ESBD_379720_1729031411097_Attachment H - STD LTD Claim Status 9.1.23-8.31.24_Claim Status Report.xlsx
XLSX spreadsheet 58 KB Posted
- Solicitation number
- 2510-006
- Issued by
- Travis County, Austin City, Texas
About this file
This document is a claim status report for long-term and short-term disability insurance coverage for the Travis County Healthcare District. The report details the claim status, coverage type, claim number, employee information, disability dates, return-to-work dates, claim end dates, and benefit information for 12 long-term disability claims and 128 short-term disability claims for the period of September 1, 2023 to August 31, 2024. The report indicates the total cumulative gross benefit for long-term disability claims is $553,555.07 and for short-term disability claims is $456,790.07.
The report provides comprehensive data on the status of each disability claim, including claim status, coverage type, claim number, employee details, disability dates, return-to-work dates, claim end dates, and benefit information. This information allows the Travis County Healthcare District to monitor and manage their disability insurance coverage and claims.
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Text version
STD LTD Claim Status 9.1.23-8.3
| TRAVIS COUNTY HEALTHCARE DISTRICT | ||
| Claim Status Detail | ||
| Data as of: 08/29/2024 | From: 09/01/2023 | To: 08/31/2024 |
| Customer: 5924797 | ||
| Report Parameters: | ||
| Customer Number: | 5924797 | |
| Group / Report: | All |
Subcode: All
Branch / Paypoint: All
| Coverage Type: | L, S | |
| Organized By: | Customer Number | |
| ***If this is the only page you received please return to Edit this Report Package and review your parameter selections from the 'Re-run the Report Package Wizard' option. | ||
| 9/4/2024 10:09:53 PM | Page 1 of 3 |
| TRAVIS COUNTY HEALTHCARE DISTRICT | ||
| Claim Status Detail | ||
| Long Term Disability | ||
| Data as of: 08/29/2024 | From: 09/01/2023 | To: 08/31/2024 |
| Customer: 5924797 |
| As of Date | From Date | To Date | Customer Name | Customer Number | Report Number | Subcode | Paypoint | Plan Code | Coverage Type | Claim Number | Employee ID | Years Of Service | State Worked | Claim Status | Gender | Claimant Age - Years | Acc/Sick | Occ/Non-Occ | WC Filed | Last Day Worked | Return to Work Date | Disability Date | Received Date | Approved Date | Denied Date | Inactive Reason Description | Benefit Start Date | Claim End Date | Claim End Code | Claim End Description | Closed Date | Base Benefit | Cumulative Gross Benefit |
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 662407128866 | 2 | TX | Denied | F | 29 | S | N | N | 5/24/2024 | 5/27/2024 | 7/12/2024 | 7/18/2024 | DCLN-CLAIM ABANDONED | 11/23/2024 | 5/27/2024 | 08 | OTHER INFO NOT RECEIVED | $2,373.30 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 701806041090 | 1 | TX | Open | F | 40 | S | N | N | 11/22/2017 | 11/26/2017 | 6/4/2018 | 6/6/2018 | Unknown | 5/27/2018 | 1/22/2042 | 97 | REACHED MAX DURATION | 3/3/2021 | $1,740.96 | $52,804.25 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 702404160350 | 3 | TX | Open | M | 59 | S | N | N | 11/28/2023 | 11/29/2023 | 4/16/2024 | 4/24/2024 | Unknown | 5/29/2024 | 5/28/2026 | 13 | UNDER INVESTIGATION | $3,583.84 | $11,109.90 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 722206061773 | 16 | TX | Closed | F | 61 | S | N | N | 1/14/2022 | 1/17/2022 | 6/6/2022 | 7/28/2022 | Unknown | 7/18/2022 | 1/22/2024 | D1 | DEATH/LUMP SUM SURVIVOR | 4/3/2024 | $2,692.56 | $48,914.84 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 722208171733 | 5 | TX | Open | F | 61 | S | N | N | 3/25/2022 | 3/26/2022 | 8/17/2022 | 9/26/2022 | Unknown | 9/24/2022 | 9/23/2026 | 97 | REACHED MAX DURATION | $4,954.49 | $54,199.27 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 722307120713 | 5 | TX | Open | F | 61 | S | N | N | 1/4/2023 | 2/14/2023 | 7/12/2023 | 8/18/2023 | Unknown | 8/15/2023 | 8/16/2025 | 01 | NEED MEDICAL/UPDATE INFO | $3,407.05 | $40,884.60 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 722403010903 | 22 | TX | Suspended | F | 41 | S | N | N | 10/13/2023 | 10/14/2023 | 3/1/2024 | 5/14/2024 | Unknown | 4/13/2024 | 7/12/2024 | 07 | NEED OTHER INFO | $4,399.99 | $13,199.97 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 732004130405 | 0 | TX | Open | F | 56 | S | N | N | 10/16/2019 | 10/17/2019 | 4/13/2020 | 6/24/2020 | Unknown | 5/6/2020 | 9/17/2028 | 97 | REACHED MAX DURATION | $5,941.03 | $192,884.56 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 732303280925 | 6 | TX | Closed | F | 35 | S | N | N | 11/8/2022 | 4/22/2024 | 11/9/2022 | 3/28/2023 | 5/9/2023 | Unknown | 5/10/2023 | 4/21/2024 | 98 | RETURNED TO WORK | 5/10/2024 | $6,000.00 | $72,000.00 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 742204250068 | 1 | TX | Closed | F | 60 | S | N | N | 8/12/2021 | 8/13/2021 | 4/25/2022 | 5/13/2022 | Unknown | 2/25/2022 | 1/13/2024 | 54 | SETTLEMENT | 1/16/2024 | $3,396.22 | $30,884.96 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 742309061267 | 1 | TX | Closed | F | 59 | S | N | N | 4/19/2023 | 4/20/2023 | 9/6/2023 | 9/11/2023 | Unknown | 10/19/2023 | 7/7/2024 | D3 | DEATH/NO ELIGIBLE SURVIVOR | 7/25/2024 | $3,408.08 | $30,672.72 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 742406220818 | 0 | TX | Open | F | 60 | S | N | N | 1/15/2024 | 1/16/2024 | 6/22/2024 | 7/9/2024 | Unknown | 7/16/2024 | 7/15/2026 | 13 | UNDER INVESTIGATION | $6,000.00 | $6,000.00 | ||||
| Total Claims for Customer 5924797 : 12 | Sum of Gross Benefit for Customer 5924797 : $553,555.07 | ||||||||||||||||||||||||||||||||
| 9/4/2024 10:09:53 PM | Page 2 of 3 |
| TRAVIS COUNTY HEALTHCARE DISTRICT | ||
| Claim Status Detail | ||
| Short Term Disability | ||
| Data as of: 08/29/2024 | From: 09/01/2023 | To: 08/31/2024 |
| Customer: 5924797 |
| As of Date | From Date | To Date | Customer Name | Customer Number | Report Number | Subcode | Paypoint | Plan Code | Coverage Type | Claim Number | Employee ID | Years Of Service | State Worked | Claim Status | Gender | Claimant Age - Years | Acc/Sick | Occ/Non-Occ | WC Filed | Last Day Worked | Return to Work Date | Disability Date | Received Date | Approved Date | Denied Date | Inactive Reason Description | Benefit Start Date | Claim End Date | Claim End Code | Claim End Description | Closed Date | Base Benefit | Cumulative Gross Benefit |
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 202403118233 | 8 | TX | Closed | F | 28 | S | N | 3/8/2024 | 3/9/2024 | 3/11/2024 | 3/14/2024 | Unknown | 3/23/2024 | 4/19/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 4/23/2024 | $673.68 | $2,694.72 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 202406108440 | 2 | TX | Denied | F | 29 | S | N | 5/24/2024 | 7/17/2024 | 5/27/2024 | 6/10/2024 | 6/19/2024 | DCLN-CLOSED DUPLICATE | 6/10/2024 | 5/27/2024 | 61 | OTHER | $547.69 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 212406198799 | 8 | TX | Closed | F | 33 | S | N | 5/31/2024 | 6/3/2024 | 6/19/2024 | 6/25/2024 | Unknown | 6/17/2024 | 7/29/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 7/30/2024 | $524.89 | $3,224.32 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 222309068356 | 0 | TX | Denied | F | 27 | S | N | 8/31/2023 | 9/1/2023 | 9/6/2023 | 9/8/2023 | 10/30/2023 | DCLN-CLOSED DUPLICATE | 9/15/2023 | 9/2/2023 | 61 | OTHER | $510.00 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 222311278388 | 0 | TX | Closed | F | 38 | S | N | 9/3/2023 | 10/9/2023 | 9/4/2023 | 11/27/2023 | 12/6/2023 | Unknown | 9/18/2023 | 10/8/2023 | 98 | RETURNED TO WORK | 12/6/2023 | $482.40 | $1,447.20 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 232310108659 | 3 | TX | Closed | F | 23 | S | N | 9/28/2023 | 9/29/2023 | 10/10/2023 | 10/17/2023 | Unknown | 10/13/2023 | 11/16/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 11/21/2023 | $560.64 | $2,803.20 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 232310258296 | 3 | TX | Closed | F | 45 | S | N | 10/13/2023 | 11/6/2023 | 10/14/2023 | 10/25/2023 | 11/1/2023 | Unknown | 10/28/2023 | 11/5/2023 | 98 | RETURNED TO WORK | 11/9/2023 | $1,180.85 | $1,518.24 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 242312118904 | 1 | TX | Closed | F | 39 | S | N | 12/5/2023 | 12/6/2023 | 12/11/2023 | 12/20/2023 | Unknown | 12/20/2023 | 1/30/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/30/2024 | $489.84 | $2,939.04 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 242404178615 | 5 | TX | Closed | F | 32 | S | N | 3/19/2024 | 5/2/2024 | 3/20/2024 | 4/17/2024 | 4/29/2024 | Unknown | 4/3/2024 | 5/1/2024 | 98 | RETURNED TO WORK | 5/2/2024 | $567.60 | $2,351.49 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 242406148658 | 4 | TX | Closed | F | 36 | S | N | 6/11/2024 | 6/12/2024 | 6/14/2024 | 6/19/2024 | Unknown | 6/26/2024 | 7/23/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 7/23/2024 | $1,400.00 | $5,600.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 252403188466 | 2 | TX | Closed | F | 29 | S | N | 3/13/2024 | 6/5/2024 | 3/14/2024 | 3/18/2024 | 3/25/2024 | Unknown | 3/28/2024 | 5/9/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 5/14/2024 | $537.84 | $3,303.88 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 252407198813 | 0 | TX | Denied | F | 37 | S | N | 7/10/2024 | 7/16/2024 | 7/19/2024 | 8/14/2024 | DCLN-PRE-EXISTING CONDITION | 7/30/2024 | 7/11/2024 | 61 | OTHER | $576.00 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 262309138637 | 6 | TX | Closed | F | 28 | S | N | 9/8/2023 | 10/24/2023 | 9/9/2023 | 9/13/2023 | 9/18/2023 | Unknown | 9/23/2023 | 10/20/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 10/24/2023 | $592.80 | $2,371.20 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 262403268805 | 3 | TX | Closed | F | 23 | S | N | 3/19/2024 | 5/1/2024 | 3/20/2024 | 3/26/2024 | 4/2/2024 | Unknown | 4/3/2024 | 4/30/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 4/30/2024 | $523.69 | $2,094.76 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 262406268069 | 3 | TX | Closed | F | 25 | S | N | 5/31/2024 | 6/1/2024 | 6/26/2024 | 7/11/2024 | Unknown | 6/15/2024 | 8/1/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 8/6/2024 | $537.84 | $3,688.05 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 272406188766 | 0 | TX | Closed | F | 45 | S | N | 6/9/2024 | 7/16/2024 | 6/13/2024 | 6/18/2024 | 7/5/2024 | Unknown | 6/27/2024 | 7/14/2024 | 98 | RETURNED TO WORK | 7/16/2024 | $1,400.00 | $3,600.00 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292305036082 | 6 | TX | Closed | F | 33 | S | N | 6/16/2023 | 6/19/2023 | 5/2/2023 | 7/21/2023 | Unknown | 7/3/2023 | 9/2/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 9/5/2023 | $460.80 | $4,081.37 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292305196964 | 1 | TX | Closed | F | 59 | S | N | 4/19/2023 | 4/20/2023 | 5/18/2023 | 6/2/2023 | Unknown | 5/4/2023 | 10/18/2023 | 97 | REACHED MAX DURATION | 10/18/2023 | $786.48 | $18,875.52 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292307206645 | 3 | TX | Denied | F | 39 | S | N | 7/20/2023 | 7/21/2023 | 7/19/2023 | 12/1/2023 | DCLN-INITIAL DENIAL | 8/4/2023 | 7/21/2023 | 08 | OTHER INFO NOT RECEIVED | $0.01 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292307266282 | 3 | TX | Closed | F | 64 | S | N | N | 7/25/2023 | 9/7/2023 | 7/26/2023 | 7/25/2023 | 8/2/2023 | Unknown | 8/9/2023 | 9/6/2023 | 98 | RETURNED TO WORK | 9/6/2023 | $592.32 | $2,453.90 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292307266284 | 0 | TX | Closed | F | 32 | S | N | 7/21/2023 | 7/22/2023 | 7/25/2023 | 8/2/2023 | Unknown | 8/5/2023 | 9/19/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 9/19/2023 | $986.40 | $6,482.06 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292307316737 | 3 | TX | Closed | M | 29 | S | N | 7/27/2023 | 9/11/2023 | 7/28/2023 | 7/28/2023 | 8/3/2023 | Unknown | 8/11/2023 | 9/10/2023 | 98 | RETURNED TO WORK | 9/20/2023 | $510.00 | $2,768.57 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292308016903 | 14 | TX | Closed | F | 42 | S | N | 7/13/2023 | 7/19/2023 | 7/31/2023 | 8/3/2023 | Unknown | 8/2/2023 | 11/26/2023 | 92 | MODIFIED RTW | 11/30/2023 | $1,400.00 | $23,400.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292308096721 | 5 | TX | Closed | F | 44 | S | N | N | 9/1/2023 | 10/30/2023 | 9/4/2023 | 8/8/2023 | 9/27/2023 | 8/28/2023 | Unknown | 9/18/2023 | 10/29/2023 | 98 | RETURNED TO WORK | 10/31/2023 | $1,400.00 | $8,400.00 | |
