00 | |||||
| 900735816UEF | 10/15/1989 | O | Permanent Partial-Major >25% | Caught; in, under, between, | Multiple Lower Extremities | Fracture | $15,714.06 | $43,726.08 | $15,714.06 | $15,714.06 | $43,726.08 | $28,012.02 | $0.00 | |||||||||
| 910971060UEF | 5/26/1991 | O | Permanent partial | Burn; fire or flame | Multiple upper extremeties | Burn | $0.00 | $0.00 | $32,549.40 | $73,015.04 | $0.00 | $0.00 | $0.00 | $4.75 | $4.75 | $4.75 | $32,554.15 | $32,554.15 | $73,024.54 | $40,470.39 | $0.00 | |
| 920075339 | 9/13/1991 | C | 7/27/2011 | Other PPD not scheduled-Minor <25% | Fall; from different level/elevation | Multiple body parts | Sprain | $12,655.46 | $12,655.46 | $27,365.18 | $27,365.18 | $0.00 | $0.00 | $40,020.64 | $40,020.64 | $40,020.64 | $0.00 | $0.00 | ||||
| 920724285UE | 12/22/1991 | O | Permanent total disability | Misc; person in act of crime | Body system and Mult. Body systems | All Other NOS | $535,129.27 | $986,062.66 | $65,077.97 | $174,871.45 | $350.00 | $350.00 | $1,044.10 | $10,000.00 | $325.84 | $1,066.67 | $601,927.18 | $601,927.18 | $1,172,350.78 | $570,423.60 | $0.00 | |
| UE92-0886441 | 4/23/1992 | R | Permanent partial | Strain; lifting | Multiple neck injury | All Other NOS | $137,288.99 | $139,640.18 | $9,608.75 | $14,956.45 | $0.00 | $0.00 | $0.00 | $0.00 | $6,736.24 | $9,098.75 | $153,633.98 | $153,633.98 | $163,695.38 | $10,061.40 | $0.00 | |
| 920325722UEF | 6/18/1992 | O | Permanent Partial-Major >25% | Vehicle; motor vehicle | Vertebrae | Fracture | $12,572.75 | $41,647.92 | $0.00 | $0.00 | $12,572.75 | $12,572.75 | $41,647.92 | $29,075.17 | $0.00 | |||||||
| 930794094UEF | 2/16/1993 | O | Permanent Partial-Major >25% | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | All Other NOS | $2,913.12 | $5,894.88 | $2,913.12 | $2,913.12 | $5,894.88 | $2,981.76 | $0.00 | |||||||||
| 960155072UEF | 9/12/1995 | O | Permanent total disability | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $104,503.59 | $104,503.59 | $89,184.26 | $90,222.25 | $132,296.73 | $132,296.73 | $4,151.13 | $4,151.13 | $4,836.11 | $4,836.11 | $334,971.82 | $334,971.82 | $336,009.81 | $1,037.99 | $0.00 | |
| 960255353UEF | 12/1/1995 | O | Permanent total disability | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Fracture | $337,322.66 | $646,236.33 | $211,675.70 | $495,377.93 | $0.00 | $0.00 | $3,285.46 | $9,500.00 | $32,138.77 | $48,830.21 | $584,422.59 | $584,422.59 | $1,199,944.47 | $615,521.88 | $2,083.97 | |
| 960574373UEF | 5/4/1996 | R | 6/22/2010 | Permanent Partial-Major >25% | Vehicle; motor vehicle | Lower back area (inc. Lumb./Lumb.-Sac.) | Multple injuries (incl phys and psych) | $309,603.04 | $326,508.61 | $141,779.83 | $227,804.28 | $1,726.27 | $1,726.27 | $7,075.95 | $40,540.11 | $26,710.81 | $27,000.00 | $486,895.90 | $486,895.90 | $623,579.27 | $136,683.37 | $0.00 |
| 970379193UEF | 2/27/1997 | O | Death Claim | Passed Out | Multiple head injury | All Other NOS | $23,093.44 | $23,093.44 | $77,940.36 | $319,301.40 | $101,033.80 | $101,033.80 | $342,394.84 | $241,361.04 | $0.00 | |||||||
| 980346970UEF | 12/2/1997 | O | Permanent total disability | Injured by; object being lifted/handled | Vertebrae | Strain | $354,617.90 | $412,717.72 | $304,687.26 | $834,647.70 | $5,388.64 | $5,388.64 | $7,622.27 | $7,622.27 | $0.00 | $0.00 | $672,316.07 | $672,316.07 | $1,260,376.33 | $588,060.26 | $0.00 | |
| 980421879UEF | 3/25/1998 | O | Permanent total disability | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Strain | $102,447.03 | $187,500.00 | $111,300.57 | $546,790.88 | $16,117.89 | $32,500.00 | $0.00 | $0.00 | $229,865.49 | $229,865.49 | $766,790.88 | $536,925.39 | $5,736.08 | |||
| 980457165UEF | 5/8/1998 | C | 11/9/2011 | Permanent partial | Strike; against or stepping on | Eye(s) | Rupture | $559.91 | $559.91 | $2,173.20 | $2,173.20 | $69,394.72 | $69,394.72 | $4,564.63 | $4,564.63 | $76,692.46 | $76,692.46 | $76,692.46 | $0.00 | $0.00 | ||
| 117050000191 | 3/17/1999 | O | Permanent total disability | Fall; from different level/elevation | Upper back area (Thoracic area) | Fracture | $100,731.18 | $121,420.81 | $1,236.06 | $1,236.06 | $7.90 | $5,000.00 | $101,975.14 | $101,975.14 | $127,656.87 | $25,681.73 | $0.00 | |||||
| 99-0423015 | 5/29/1999 | O | Permanent partial | Injured by; falling or flying object | Upper arm(s) | All Other NOS | $1,128.25 | $1,128.25 | $4,328.64 | $16,355.08 | $5,456.89 | $5,456.89 | $17,483.33 | $12,026.44 | $0.00 | |||||||
| 178270UEF | 11/10/2000 | O | Permanent partial | Cut; caught, punctured, scraped, | Finger(s) | Amputation | $10,390.03 | $10,390.03 | $49,163.30 | $49,568.30 | $19,873.97 | $19,873.97 | $0.00 | $0.00 | $79,427.30 | $79,427.30 | $79,832.30 | $405.00 | $0.00 | |||
| 186996UEF | 5/6/2001 | C | 11/29/2011 | Permanent partial | Strain; lifting | Shoulder(s) | Strain | $6,347.91 | $6,347.91 | $4,062.80 | $4,062.80 | $1,266.94 | $1,266.94 | $11,677.65 | $11,677.65 | $11,677.65 | $0.00 | $0.00 | ||||
| 190394UEF | 9/17/2001 | O | Death Claim | Burn; contact | Body system and Mult. Body systems | Burn | $44,874.05 | $44,877.05 | $127,010.16 | $185,646.06 | $548.56 | $551.56 | $172,432.77 | $172,432.77 | $231,074.67 | $58,641.90 | $0.00 | |||||
| 190485UEF | 9/17/2001 | O | Permanent Partial-Major >25% | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Burn | $137,881.49 | $137,881.49 | $104,383.02 | $163,630.47 | $2,283.53 | $2,283.53 | $3,980.72 | $3,980.72 | $428.86 | $428.86 | $248,957.62 | $248,957.62 | $308,205.07 | $59,247.45 | $0.00 | |
| UE01-90388 | 9/17/2001 | O | Permanent Partial-Major >25% | Injured by; explosion or flare back | Multiple upper extremeties | Burn | $303,212.19 | $303,212.19 | $125,576.02 | $303,712.24 | $701.93 | $701.93 | $0.00 | $0.00 | $5,982.02 | $5,982.02 | $435,472.16 | $435,472.16 | $613,608.38 | $178,136.22 | $0.00 | |
| UE01-96717 | 1/3/2002 | O | Other PPD not scheduled-Minor <25% | Strain; lifting | Upper back area (Thoracic area) | Strain | $33,694.44 | $37,357.72 | $96,284.12 | $110,539.02 | $15,545.85 | $15,545.85 | $589.06 | $8,903.80 | $429.68 | $859.04 | $146,543.15 | $146,543.15 | $173,205.43 | $26,662.28 | $0.00 | |
| UE01-98382 | 2/13/2002 | R | 6/10/2008 | Permanent partial | Strain; lifting | Multiple upper extremeties | Strain | $116,657.10 | $117,920.24 | $17,450.40 | $17,450.40 | $16,423.00 | $16,423.00 | $2,296.00 | $3,796.00 | $3,650.40 | $3,650.40 | $156,476.90 | $156,476.90 | $159,240.04 | $2,763.14 | $0.00 |
| UE03-00028 | 3/3/2002 | O | Permanent partial | Strike; against or stepping on | Knee(s) | Infection | $3,597.09 | $3,597.09 | $7,930.51 | $17,350.20 | $0.00 | $0.00 | $0.00 | $0.00 | $526.70 | $526.70 | $12,054.30 | $12,054.30 | $21,473.99 | $9,419.69 | $0.00 | |
| 207493UEA | 10/25/2002 | C | 12/6/2011 | Permanent Partial-Major >25% | Burn; electrical current | Multiple upper extremeties | Burn | $83,982.94 | $83,982.94 | $45,312.44 | $45,312.44 | $9,926.46 | $9,926.46 | $2,183.85 | $2,183.85 | $2,183.71 | $2,183.71 | $143,589.40 | $143,589.40 | $143,589.40 | $0.00 | $0.00 |
| UE03-00029 | 1/13/2003 | R | 1/5/2005 | Permanent Partial-Major >25% | Strain; pushing or pulling | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $55,791.50 | $55,791.50 | $73,337.45 | $86,721.44 | $13,546.12 | $13,546.12 | $0.00 | $0.00 | $172.48 | $172.48 | $142,847.55 | $142,847.55 | $156,231.54 | $13,383.99 | $0.00 |
| UE04-00036 | 4/11/2003 | O | Permanent Partial-Major >25% | Cut; caught, punctured, scraped, | Finger(s) | VDT - related disease | $3,573.26 | $3,573.26 | $144,415.32 | $260,292.94 | $36,055.47 | $36,055.47 | $230.35 | $230.35 | $184,274.40 | $184,274.40 | $300,152.02 | $115,877.62 | $0.00 | |||
| UE03-00022 | 7/29/2003 | O | Permanent total disability | Injured by; falling or flying object | Multiple head injury | All Other NOS | $43,553.69 | $191,296.49 | $226,966.69 | $1,115,236.51 | $17,344.77 | $17,344.77 | $1,374.00 | $13,973.99 | $11,304.33 | $12,000.00 | $300,543.48 | $300,543.48 | $1,349,851.76 | $1,049,308.28 | $113,937.64 | |
| UE04-00040 | 10/28/2003 | C | 10/27/2011 | Temporary total disability | Passed Out | Multiple upper extremeties | VDT - related disease | $18,098.88 | $18,098.88 | $30,029.47 | $30,029.47 | $6,008.00 | $6,008.00 | $0.00 | $0.00 | $266.00 | $266.00 | $54,402.35 | $54,402.35 | $54,402.35 | $0.00 | $0.00 |
| UE04-00025 | 2/15/2004 | R | 11/9/2006 | Permanent partial | Injured by; Another Person | Facial bones | Fracture | $17,853.69 | $22,506.08 | $0.00 | $0.00 | $110.00 | $5,501.32 | $5.50 | $750.00 | $17,969.19 | $17,969.19 | $28,757.40 | $10,788.21 | $0.00 | ||
| 077050000062 | 9/20/2004 | O | Permanent partial | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $24,854.41 | $34,730.22 | $29,204.54 | $45,952.42 | $0.00 | $0.00 | $431.50 | $800.00 | $3,008.67 | $3,082.86 | $57,499.12 | $57,499.12 | $84,565.50 | $27,066.38 | $0.00 | |
| UE05-00014 | 1/30/2005 | O | Permanent partial | Injured by; moving parts of machine | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $82,810.32 | $82,810.32 | $69,760.24 | $78,085.55 | $0.00 | $0.00 | $1,918.56 | $1,918.56 | $154,489.12 | $154,489.12 | $162,814.43 | $8,325.31 | $0.00 | |||
| UE05-00060 | 9/9/2005 | O | Permanent Partial-Major >25% | Injured by; object being lifted/handled | Upper arm(s) | Amputation | $207,832.89 | $362,680.74 | $195,322.36 | $951,231.50 | $0.00 | $0.00 | $0.00 | $1,000.00 | $6,975.95 | $10,000.00 | $410,131.20 | $410,131.20 | $1,324,912.24 | $914,781.04 | $0.00 | |
| UE06-00002 | 12/12/2005 | R | 5/29/2007 | Permanent Partial-Major >25% | Vehicle; motor vehicle | Multiple upper extremeties | Multiple physical injuries only | $85,812.30 | $85,812.30 | $149,023.56 | $176,213.88 | $3,559.92 | $3,559.92 | $1,611.14 | $1,611.14 | $240,006.92 | $240,006.92 | $267,197.24 | $27,190.32 | $813.01 | ||
| UE06-00033 | 3/20/2006 | O | Permanent partial | Fall, slip or trip, | Multiple upper extremeties | Strain | $28,113.47 | $34,005.16 | $21,619.62 | $33,500.00 | $6,149.60 | $15,861.60 | $0.00 | $1,600.00 | $2,227.05 | $3,219.80 | $58,109.74 | $58,109.74 | $88,186.56 | $30,076.82 | $0.00 | |
| 087050000037 | 1/28/2007 | C | 11/30/2011 | Other PPD not scheduled-Minor <25% | Injured by; falling or flying object | Multiple body parts | Sprain | $6,855.46 | $6,855.46 | $20,346.19 | $20,346.19 | $6.85 | $6.85 | $27,208.50 | $27,208.50 | $27,208.50 | $0.00 | $0.00 | ||||
| 077050000077 | 5/10/2007 | O | Permanent partial | Strike; object being lifted or handled | Multiple head injury | Head Trauma | $11,041.19 | $14,541.19 | $0.00 | $16,298.74 | $1,435.75 | $1,435.75 | $12,476.94 | $12,476.94 | $32,275.68 | $19,798.74 | $0.00 | |||||
| 087050000085 | 11/26/2007 | O | 5/23/2008 | Temporary total disability | Strain; lifting | Multiple upper extremeties | Strain | $276.72 | $400.00 | $52,356.68 | $52,356.68 | $0.00 | $0.00 | $6.50 | $6.50 | $52,639.90 | $52,639.90 | $52,763.18 | $123.28 | $0.00 | ||
| 107050000187 | 3/15/2008 | O | Permanent partial | Fall; from different level/elevation | Multiple body parts | Multple injuries (incl phys and psych) | $5,668.30 | $6,673.00 | $0.00 | $7,500.00 | $7.25 | $20.00 | $5,675.55 | $5,675.55 | $14,193.00 | $8,517.45 | $0.00 | |||||
| 097050000096 | 6/3/2008 | O | Temporary total disability | Strain; lifting | Knee (left) | Strain | $250.00 | $27,000.00 | $17,385.95 | $24,470.69 | $880.84 | $2,500.00 | $18,516.79 | $18,516.79 | $53,970.69 | $35,453.90 | $0.00 | |||||
| 117050000201 | 9/18/2008 | O | Permanent partial | Injured by; falling or flying object | Multiple body parts | Multiple physical injuries only | $0.00 | $50,000.00 | $575.20 | $47,903.80 | $0.00 | $0.00 | $575.20 | $575.20 | $97,903.80 | $97,328.60 | $0.00 | |||||
| 097050000161 | 11/5/2008 | C | 7/11/2011 | Permanent partial | Strain; lifting | Multiple body parts | Multiple physical injuries only | $13,578.41 | $13,578.41 | $34,982.99 | $34,982.99 | $389.48 | $389.48 | $5,005.44 | $5,005.44 | $53,956.32 | $53,956.32 | $53,956.32 | $0.00 | $0.00 | ||
| 097050001163 | 1/6/2009 | C | 11/8/2011 | Permanent partial | Strike; moving parts of machine | Wrist and hand (left) | Fracture | $28,792.15 | $28,792.15 | $68,758.00 | $68,758.00 | $12,892.70 | $12,892.70 | $2,931.54 | $2,931.54 | $113,374.39 | $113,374.39 | $113,374.39 | $0.00 | $1,774.71 | ||
| 097050001403 | 2/5/2009 | O | Permanent partial | Strain; twisting | Foot (left) | Strain | $20,261.96 | $31,854.22 | $11,324.88 | $21,804.97 | $2,826.98 | $3,539.25 | $34,413.82 | $34,413.82 | $57,198.44 | $22,784.62 | $0.00 | |||||
| 097050001147 | 6/27/2009 | O | Permanent partial | Fall; from ladder or scaffolding | Ankle (right) | Fracture | $9,804.82 | $12,934.89 | $17,623.82 | $17,623.82 | $12,797.43 | $15,000.00 | $1,282.60 | $1,282.60 | $41,508.67 | $41,508.67 | $46,841.31 | $5,332.64 | $0.00 | |||
| 107050000366 | 7/25/2009 | C | 10/27/2011 | Temporary total disability | Injured by; motor vehicle | Lower back area (inc. Lumb./Lumb.-Sac.) | Multiple physical injuries only | $669.70 | $669.70 | $119.05 | $119.05 | $80.25 | $80.25 | $869.00 | $869.00 | $869.00 | $0.00 | $0.00 | ||||
| 107050000320 | 10/1/2009 | O | Medical only | Fall; from different level/elevation | Multiple body parts | Multiple physical injuries only | $3,189.22 | $6,500.00 | $20.15 | $100.00 | $3,209.37 | $3,209.37 | $6,600.00 | $3,390.63 | $0.00 | |||||||
| 107050000531 | 10/23/2009 | O | Temporary total disability | Fall, slip or trip, | Lower back area (inc. Lumb./Lumb.-Sac.) | PAIN | $7,379.62 | $8,200.00 | $15,158.26 | $35,940.60 | $0.00 | $0.00 | $2,679.53 | $3,500.00 | $25,217.41 | $25,217.41 | $47,640.60 | $22,423.19 | $0.00 | |||
| 107050000131 | 11/13/2009 | C | 9/29/2011 | Permanent partial | Fall; from ladder or scaffolding | Lower leg (right) | Fracture | $16,960.66 | $16,960.66 | $35,200.54 | $35,200.54 | $12,021.38 | $12,021.38 | $7.25 | $7.25 | $64,189.83 | $64,189.83 | $64,189.83 | $0.00 | $0.00 | ||
| 107050000884 | 12/15/2009 | O | Permanent partial | Fall, slip or trip, | Wrist (right) | Fracture | $19,430.20 | $35,605.34 | $7,620.48 | $27,180.59 | $876.28 | $15,000.00 | $10.25 | $3,007.25 | $27,937.21 | $27,937.21 | $80,793.18 | $52,855.97 | $0.00 | |||