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292308106915 | 3 | TX | Closed | F | 29 | S | N | N | 8/3/2023 | 10/27/2023 | 8/4/2023 | 8/9/2023 | 8/17/2023 | Unknown | 8/18/2023 | 9/17/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 9/19/2023 | $597.60 | $2,646.51 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292308166527 | 1 | TX | Closed | F | 23 | S | N | 8/8/2023 | 8/21/2023 | 8/15/2023 | 9/8/2023 | Unknown | 9/4/2023 | 10/13/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 10/17/2023 | $521.76 | $2,981.49 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292308176670 | 8 | TX | Closed | F | 64 | S | N | 7/25/2023 | 12/4/2023 | 7/27/2023 | 8/16/2023 | 8/21/2023 | Unknown | 8/10/2023 | 12/1/2023 | 98 | RETURNED TO WORK | 12/11/2023 | $812.16 | $13,226.60 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292308216941 | 1 | TX | Closed | F | 35 | S | N | 8/18/2023 | 8/20/2023 | 8/18/2023 | 8/28/2023 | Unknown | 9/3/2023 | 10/14/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 10/17/2023 | $1,400.00 | $8,400.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292308286753 | 1 | TX | Denied | F | 35 | S | N | 8/18/2023 | 8/19/2023 | 8/26/2023 | 8/31/2023 | 9/15/2023 | DCLN-CLOSED DUPLICATE | 9/2/2023 | 8/19/2023 | 61 | OTHER | $1,400.00 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292309056496 | 13 | TX | Closed | F | 34 | S | N | 8/25/2023 | 8/26/2023 | 9/1/2023 | 9/12/2023 | Unknown | 9/9/2023 | 10/6/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 10/10/2023 | $885.60 | $3,542.40 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292309066712 | 0 | TX | Denied | F | 27 | S | N | 8/31/2023 | 9/1/2023 | 9/5/2023 | 10/14/2023 | DCLN-CLOSED DUPLICATE | 9/15/2023 | 9/1/2023 | 01 | NEED MEDICAL/UPDATE INFO | $510.00 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292309066732 | 0 | TX | Closed | F | 27 | S | N | 8/31/2023 | 9/1/2023 | 9/5/2023 | 9/11/2023 | Unknown | 9/15/2023 | 10/12/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 10/17/2023 | $510.00 | $2,040.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292309186187 | 4 | TX | Closed | F | 28 | S | N | 9/20/2023 | 9/21/2023 | 9/15/2023 | 9/21/2023 | Unknown | 10/5/2023 | 11/1/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 11/3/2023 | $567.60 | $2,432.57 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292309286564 | 0 | TX | Denied | F | 29 | S | N | 9/15/2023 | 9/20/2023 | 9/27/2023 | 10/10/2023 | DCLN-PRE-EXISTING CONDITION | 10/4/2023 | 9/20/2023 | 61 | OTHER | $1,378.85 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292310046176 | 8 | TX | Closed | F | 38 | S | N | 10/16/2023 | 10/17/2023 | 10/3/2023 | 11/4/2023 | Unknown | 10/31/2023 | 11/28/2023 | 63 | NO RTW DATE FROM CUSTOMER | 12/9/2023 | $670.31 | $2,777.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292310066558 | 2 | TX | Closed | F | 30 | S | N | 10/3/2023 | 10/4/2023 | 10/5/2023 | 11/4/2023 | Unknown | 10/18/2023 | 11/14/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 11/14/2023 | $592.08 | $2,368.32 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292310096627 | 0 | TX | Denied | F | 39 | S | N | 9/3/2023 | 9/7/2023 | 10/6/2023 | 1/22/2024 | DCLN-CLOSED DUPLICATE | 9/21/2023 | 9/7/2023 | 61 | OTHER | $482.40 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292310096675 | 3 | TX | Denied | F | 23 | S | N | 9/28/2023 | 9/29/2023 | 10/6/2023 | 12/7/2023 | DCLN-CLOSED DUPLICATE | 10/13/2023 | 9/29/2023 | 61 | OTHER | $560.64 