| 117050000028 | 2/9/2010 | C | 10/27/2011 | Medical only | Climbing | Knee (left) | Sprain | $312.13 | $312.13 | $0.00 | $0.00 | $312.13 | $312.13 | $312.13 | $0.00 | $0.00 | ||||||
| 107050000443 | 3/13/2010 | O | Permanent partial | Injured by; struck or injured | Multiple body parts | Laceration | $9,353.07 | $22,247.22 | $573.32 | $3,648.40 | $5,538.98 | $6,517.41 | $15,465.37 | $15,465.37 | $32,413.03 | $16,947.66 | $560.26 | |||||
| 117050000188 | 3/14/2010 | O | Permanent partial | Cut; broken glass | Soft tissue neck | Laceration | $8,964.40 | $15,000.00 | $682.00 | $2,376.00 | $7.90 | $50.00 | $9,654.30 | $9,654.30 | $17,426.00 | $7,771.70 | $0.00 | |||||
| 107050000638 | 5/3/2010 | C | 11/30/2011 | Permanent partial | Strain; lifting | Shoulder (right) | Sprain | $4,505.99 | $4,505.99 | $18,569.30 | $18,569.30 | $7.25 | $7.25 | $23,082.54 | $23,082.54 | $23,082.54 | $0.00 | $0.00 | ||||
| 117050000133 | 6/15/2010 | C | 10/27/2011 | Temporary total disability | Cut; object being lifted or handled | Thumb (right) | Laceration | $473.46 | $473.46 | $0.00 | $0.00 | $473.46 | $473.46 | $473.46 | $0.00 | $0.00 | ||||||
| 107050001151 | 7/7/2010 | O | Medical only | Unknown | Ear(s) | PAIN | $1,475.50 | $3,300.00 | $7.25 | $10.00 | $1,482.75 | $1,482.75 | $3,310.00 | $1,827.25 | $0.00 | |||||||
| 107050001086 | 8/7/2010 | C | 7/14/2011 | Medical only | Vehicle; collide with other vehicle | Multiple body parts | Multiple physical injuries only | $7,071.76 | $7,071.76 | $7,071.76 | $7,071.76 | $7,071.76 | $0.00 | $0.00 | ||||||||
| 107050001113 | 8/12/2010 | O | Temporary total disability | Injured by; hand tool or machine in use | Finger(s) (right) | Foreign body | $479.18 | $2,000.00 | $0.00 | $10.00 | $479.18 | $479.18 | $2,010.00 | $1,530.82 | $0.00 | |||||||
| 117050000214 | 8/13/2010 | O | Permanent partial | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $12,814.50 | $15,301.89 | $4,114.80 | $36,278.16 | $0.00 | $500.00 | $7.55 | $57.55 | $16,936.85 | $16,936.85 | $52,137.60 | $35,200.75 | $0.00 | |||
| 107050001115 | 8/19/2010 | O | Permanent partial | Slipped: did not fall | Shoulder (right) | Strain | $11,406.88 | $11,700.00 | $0.00 | $0.00 | $0.00 | $0.00 | $7.25 | $10.00 | $11,414.13 | $11,414.13 | $11,710.00 | $295.87 | $0.00 | |||
| 107050001240 | 8/22/2010 | O | Permanent partial | Slipped: did not fall | Multiple body parts | Strain | $9,737.97 | $15,900.00 | $30,477.15 | $62,913.30 | $1,403.00 | $1,450.00 | $2,867.25 | $3,800.00 | $44,485.37 | $44,485.37 | $84,063.30 | $39,577.93 | $0.00 | |||
| 107050001186 | 9/16/2010 | C | 7/8/2011 | Medical only | Fall, slip or trip, | Multiple body parts | Multiple physical injuries only | $1,158.01 | $1,158.01 | $35.60 | $35.60 | $1,193.61 | $1,193.61 | $1,193.61 | $0.00 | $0.00 | ||||||
| 117050000141 | 10/23/2010 | O | Permanent partial | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $551.00 | $4,000.00 | $0.00 | $0.00 | $0.00 | $10.00 | $551.00 | $551.00 | $4,010.00 | $3,459.00 | $0.00 | |||||
| 117050000051 | 11/8/2010 | O | Medical only | Unknown | Knee (left) | Strain | $446.29 | $1,000.00 | $0.00 | $0.00 | $446.29 | $446.29 | $1,000.00 | $553.71 | $0.00 | |||||||
| 117050000180 | 12/6/2010 | C | 7/29/2011 | Medical only | Cut; hand tool, utensil, not powered | Hand (right) | Laceration | $315.58 | $315.58 | $0.00 | $0.00 | $315.58 | $315.58 | $315.58 | $0.00 | $0.00 | ||||||
| 117050000165 | 12/17/2010 | C | 10/6/2011 | Medical only | Injured by; animal or insect | Mouth | Laceration | $273.44 | $273.44 | $0.00 | $0.00 | $273.44 | $273.44 | $273.44 | $0.00 | $0.00 | ||||||
| 117050000250 | 12/30/2010 | O | Permanent partial | Fall; on same level | Ankle (left) | Fracture | $2,858.10 | $3,700.00 | $0.00 | $0.00 | $16.37 | $20.00 | $2,874.47 | $2,874.47 | $3,720.00 | $845.53 | $0.00 | |||||
| 117050000329 | 3/11/2011 | O | Medical only | Vehicle; crash of airplane | Disk (Neck) | Strain | $671.22 | $1,400.00 | $0.00 | $0.00 | $0.00 | $10.00 | $671.22 | $671.22 | $1,410.00 | $738.78 | $0.00 | |||||
| 117050000500 | 3/16/2011 | O | Medical only | Vehicle; collide with other vehicle | Lower back area (inc. Lumb./Lumb.-Sac.) | PAIN | $0.00 | $200.00 | $1,079.00 | $2,300.00 | $1,079.00 | $1,079.00 | $2,500.00 | $1,421.00 | $0.00 | |||||||
| 117050000225 | 3/18/2011 | C | 10/6/2011 | Medical only | Strain; lifting | Groin | Hernia | $0.00 | $0.00 | $7.55 | $7.55 | $7.55 | $7.55 | $7.55 | $0.00 | $0.00 | ||||||
| 117050000523 | 4/12/2011 | O | Medical only | Fall; from ladder or scaffolding | Multiple body parts | Multiple physical injuries only | $0.00 | $2,500.00 | $0.00 | $300.00 | $0.00 | $0.00 | $2,800.00 | $2,800.00 | $0.00 | |||||||
| 117050000394 | 5/30/2011 | O | Permanent partial | Vehicle; collide with other vehicle | Soft tissue neck | Sprain | $0.00 | $700.00 | $0.00 | $0.00 | $0.00 | $558.00 | $0.00 | $0.00 | $1,258.00 | $1,258.00 | $0.00 | |||||
| 117050000509 | 8/20/2011 | O | Permanent partial | Vehicle; upset | Multiple neck injury | Fracture | $0.00 | $200.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $8.00 | $0.00 | $0.00 | $208.00 | $208.00 | $0.00 | |||
| 117050000555 | 9/27/2011 | O | Permanent partial | Caught; machine or machinery | Finger(s) (right) | Amputation | $0.00 | $200.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $200.00 | $200.00 | $0.00 |
OPEN CLAIMS OR CLOSED BUT WERE OPEN IN THE PERIOD OF 1/1/2012 - 12/31/2012
| Claim No | Loss Date | Claim Status | Last Closed | Loss Type Descr | Loss Cause Descr | Body Part Descr | Loss Nature Descr | Med Paid | Med Incurred | Ind Paid | Ind Incurred | Rhb Paid | Rhb Incurred | Leg Paid | Leg Incurred | Oth Paid | Oth Incurred | Asof Paid | Tot Paid | Tot Incr | Tot Rsv | Asof Recovered |
| 810168814UEF | 1/27/1981 | O | Death Claim | Misc; person in act of crime | Multiple head injury | All Other NOS | $30,799.89 | $30,799.89 | $110,132.61 | $342,665.55 | $140,932.50 | $140,932.50 | $373,465.44 | $232,532.94 | $0.00 | |||||||
| UE01-69611 | 6/1/1983 | R | 6/6/2007 | Medical only | Passed Out | Multiple neck injury | Laceration | $6,722.27 | $9,176.30 | $217.00 | $217.00 | $6,939.27 | $6,939.27 | $9,393.30 | $2,454.03 | $0.00 | ||||||
| 830227787UEF | 6/21/1983 | O | Permanent Partial-Major >25% | Caught; in, under, between, | Hand(s) | Amputation | $12,489.12 | $28,546.56 | $12,489.12 | $12,489.12 | $28,546.56 | $16,057.44 | $0.00 | |||||||||
| 860690102UEF | 1/1/1986 | O | Permanent total disability | Injured by; moving parts of machine | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $7,256.03 | $7,256.03 | $169,355.78 | $276,544.27 | $1,206.50 | $6,800.00 | $1,292.75 | $2,585.50 | $179,111.06 | $179,111.06 | $293,185.80 | $114,074.74 | $0.00 | |||
| 870628331UEF | 1/21/1986 | O | Permanent total disability | Burn; electrical current | Upper arm(s) | Strain | $116,727.67 | $279,353.08 | $140,592.68 | $323,590.65 | $1,983.30 | $1,983.30 | $1,576.88 | $4,104.36 | $260,880.53 | $260,880.53 | $609,031.39 | $348,150.86 | $0.00 | |||
| 880307648UEF | 5/8/1988 | O | Death Claim | Strike; against or stepping on | Body system and Mult. Body systems | All Other NOS | $237,915.60 | $333,687.74 | $237,915.60 | $237,915.60 | $333,687.74 | $95,772.14 | $0.00 | |||||||||
| 880913150UEF | 6/27/1988 | R | 7/30/2004 | Permanent Partial-Major >25% | Caught; in, under, between, | Finger(s) | Amputation | $2,697.12 | $8,268.00 | $0.00 | $0.00 | $2,697.12 | $2,697.12 | $8,268.00 | $5,570.88 | $0.00 | ||||||
| 890673873UEF | 11/11/1988 | O | Permanent total disability | Passed Out | Multiple head injury | Multple injuries (incl phys and psych) | $19,168.10 | $57,500.00 | $176,815.74 | $463,337.55 | $1,957.22 | $3,800.00 | $197,941.06 | $197,941.06 | $524,637.55 | $326,696.49 | $0.00 | |||||
| 900735816UEF | 10/15/1989 | O | Permanent Partial-Major >25% | Caught; in, under, between, | Multiple Lower Extremities | Fracture | $17,308.24 | $43,726.08 | $17,308.24 | $17,308.24 | $43,726.08 | $26,417.84 | $0.00 | |||||||||
| 910971060UEF | 5/26/1991 | O | Permanent partial | Burn; fire or flame | Multiple upper extremeties | Burn | $0.00 | $0.00 | $35,338.44 | $73,015.04 | $0.00 | $0.00 | $0.00 | $4.75 | $4.75 | $4.75 | $35,343.19 | $35,343.19 | $73,024.54 | $37,681.35 | $0.00 | |
| 920075339 | 9/13/1991 | R | 7/27/2011 | Other PPD not scheduled-Minor <25% | Fall; from different level/elevation | Multiple body parts | Sprain | $16,655.46 | $16,655.46 | $27,365.18 | $27,365.18 | $899.87 | $1,500.00 | $44,920.51 | $44,920.51 | $45,520.64 | $600.13 | $0.00 | ||||
| 920724285UE | 12/22/1991 | O | Permanent total disability | Misc; person in act of crime | Body system and Mult. Body systems | All Other NOS | $571,796.15 | $986,062.66 | $70,643.97 | $174,871.45 | $350.00 | $350.00 | $1,044.10 | $10,000.00 | $325.84 | $1,066.67 | $644,160.06 | $644,160.06 | $1,172,350.78 | $528,190.72 | $0.00 | |
| UE92-0886441 | 4/23/1992 | R | Permanent partial | Strain; lifting | Multiple neck injury | All Other NOS | $138,099.19 | $153,290.10 | $9,608.75 | $9,608.75 | $0.00 | $0.00 | $0.00 | $0.00 | $6,736.24 | $6,736.24 | $154,444.18 | $154,444.18 | $169,635.09 | $15,190.91 | $0.00 | |
| 920325722UEF | 6/18/1992 | O | Permanent Partial-Major >25% | Vehicle; motor vehicle | Vertebrae | Fracture | $13,668.59 | $41,647.92 | $8.25 | $8.25 | $13,676.84 | $13,676.84 | $41,656.17 | $27,979.33 | $0.00 | |||||||
| 930794094UEF | 2/16/1993 | O | Permanent Partial-Major >25% | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | All Other NOS | $3,051.84 | $5,894.88 | $3,051.84 | $3,051.84 | $5,894.88 | $2,843.04 | $0.00 | |||||||||
| 960155072UEF | 9/12/1995 | O | Permanent total disability | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $104,503.59 | $104,503.59 | $89,352.62 | $90,222.25 | $132,296.73 | $132,296.73 | $4,151.13 | $4,151.13 | $4,836.11 | $4,836.11 | $335,140.18 | $335,140.18 | $336,009.81 | $869.63 | $0.00 | |
| 960255353UEF | 12/1/1995 | O | Permanent total disability | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Fracture | $363,764.32 | $646,236.33 | $229,688.54 | $495,377.93 | $0.00 | $0.00 | $3,285.46 | $9,500.00 | $33,864.51 | $48,830.21 | $630,602.83 | $630,602.83 | $1,199,944.47 | $569,341.64 | $2,083.97 | |
| 960574373UEF | 5/4/1996 | R | 6/22/2010 | Permanent Partial-Major >25% | Vehicle; motor vehicle | Lower back area (inc. Lumb./Lumb.-Sac.) | Multple injuries (incl phys and psych) | $309,603.04 | $326,508.61 | $141,779.83 | $227,804.28 | $1,726.27 | $1,726.27 | $7,075.95 | $40,540.11 | $26,710.81 | $27,000.00 | $486,895.90 | $486,895.90 | $623,579.27 | $136,683.37 | $0.00 |
| 970379193UEF | 2/27/1997 | O | Death Claim | Passed Out | Multiple head injury | All Other NOS | $23,093.44 | $23,093.44 | $86,600.40 | $319,301.40 | $109,693.84 | $109,693.84 | $342,394.84 | $232,701.00 | $0.00 | |||||||
| 980346970UEF | 12/2/1997 | O | Permanent total disability | Injured by; object being lifted/handled | Vertebrae | Strain | $359,068.69 | $412,717.72 | $331,520.70 | $834,647.70 | $5,388.64 | $5,388.64 | $7,622.27 | $7,622.27 | $403.43 | $1,029.75 | $704,003.73 | $704,003.73 | $1,261,406.08 | $557,402.35 | $0.00 | |
| 980421879UEF | 3/25/1998 | O | Permanent total disability | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Strain | $115,961.96 | $187,500.00 | $128,694.93 | $546,790.88 | $16,117.89 | $32,500.00 | $0.00 | $0.00 | $260,774.78 | $260,774.78 | $766,790.88 | $506,016.10 | $5,736.08 | |||
| 117050000191 | 3/17/1999 | O | Permanent total disability | Fall; from different level/elevation | Upper back area (Thoracic area) | Fracture | $40,844.43 | $121,420.81 | $98,782.83 | $108,737.46 | $7.90 | $5,000.00 | $139,635.16 | $139,635.16 | $235,158.27 | $95,523.11 | $0.00 | |||||
| 99-0423015 | 5/29/1999 | C | 4/23/2012 | Permanent partial | Injured by; falling or flying object | Upper arm(s) | All Other NOS | $1,128.25 | $1,128.25 | $4,328.64 | $4,328.64 | $5,456.89 | $5,456.89 | $5,456.89 | $0.00 | $0.00 | ||||||
| 178270UEF | 11/10/2000 | C | 1/4/2012 | Permanent partial | Cut; caught, punctured, scraped, | Finger(s) | Amputation | $10,390.03 | $10,390.03 | $49,163.30 | $49,163.30 | $19,873.97 | $19,873.97 | $0.00 | $0.00 | $79,427.30 | $79,427.30 | $79,427.30 | $0.00 | $0.00 | ||
| 190394UEF | 9/17/2001 | O | Death Claim | Burn; contact | Body system and Mult. Body systems | Burn | $44,874.05 | $44,877.05 | $139,354.56 | $185,646.06 | $548.56 | $551.56 | $184,777.17 | $184,777.17 | $231,074.67 | $46,297.50 | $0.00 | |||||
| 190485UEF | 9/17/2001 | O | Permanent Partial-Major >25% | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Burn | $137,881.49 | $137,881.49 | $106,138.50 | $163,630.47 | $2,283.53 | $2,283.53 | $3,980.72 | $3,980.72 | $428.86 | $428.86 | $250,713.10 | $250,713.10 | $308,205.07 | $57,491.97 | $0.00 | |
| UE01-90388 | 9/17/2001 | O | Permanent Partial-Major >25% | Injured by; explosion or flare back | Multiple upper extremeties | Burn | $303,212.19 | $303,212.19 | $131,211.82 | $303,712.24 | $701.93 | $701.93 | $0.00 | $0.00 | $5,982.02 | $5,982.02 | $441,107.96 | $441,107.96 | $613,608.38 | $172,500.42 | $0.00 | |
| UE01-96717 | 1/3/2002 | C | 6/29/2012 | Other PPD not scheduled-Minor <25% | Strain; lifting | Upper back area (Thoracic area) | Strain | $33,694.44 | $33,694.44 | $138,750.71 | $138,750.71 | $15,545.85 | $15,545.85 | $589.06 | $589.06 | $429.68 | $429.68 | $189,009.74 | $189,009.74 | $189,009.74 | $0.00 | $0.00 |
| UE01-98382 | 2/13/2002 | R | 6/10/2008 | Permanent partial | Strain; lifting | Multiple upper extremeties | Strain | $116,657.10 | $117,920.24 | $17,450.40 | $17,450.40 | $16,423.00 | $16,423.00 | $2,296.00 | $3,796.00 | $3,650.40 | $3,650.40 | $156,476.90 | $156,476.90 | $159,240.04 | $2,763.14 | $0.00 |
| UE03-00028 | 3/3/2002 | O | Permanent partial | Strike; against or stepping on | Knee(s) | Infection | $3,597.09 | $3,597.09 | $8,773.03 | $17,350.20 | $0.00 | $0.00 | $0.00 | $0.00 | $526.70 | $526.70 | $12,896.82 | $12,896.82 | $21,473.99 | $8,577.17 | $0.00 | |
| UE03-00029 | 1/13/2003 | R | 1/5/2005 | Permanent Partial-Major >25% | Strain; pushing or pulling | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $55,791.50 | $55,791.50 | $75,967.49 | $86,721.44 | $13,546.12 | $13,546.12 | $0.00 | $0.00 | $172.48 | $172.48 | $145,477.59 | $145,477.59 | $156,231.54 | $10,753.95 | $0.00 |
| UE04-00036 | 4/11/2003 | O | Permanent Partial-Major >25% | Cut; caught, punctured, scraped, | Finger(s) | VDT - related disease | $3,573.26 | $3,573.26 | $148,630.92 | $260,292.94 | $36,055.47 | $36,055.47 | $230.35 | $230.35 | $188,490.00 | $188,490.00 | $300,152.02 | $111,662.02 | $0.00 | |||
| UE03-00022 | 7/29/2003 | O | Permanent total disability | Injured by; falling or flying object | Multiple head injury | All Other NOS | $43,553.69 | $191,296.49 | $251,963.09 | $1,115,236.51 | $17,344.77 | $17,344.77 | $1,374.00 | $13,973.99 | $11,304.33 | $12,000.00 | $325,539.88 | $325,539.88 | $1,349,851.76 | $1,024,311.88 | $113,937.64 | |
| UE04-00025 | 2/15/2004 | R | 11/9/2006 | Permanent partial | Injured by; Another Person | Facial bones | Fracture | $18,027.35 | $22,506.08 | $800.00 | $800.00 | $110.00 | $110.00 | $5.50 | $20.00 | $18,942.85 | $18,942.85 | $23,436.08 | $4,493.23 | $0.00 | ||
| 077050000062 | 9/20/2004 | O | Permanent partial | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $26,912.53 | $34,730.22 | $57,312.29 | $58,452.42 | $0.00 | $0.00 | $431.50 | $800.00 | $6,624.42 | $8,082.86 | $91,280.74 | $91,280.74 | $102,065.50 | $10,784.76 | $0.00 | |
| UE05-00015 | 12/17/2004 | R | 6/11/2007 | Permanent partial | Fall, slip or trip, | Knee(s) | Sprain | $25,835.76 | $25,835.76 | $49,292.52 | $49,292.52 | $0.00 | $0.00 | $0.00 | $0.00 | $8.25 | $10.00 | $75,136.53 | $75,136.53 | $75,138.28 | $1.75 | $0.00 |
| UE05-00014 | 1/30/2005 | O | Permanent partial | Injured by; moving parts of machine | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $82,810.32 | $82,810.32 | $70,085.92 | $78,085.55 | $0.00 | $0.00 | $1,918.56 | $1,918.56 | $154,814.80 | $154,814.80 | $162,814.43 | $7,999.63 | $0.00 | |||
| UE05-00060 | 9/9/2005 | O | Permanent Partial-Major >25% | Injured by; object being lifted/handled | Upper arm(s) | Amputation | $209,054.53 | $362,680.74 | $200,849.00 | $951,231.50 | $0.00 | $0.00 | $0.00 | $1,000.00 | $6,975.95 | $10,000.00 | $416,879.48 | $416,879.48 | $1,324,912.24 | $908,032.76 | $0.00 | |
| UE06-00002 | 12/12/2005 | R | 5/29/2007 | Permanent Partial-Major >25% | Vehicle; motor vehicle | Multiple upper extremeties | Multiple physical injuries only | $85,812.30 | $85,812.30 | $149,900.28 | $176,213.88 | $3,559.92 | $3,559.92 | $1,611.14 | $1,611.14 | $240,883.64 | $240,883.64 | $267,197.24 | $26,313.60 | $813.01 | ||
| UE06-00033 | 3/20/2006 | O | Permanent partial | Fall, slip or trip, | Multiple upper extremeties | Strain | $36,183.83 | $37,505.16 | $25,001.46 | $36,420.68 | $8,081.48 | $15,861.60 | $0.00 | $0.00 | $6,946.00 | $7,278.80 | $76,212.77 | $76,212.77 | $97,066.24 | $20,853.47 | $0.00 | |
| 077050000077 | 5/10/2007 | O | Permanent partial | Strike; object being lifted or handled | Multiple head injury | Head Trauma | $12,464.70 | $15,241.19 | $6,926.68 | $21,457.60 | $1,435.75 | $1,435.75 | $20,827.13 | $20,827.13 | $38,134.54 | $17,307.41 | $0.00 | |||||
| 087050000085 | 11/26/2007 | C | 8/30/2012 | Temporary total disability | Strain; lifting | Multiple upper extremeties | Strain | $276.72 | $276.72 | $52,356.68 | $52,356.68 | $0.00 | $0.00 | $6.50 | $6.50 | $52,639.90 | $52,639.90 | $52,639.90 | $0.00 | $0.00 | ||
| 107050000187 | 3/15/2008 | C | 10/23/2012 | Permanent partial | Fall; from different level/elevation | Multiple body parts | Multple injuries (incl phys and psych) | $6,966.22 | $6,966.22 | $7,902.70 | $7,902.70 | $7.25 | $7.25 | $14,876.17 | $14,876.17 | $14,876.17 | $0.00 | $0.00 | ||||
| 097050000096 | 6/3/2008 | C | 2/9/2012 | Temporary total disability | Strain; lifting | Knee (left) | Strain | $250.00 | $250.00 | $17,385.95 | $17,385.95 | $880.84 | $880.84 | $18,516.79 | $18,516.79 | $18,516.79 | $0.00 | $0.00 | ||||
| 117050000201 | 9/18/2008 | O | Permanent partial | Injured by; falling or flying object | Multiple body parts | Multiple physical injuries only | $36,411.87 | $50,000.00 | $9,462.04 | $47,903.80 | $0.00 | $10.00 | $45,873.91 | $45,873.91 | $97,913.80 | $52,039.89 | $0.00 | |||||
| 097050001163 | 1/6/2009 | C | 2/20/2012 | Permanent partial | Strike; moving parts of machine | Wrist and hand (left) | Fracture | $29,744.55 | $29,744.55 | $68,758.00 | $68,758.00 | $12,892.70 | $12,892.70 | $2,931.54 | $2,931.54 | $114,326.79 | $114,326.79 | $114,326.79 | $0.00 | $1,774.71 | ||
| 097050001403 | 2/5/2009 | C | 5/31/2012 | Permanent partial | Strain; twisting | Foot (left) | Strain | $20,261.96 | $20,261.96 | $21,127.55 | $21,127.55 | $2,826.98 | $2,826.98 | $44,216.49 | $44,216.49 | $44,216.49 | $0.00 | $0.00 | ||||
| 127050000178 | 2/23/2009 | O | Permanent partial | Injured by; hand tool or machine in use | Eye (right) | Rupture | $884.16 | $5,000.00 | $0.00 | $0.00 | $8.25 | $8.25 | $892.41 | $892.41 | $5,008.25 | $4,115.84 | $0.00 | |||||
| 117050000524 | 4/2/2009 | C | 3/21/2012 | Medical only | Fall, slip or trip, | Trachea | Crushing | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| 097050001147 | 6/27/2009 | C | 5/1/2012 | Permanent partial | Fall; from ladder or scaffolding | Ankle (right) | Fracture | $9,804.82 | $9,804.82 | $17,623.82 | $17,623.82 | $17,235.83 | $17,235.83 | $1,282.60 | $1,282.60 | $45,947.07 | $45,947.07 | $45,947.07 | $0.00 | $0.00 | ||
| 097050001390 | 6/30/2009 | C | 4/25/2012 | Medical only | Vehicle; collide with other vehicle | Multiple body parts | Multiple physical injuries only | $0.00 | $0.00 | $1,332.00 | $1,332.00 | $7.25 | $7.25 | $1,339.25 | $1,339.25 | $1,339.25 | $0.00 | $0.00 | ||||
| 107050000366 | 7/25/2009 | C | 6/1/2012 | Temporary total disability | Injured by; motor vehicle | Lower back area (inc. Lumb./Lumb.-Sac.) | Multiple physical injuries only | $1,770.60 | $1,770.60 | $119.05 | $119.05 | $80.25 | $80.25 | $1,969.90 | $1,969.90 | $1,969.90 | $0.00 | $0.00 | ||||
| 107050000320 | 10/1/2009 | C | 9/4/2012 | Medical only | Fall; from different level/elevation | Multiple body parts | Multiple physical injuries only | $5,092.59 | $5,092.59 | $20.15 | $20.15 | $5,112.74 | $5,112.74 | $5,112.74 | $0.00 | $0.00 | ||||||
| 107050000531 | 10/23/2009 | O | Temporary total disability | Fall, slip or trip, | Lower back area (inc. Lumb./Lumb.-Sac.) | PAIN | $10,691.93 | $11,000.00 | $20,416.44 | $35,940.60 | $400.00 | $400.00 | $2,679.53 | $3,500.00 | $34,187.90 | $34,187.90 | $50,840.60 | $16,652.70 | $0.00 | |||
| 107050000884 | 12/15/2009 | C | 5/10/2012 | Permanent partial | Fall, slip or trip, | Wrist (right) | Fracture | $19,639.86 | $19,639.86 | $32,930.40 | $32,930.40 | $876.28 | $876.28 | $10.25 | $10.25 | $53,456.79 | $53,456.79 | $53,456.79 | $0.00 | $0.00 | ||
| 107050000443 | 3/13/2010 | C | 8/28/2012 | Permanent partial | Injured by; struck or injured | Multiple body parts | Laceration | $11,248.74 | $11,248.74 | $7,552.28 | $7,552.28 | $5,799.78 | $5,799.78 | $24,600.80 | $24,600.80 | $24,600.80 | $0.00 | $560.26 | ||||
| 117050000188 | 3/14/2010 | O | Permanent partial | Cut; broken glass | Soft tissue neck | Laceration | $13,382.71 | $15,000.00 | $11,088.08 | $12,387.27 | $7.90 | $1,680.00 | $24,478.69 | $24,478.69 | $29,067.27 | $4,588.58 | $0.00 | |||||
| 107050001219 | 5/31/2010 | C | 8/17/2012 | Medical only | Strike; object being lifted or handled | Multiple body parts | Multiple physical injuries only | $0.00 | $0.00 | $57.02 | $57.02 | $57.02 | $57.02 | $57.02 | $0.00 | $0.00 | ||||||
| 107050001151 | 7/7/2010 | C | 6/13/2012 | Medical only | Unknown | Ear(s) | PAIN | $2,613.41 | $2,613.41 | $7.25 | $7.25 | $2,620.66 | $2,620.66 | $2,620.66 | $0.00 | $0.00 | ||||||
| 107050001113 | 8/12/2010 | C | 7/25/2012 | Temporary total disability | Injured by; hand tool or machine in use | Finger(s) (right) | Foreign body | $509.89 | $509.89 | $0.00 | $0.00 | $509.89 | $509.89 | $509.89 | $0.00 | $0.00 | ||||||
| 117050000214 | 8/13/2010 | O | Permanent partial | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $24,003.10 | $25,856.42 | $42,760.42 | $44,009.15 | $911.04 | $911.04 | $3,250.75 | $3,250.75 | $70,925.31 | $70,925.31 | $74,027.36 | $3,102.05 | $0.00 | |||
| 107050001115 | 8/19/2010 | O | Permanent partial | Slipped: did not fall | Shoulder (right) | Strain | $12,454.06 | $15,700.00 | $32,240.88 | $32,535.19 | $0.00 | $1,100.00 | $7.25 | $10.00 | $44,702.19 | $44,702.19 | $49,345.19 | $4,643.00 | $0.00 | |||
| 107050001240 | 8/22/2010 | O | Permanent partial | Slipped: did not fall | Multiple body parts | Strain | $12,920.13 | $15,900.00 | $31,646.98 | $62,913.30 | $2,389.00 | $2,650.00 | $2,946.25 | $3,800.00 | $49,902.36 | $49,902.36 | $85,263.30 | $35,360.94 | $0.00 | |||
| 107050001166 | 9/1/2010 | C | 11/13/2012 | Medical only | Strike; against or stepping on | Multiple body parts | Multiple physical injuries only | $1,249.91 | $1,249.91 | $7.55 | $7.55 | $1,257.46 | $1,257.46 | $1,257.46 | $0.00 | $0.00 | ||||||
| 117050000129 | 9/8/2010 | C | 2/20/2012 | Medical only | Fall; from ladder or scaffolding | Lower back area (inc. Lumb./Lumb.-Sac.) | Contusion | $0.00 | $0.00 | $2.85 | $2.85 | $2.85 | $2.85 | $2.85 | $0.00 | $0.00 | ||||||
| 117050000141 | 10/23/2010 | C | 10/2/2012 | Permanent partial | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $4,497.05 | $4,497.05 | $3,523.41 | $3,523.41 | $0.00 | $0.00 | $8,020.46 | $8,020.46 | $8,020.46 | $0.00 | $0.00 | ||||
| 117050000051 | 11/8/2010 | O | Medical only | Unknown | Knee (left) | Strain | $770.23 | $1,000.00 | $0.00 | $0.00 | $770.23 | $770.23 | $1,000.00 | $229.77 | $0.00 | |||||||
| 117050000250 | 12/30/2010 | O | Permanent partial | Fall; on same level | Ankle (left) | Fracture | $6,046.36 | $8,700.00 | $0.00 | $9,974.86 | $16.37 | $20.00 | $6,062.73 | $6,062.73 | $18,694.86 | $12,632.13 | $0.00 | |||||
| 127050000154 | 1/13/2011 | O | Temporary total disability | Strain; reaching | Abdomen incl. groin | Hernia | $88.50 | $8,400.00 | $799.96 | $799.96 | $8.25 | $8.25 | $896.71 | $896.71 | $9,208.21 | $8,311.50 | $0.00 | |||||
| 127050000080 | 2/17/2011 | C | 10/16/2012 | Medical only | Burn; steam or hot fluids | Hand (left) | Burn | $301.63 | $301.63 | $8.25 | $8.25 | $309.88 | $309.88 | $309.88 | $0.00 | $0.00 | ||||||
| 117050000329 | 3/11/2011 | C | 1/20/2012 | Medical only | Vehicle; crash of airplane | Disk (Neck) | Strain | $671.22 | $671.22 | $0.00 | $0.00 | $0.00 | $0.00 | $671.22 | $671.22 | $671.22 | $0.00 | $0.00 | ||||
| 117050000523 | 4/12/2011 | C | 8/14/2012 | Medical only | Fall; from ladder or scaffolding | Multiple body parts | Multiple physical injuries only | $1,187.02 | $1,187.02 | $362.86 | $362.86 | $1,549.88 | $1,549.88 | $1,549.88 | $0.00 | $0.00 | ||||||
| 127050000272 | 4/28/2011 | O | Permanent partial | Strike; object being lifted or handled | Lower leg (left) | Fracture | $6,615.70 | $12,780.37 | $3,179.08 | $26,039.88 | $0.00 | $0.00 | $8.25 | $8.25 | $9,803.03 | $9,803.03 | $38,828.50 | $29,025.47 | $0.00 | |||
| 117050000394 | 5/30/2011 | O | Permanent partial | Vehicle; collide with other vehicle | Soft tissue neck | Sprain | $2,484.03 | $4,500.00 | $0.00 | $0.00 | $447.00 | $558.00 | $2,931.03 | $2,931.03 | $5,058.00 | $2,126.97 | $0.00 | |||||
| 117050000509 | 8/20/2011 | O | Permanent partial | Vehicle; upset | Multiple neck injury | Fracture | $34,276.25 | $47,241.53 | $4,800.56 | $31,275.27 | $1,291.29 | $1,700.00 | $56.89 | $108.00 | $40,424.99 | $40,424.99 | $80,324.80 | $39,899.81 | $0.00 | |||
| 117050000555 | 9/27/2011 | C | 6/1/2012 | Permanent partial | Caught; machine or machinery | Finger(s) (right) | Amputation | $623.98 | $623.98 | $26,914.30 | $26,914.30 | $8.25 | $8.25 | $27,546.53 | $27,546.53 | $27,546.53 | $0.00 | $0.00 | ||||
| 127050000104 | 10/1/2011 | O | Permanent partial | Vehicle; collide with other vehicle | Multiple body parts | Amputation | $5,173.46 | $15,300.00 | $12,424.04 | $29,029.30 | $8.25 | $8.25 | $17,605.75 | $17,605.75 | $44,337.55 | $26,731.80 | $0.00 | |||||
| 127050000316 | 10/16/2011 | O | Temporary total disability | Strike; object being lifted or handled | Multiple body parts | Sprain | $518.11 | $1,700.00 | $0.00 | $0.00 | $0.00 | $10.00 | $518.11 | $518.11 | $1,710.00 | $1,191.89 | $0.00 | |||||
| 127050000056 | 11/28/2011 | C | 12/3/2012 | Permanent partial | Misc; person in act of crime | Multiple body parts | Multiple physical injuries only | $13,592.75 | $13,592.75 | $0.00 | $0.00 | $8.25 | $8.25 | $13,601.00 | $13,601.00 | $13,601.00 | $0.00 | $0.00 | ||||
| 127050000301 | 2/3/2012 | O | Permanent partial | Fall; from different level/elevation | Multiple body parts | Fracture | $26,386.75 | $28,904.41 | $2,410.65 | $33,801.86 | $0.00 | $100.00 | $28,797.40 | $28,797.40 | $62,806.27 | $34,008.87 | $0.00 | |||||
| 127050000188 | 3/1/2012 | O | Death Claim | Misc; person in act of crime | Multiple body parts | Bullet Wound | $0.00 | $2,300.00 | $14,295.21 | $150,316.95 | $495.35 | $800.00 | $14,790.56 | $14,790.56 | $153,416.95 | $138,626.39 | $0.00 | |||||
| 127050000221 | 3/6/2012 | O | Permanent partial | Misc; foreign matter (body) in eye(s) | Eye (right) | Laceration | $2,596.13 | $27,519.27 | $0.00 | $23,479.16 | $0.00 | $1,000.00 | $658.90 | $3,158.90 | $3,255.03 | $3,255.03 | $55,157.33 | $51,902.30 | $0.00 | |||
| 127050000192 | 4/2/2012 | O | Permanent partial | Fall; on same level | Multiple body parts | Fracture | $10,842.71 | $15,574.00 | $15,837.23 | $31,587.33 | $0.00 | $560.00 | $2,886.51 | $3,408.25 | $29,566.45 | $29,566.45 | $51,129.58 | $21,563.13 | $0.00 | |||
| 127050000273 | 4/9/2012 | C | 12/24/2012 | Medical only | Cut; object being lifted or handled | Finger(s) (left) | Laceration | $419.77 | $419.77 | $8.25 | $8.25 | $428.02 | $428.02 | $428.02 | $0.00 | $0.00 | ||||||
| 127050000280 | 5/4/2012 | C | 12/28/2012 | Medical only | Collision/Person | Skull | Concussion | $989.52 | $989.52 | $0.00 | $0.00 | $989.52 | $989.52 | $989.52 | $0.00 | $0.00 | ||||||
| 127050000220 | 5/8/2012 | C | 9/4/2012 | Temporary total disability | Strain; reaching | Multiple body parts | Strain | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | ||||||
| 127050000254 | 5/18/2012 | O | Medical only | Strain; twisting | Multiple upper extremeties | Strain | $0.00 | $200.00 | $0.00 | $10.00 | $0.00 | $0.00 | $210.00 | $210.00 | $0.00 | |||||||
| 127050000257 | 6/9/2012 | O | Temporary total disability | Dancing | Knee (left) | Sprain | $245.86 | $2,000.00 | $0.00 | $1,000.00 | $0.00 | $100.00 | $245.86 | $245.86 | $3,100.00 | $2,854.14 | $0.00 | |||||
| 127050000323 | 8/21/2012 | O | Medical only | Injured by; animal or insect | Upper arm(s) | Cellulitis | $64.85 | $500.00 | $64.85 | $64.85 | $500.00 | $435.15 | $0.00 |
OPEN CLAIMS OR CLOSED BUT WERE OPEN IN THE PERIOD OF 1/1/2013 - 12/31/2013
| Claim No | Loss Date | Claim Status | Last Closed | Loss Type Descr | Loss Cause Descr | Body Part Descr | Loss Nature Descr | Med Paid | Med Incurred | Ind Paid | Ind Incurred | Rhb Paid | Rhb Incurred | Leg Paid | Leg Incurred | Oth Paid | Oth Incurred | Asof Paid | Tot Paid | Tot Incr | Tot Rsv | Asof Recovered |
| 810168814UEF | 1/27/1981 | O | Death Claim | Misc; person in act of crime | Multiple head injury | All Other NOS | $30,799.89 | $30,799.89 | $121,332.57 | $342,665.55 | $152,132.46 | $152,132.46 | $373,465.44 | $221,332.98 | $0.00 | |||||||
| UE01-69611 | 6/1/1983 | C | 5/20/2013 | Medical only | Passed Out | Multiple neck injury | Laceration | $6,722.27 | $6,722.27 | $217.00 | $217.00 | $6,939.27 | $6,939.27 | $6,939.27 | $0.00 | $0.00 | ||||||
| 830227787UEF | 6/21/1983 | O | Permanent Partial-Major >25% | Caught; in, under, between, | Hand(s) | Amputation | $13,381.20 | $28,546.56 | $13,381.20 | $13,381.20 | $28,546.56 | $15,165.36 | $0.00 | |||||||||
| 860690102UEF | 1/1/1986 | O | Permanent total disability | Injured by; moving parts of machine | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $7,256.03 | $7,256.03 | $183,270.14 | $276,544.27 | $1,206.50 | $6,800.00 | $1,292.75 | $2,585.50 | $193,025.42 | $193,025.42 | $293,185.80 | $100,160.38 | $0.00 | |||
| 870628331UEF | 1/21/1986 | C | 6/6/2013 | Permanent total disability | Burn; electrical current | Upper arm(s) | Strain | $117,223.82 | $117,223.82 | $141,804.63 | $141,804.63 | $1,983.30 | $1,983.30 | $1,793.04 | $1,793.04 | $262,804.79 | $262,804.79 | $262,804.79 | $0.00 | $0.00 | ||
| 880307648UEF | 5/8/1988 | O | Death Claim | Strike; against or stepping on | Body system and Mult. Body systems | All Other NOS | $256,333.32 | $333,687.74 | $256,333.32 | $256,333.32 | $333,687.74 | $77,354.42 | $0.00 | |||||||||
| 880913150UEF | 6/27/1988 | R | 7/30/2004 | Permanent Partial-Major >25% | Caught; in, under, between, | Finger(s) | Amputation | $2,921.88 | $8,268.00 | $0.00 | $0.00 | $2,921.88 | $2,921.88 | $8,268.00 | $5,346.12 | $0.00 | ||||||
| 890673873UEF | 11/11/1988 | O | Permanent total disability | Passed Out | Multiple head injury | Multple injuries (incl phys and psych) | $19,782.41 | $57,500.00 | $190,429.86 | $463,337.55 | $1,957.22 | $3,800.00 | $212,169.49 | $212,169.49 | $524,637.55 | $312,468.06 | $27.82 | |||||
| 900735816UEF | 10/15/1989 | O | Permanent Partial-Major >25% | Caught; in, under, between, | Multiple Lower Extremities | Fracture | $18,674.68 | $43,726.08 | $18,674.68 | $18,674.68 | $43,726.08 | $25,051.40 | $0.00 | |||||||||
| 910971060UEF | 5/26/1991 | O | Permanent partial | Burn; fire or flame | Multiple upper extremeties | Burn | $0.00 | $0.00 | $38,127.48 | $73,015.04 | $0.00 | $0.00 | $0.00 | $4.75 | $4.75 | $4.75 | $38,132.23 | $38,132.23 | $73,024.54 | $34,892.31 | $0.00 | |
| 920075339 | 9/13/1991 | C | 2/11/2013 | Other PPD not scheduled-Minor <25% | Fall; from different level/elevation | Multiple body parts | Sprain | $16,655.46 | $16,655.46 | $27,365.18 | $27,365.18 | $899.87 | $899.87 | $44,920.51 | $44,920.51 | $44,920.51 | $0.00 | $0.00 | ||||
| 920724285UE | 12/22/1991 | O | Permanent total disability | Misc; person in act of crime | Body system and Mult. Body systems | All Other NOS | $616,700.66 | $986,062.66 | $76,210.14 | $174,871.45 | $350.00 | $350.00 | $1,044.10 | $10,000.00 | $325.84 | $1,066.67 | $694,630.74 | $694,630.74 | $1,172,350.78 | $477,720.04 | $0.00 | |
| UE92-0886441 | 4/23/1992 | R | Permanent partial | Strain; lifting | Multiple neck injury | All Other NOS | $139,090.42 | $153,290.10 | $9,608.75 | $9,608.75 | $0.00 | $0.00 | $0.00 | $0.00 | $6,736.24 | $6,736.24 | $155,435.41 | $155,435.41 | $169,635.09 | $14,199.68 | $0.00 | |
| 920325722UEF | 6/18/1992 | O | Permanent Partial-Major >25% | Vehicle; motor vehicle | Vertebrae | Fracture | $14,764.43 | $41,647.92 | $8.25 | $8.25 | $14,772.68 | $14,772.68 | $41,656.17 | $26,883.49 | $0.00 | |||||||
| 930794094UEF | 2/16/1993 | O | Permanent Partial-Major >25% | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | All Other NOS | $3,190.56 | $5,894.88 | $3,190.56 | $3,190.56 | $5,894.88 | $2,704.32 | $0.00 | |||||||||
| 960155072UEF | 9/12/1995 | O | Permanent total disability | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $174,372.94 | $207,912.60 | $94,657.13 | $108,251.44 | $132,296.73 | $132,296.73 | $4,151.13 | $4,151.13 | $12,135.26 | $14,311.84 | $417,613.19 | $417,613.19 | $466,923.74 | $49,310.55 | $0.00 | |
| 960255353UEF | 12/1/1995 | O | Permanent total disability | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Fracture | $387,258.75 | $646,236.33 | $247,701.38 | $495,377.93 | $0.00 | $0.00 | $3,285.46 | $9,500.00 | $36,133.68 | $48,830.21 | $674,379.27 | $674,379.27 | $1,199,944.47 | $525,565.20 | $2,083.97 | |
| 960574373UEF | 5/4/1996 | R | 6/22/2010 | Permanent Partial-Major >25% | Vehicle; motor vehicle | Lower back area (inc. Lumb./Lumb.-Sac.) | Multple injuries (incl phys and psych) | $309,603.04 | $326,508.61 | $141,779.83 | $227,804.28 | $1,726.27 | $1,726.27 | $7,075.95 | $40,540.11 | $26,710.81 | $27,000.00 | $486,895.90 | $486,895.90 | $623,579.27 | $136,683.37 | $0.00 |
| 970379193UEF | 2/27/1997 | O | Death Claim | Passed Out | Multiple head injury | All Other NOS | $23,093.44 | $23,093.44 | $95,260.44 | $319,301.40 | $118,353.88 | $118,353.88 | $342,394.84 | $224,040.96 | $0.00 | |||||||
| 980346970UEF | 12/2/1997 | O | Permanent total disability | Injured by; object being lifted/handled | Vertebrae | Strain | $366,016.64 | $412,717.72 | $358,354.14 | $834,647.70 | $5,388.64 | $5,388.64 | $7,622.27 | $7,622.27 | $403.43 | $1,029.75 | $737,785.12 | $737,785.12 | $1,261,406.08 | $523,620.96 | $0.00 | |
| 980421879UEF | 3/25/1998 | O | Permanent total disability | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Strain | $115,961.96 | $115,961.96 | $134,493.05 | $134,493.05 | $16,117.89 | $16,117.89 | $1,901.47 | $7,500.00 | $268,474.37 | $268,474.37 | $274,072.90 | $5,598.53 | $5,736.08 | |||
| 117050000191 | 3/17/1999 | O | Permanent total disability | Fall; from different level/elevation | Upper back area (Thoracic area) | Fracture | $67,574.95 | $121,420.81 | $105,949.59 | $108,737.46 | $7.90 | $5,000.00 | $173,532.44 | $173,532.44 | $235,158.27 | $61,625.83 | $0.00 | |||||
| 190394UEF | 9/17/2001 | O | Death Claim | Burn; contact | Body system and Mult. Body systems | Burn | $44,874.05 | $44,877.05 | $151,698.96 | $185,646.06 | $548.56 | $551.56 | $197,121.57 | $197,121.57 | $231,074.67 | $33,953.10 | $0.00 | |||||
| 190485UEF | 9/17/2001 | O | Permanent Partial-Major >25% | Misc; other - miscellaneous, | Insufficient info to identify/unclass. | Burn | $137,881.49 | $137,881.49 | $107,893.98 | $163,630.47 | $2,283.53 | $2,283.53 | $3,980.72 | $3,980.72 | $428.86 | $428.86 | $252,468.58 | $252,468.58 | $308,205.07 | $55,736.49 | $0.00 | |
| UE01-90388 | 9/17/2001 | O | Permanent Partial-Major >25% | Injured by; explosion or flare back | Multiple upper extremeties | Burn | $303,212.19 | $303,212.19 | $136,847.61 | $303,712.24 | $701.93 | $701.93 | $0.00 | $0.00 | $5,982.02 | $5,982.02 | $446,743.75 | $446,743.75 | $613,608.38 | $166,864.63 | $0.00 | |
| UE01-98382 | 2/13/2002 | C | 7/10/2013 | Permanent partial | Strain; lifting | Multiple upper extremeties | Strain | $116,657.10 | $116,657.10 | $17,450.40 | $17,450.40 | $16,423.00 | $16,423.00 | $2,296.00 | $2,296.00 | $3,650.40 | $3,650.40 | $156,476.90 | $156,476.90 | $156,476.90 | $0.00 | $0.00 |
| UE03-00028 | 3/3/2002 | O | Permanent partial | Strike; against or stepping on | Knee(s) | Infection | $3,597.09 | $3,597.09 | $9,615.55 | $17,350.20 | $0.00 | $0.00 | $0.00 | $0.00 | $526.70 | $526.70 | $13,739.34 | $13,739.34 | $21,473.99 | $7,734.65 | $0.00 | |
| UE03-00029 | 1/13/2003 | R | 1/5/2005 | Permanent Partial-Major >25% | Strain; pushing or pulling | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $55,791.50 | $55,791.50 | $78,597.53 | $86,721.44 | $13,546.12 | $13,546.12 | $0.00 | $0.00 | $172.48 | $172.48 | $148,107.63 | $148,107.63 | $156,231.54 | $8,123.91 | $0.00 |
| UE04-00036 | 4/11/2003 | C | 6/26/2013 | Permanent Partial-Major >25% | Cut; caught, punctured, scraped, | Finger(s) | VDT - related disease | $3,573.26 | $3,573.26 | $150,036.12 | $150,036.12 | $36,055.47 | $36,055.47 | $230.35 | $230.35 | $189,895.20 | $189,895.20 | $189,895.20 | $0.00 | $0.00 | ||
| UE03-00022 | 7/29/2003 | O | Permanent total disability | Injured by; falling or flying object | Multiple head injury | All Other NOS | $43,553.69 | $43,553.69 | $278,046.29 | $1,115,236.51 | $17,344.77 | $17,344.77 | $1,374.00 | $1,374.00 | $11,304.33 | $11,304.33 | $351,623.08 | $351,623.08 | $1,188,813.30 | $837,190.22 | $113,937.64 | |
| UE04-00025 | 2/15/2004 | C | 2/20/2013 | Permanent partial | Injured by; Another Person | Facial bones | Fracture | $18,027.35 | $18,027.35 | $800.00 | $800.00 | $110.00 | $110.00 | $5.50 | $5.50 | $18,942.85 | $18,942.85 | $18,942.85 | $0.00 | $0.00 | ||
| 077050000062 | 9/20/2004 | O | Permanent partial | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $36,758.40 | $54,971.84 | $64,938.09 | $91,366.89 | $0.00 | $3,000.00 | $431.50 | $431.50 | $14,955.73 | $17,714.71 | $117,083.72 | $117,083.72 | $167,484.94 | $50,401.22 | $0.00 | |
| UE05-00015 | 12/17/2004 | C | 7/15/2013 | Permanent partial | Fall, slip or trip, | Knee(s) | Sprain | $27,407.76 | $27,407.76 | $49,292.52 | $49,292.52 | $0.00 | $0.00 | $0.00 | $0.00 | $8.25 | $8.25 | $76,708.53 | $76,708.53 | $76,708.53 | $0.00 | $0.00 |
| UE05-00014 | 1/30/2005 | O | Permanent partial | Injured by; moving parts of machine | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $82,810.32 | $82,810.32 | $70,411.60 | $78,085.55 | $0.00 | $0.00 | $1,918.56 | $1,918.56 | $155,140.48 | $155,140.48 | $162,814.43 | $7,673.95 | $0.00 | |||
| UE05-00060 | 9/9/2005 | C | 9/3/2013 | Permanent Partial-Major >25% | Injured by; object being lifted/handled | Upper arm(s) | Amputation | $209,287.67 | $209,287.67 | $200,849.00 | $200,849.00 | $0.00 | $0.00 | $0.00 | $0.00 | $6,975.95 | $6,975.95 | $417,112.62 | $417,112.62 | $417,112.62 | $0.00 | $0.00 |
| UE06-00002 | 12/12/2005 | R | 5/29/2007 | Permanent Partial-Major >25% | Vehicle; motor vehicle | Multiple upper extremeties | Multiple physical injuries only | $85,812.30 | $85,812.30 | $150,777.00 | $176,213.88 | $3,559.92 | $3,559.92 | $1,611.14 | $1,611.14 | $241,760.36 | $241,760.36 | $267,197.24 | $25,436.88 | $813.01 | ||
| UE06-00033 | 3/20/2006 | C | 5/14/2013 | Permanent partial | Fall, slip or trip, | Multiple upper extremeties | Strain | $39,185.93 | $39,185.93 | $25,001.46 | $25,001.46 | $10,306.15 | $10,306.15 | $0.00 | $0.00 | $6,946.00 | $6,946.00 | $81,439.54 | $81,439.54 | $81,439.54 | $0.00 | $18.49 |
| 077050000077 | 5/10/2007 | O | Permanent partial | Strike; object being lifted or handled | Multiple head injury | Head Trauma | $14,083.64 | $15,241.19 | $8,154.04 | $21,457.60 | $1,435.75 | $1,435.75 | $23,673.43 | $23,673.43 | $38,134.54 | $14,461.11 | $0.00 | |||||
| 117050000201 | 9/18/2008 | O | Permanent partial | Injured by; falling or flying object | Multiple body parts | Multiple physical injuries only | $43,336.06 | $50,000.00 | $12,714.34 | $47,903.80 | $0.00 | $10.00 | $56,050.40 | $56,050.40 | $97,913.80 | $41,863.40 | $0.00 | |||||
| 097050001163 | 1/6/2009 | C | 7/12/2013 | Permanent partial | Strike; moving parts of machine | Wrist and hand (left) | Fracture | $30,741.00 | $30,741.00 | $68,758.00 | $68,758.00 | $12,892.70 | $12,892.70 | $2,931.54 | $2,931.54 | $115,323.24 | $115,323.24 | $115,323.24 | $0.00 | $1,774.71 | ||
| 127050000178 | 2/23/2009 | O | Permanent partial | Injured by; hand tool or machine in use | Eye (right) | Rupture | $2,259.39 | $19,720.09 | $0.00 | $26,580.31 | $8.25 | $8.25 | $2,267.64 | $2,267.64 | $46,308.65 | $44,041.01 | $0.00 | |||||
| 107050000531 | 10/23/2009 | O | Temporary total disability | Fall, slip or trip, | Lower back area (inc. Lumb./Lumb.-Sac.) | PAIN | $11,963.64 | $23,000.00 | $20,416.44 | $25,416.44 | $400.00 | $400.00 | $2,679.53 | $3,500.00 | $35,459.61 | $35,459.61 | $52,316.44 | $16,856.83 | $0.00 | |||
| 107050000131 | 11/13/2009 | C | 10/1/2013 | Permanent partial | Fall; from ladder or scaffolding | Lower leg (right) | Fracture | $19,778.26 | $19,778.26 | $35,200.54 | $35,200.54 | $12,021.38 | $12,021.38 | $7.25 | $7.25 | $67,007.43 | $67,007.43 | $67,007.43 | $0.00 | $0.00 | ||
| 117050000188 | 3/14/2010 | C | 1/2/2013 | Permanent partial | Cut; broken glass | Soft tissue neck | Laceration | $13,382.71 | $13,382.71 | $11,088.08 | $11,088.08 | $7.90 | $7.90 | $24,478.69 | $24,478.69 | $24,478.69 | $0.00 | $0.00 | ||||
| 117050000214 | 8/13/2010 | C | 1/8/2013 | Permanent partial | Strain; lifting | Lower back area (inc. Lumb./Lumb.-Sac.) | Strain | $24,003.10 | $24,003.10 | $42,760.42 | $42,760.42 | $911.04 | $911.04 | $3,250.75 | $3,250.75 | $70,925.31 | $70,925.31 | $70,925.31 | $0.00 | $0.00 |
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File details come from the government source that posted it. Updated .