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292310176701 | 1 | TX | Denied | F | 61 | S | N | 10/5/2023 | 10/16/2023 | 10/6/2023 | 10/16/2023 | 12/3/2023 | DCLN-WAITING PRD NOT SATISFIED | 10/20/2023 | 10/15/2023 | 98 | RETURNED TO WORK | $634.80 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292310176710 | 1 | TX | Closed | F | 24 | S | N | 10/12/2023 | 10/13/2023 | 10/16/2023 | 11/13/2023 | Unknown | 10/27/2023 | 11/23/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 11/28/2023 | $597.36 | $2,389.44 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292310196000 | 16 | TX | Closed | F | 56 | S | N | 10/27/2023 | 1/8/2024 | 10/30/2023 | 10/18/2023 | 12/1/2023 | Unknown | 11/13/2023 | 1/7/2024 | 98 | RETURNED TO WORK | 1/19/2024 | $737.28 | $5,898.24 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292310266933 | 5 | TX | Closed | F | 30 | S | N | 10/20/2023 | 10/23/2023 | 10/26/2023 | 11/2/2023 | Unknown | 11/6/2023 | 12/19/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 12/19/2023 | $605.52 | $3,756.70 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292310316226 | 0 | TX | Closed | F | 27 | S | N | 10/27/2023 | 10/30/2023 | 10/30/2023 | 11/6/2023 | Unknown | 11/13/2023 | 12/10/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 12/22/2023 | $1,007.30 | $4,029.20 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292311026572 | 22 | TX | Closed | F | 41 | S | N | 10/13/2023 | 10/14/2023 | 11/1/2023 | 11/7/2023 | Unknown | 10/28/2023 | 4/12/2024 | 97 | REACHED MAX DURATION | 4/16/2024 | $1,015.39 | $24,369.36 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292311086320 | 4 | TX | Closed | F | 35 | S | N | N | 11/12/2023 | 11/13/2023 | 11/8/2023 | 11/20/2023 | Unknown | 11/27/2023 | 12/24/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 12/26/2023 | $1,176.92 | $4,707.68 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292311146857 | 0 | TX | Closed | F | 28 | S | N | 11/13/2023 | 11/14/2023 | 11/13/2023 | 11/22/2023 | Unknown | 11/28/2023 | 12/26/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 12/26/2023 | $523.44 | $2,168.53 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292311286233 | 7 | TX | Closed | F | 33 | S | N | 11/13/2023 | 11/14/2023 | 11/27/2023 | 12/6/2023 | Unknown | 11/28/2023 | 12/26/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 12/26/2023 | $924.23 | $3,828.96 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292312046917 | 4 | TX | Closed | F | 34 | S | N | 11/22/2023 | 11/23/2023 | 12/1/2023 | 12/18/2023 | Unknown | 12/7/2023 | 2/13/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 2/13/2024 | $546.96 | $5,391.46 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292312056193 | 2 | TX | Closed | F | 33 | S | N | 12/1/2023 | 12/4/2023 | 12/5/2023 | 12/12/2023 | Unknown | 12/18/2023 | 1/14/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/16/2024 | $737.28 | $2,949.12 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292312086566 | 1 | TX | Closed | F | 39 | S | N | 12/6/2023 | 12/7/2023 | 12/7/2023 | 12/15/2023 | Unknown | 12/21/2023 | 1/30/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/30/2024 | $489.84 | $2,869.06 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292312086574 | 7 | TX | Closed | F | 55 | S | N | N | 12/11/2023 | 1/17/2024 | 12/12/2023 | 12/7/2023 | 12/27/2023 | Unknown | 12/26/2023 | 1/16/2024 | 98 | RETURNED TO WORK | 1/16/2024 | $534.00 | $1,678.28 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292312086581 | 1 | TX | Closed | F | 39 | S | N | 12/5/2023 | 12/6/2023 | 12/7/2023 | 12/15/2023 | Unknown | 12/20/2023 | 1/30/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/30/2024 | $489.84 | $2,939.04 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292312136061 | 13334939 | 7 | TX | Denied | F | 55 | S | N | 12/11/2023 | 12/12/2023 | 12/12/2023 | 12/19/2023 | DCLN-CLOSED DUPLICATE | 12/26/2023 | 12/19/2023 | 61 | OTHER | $534.00 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292312206958 | 3 | TX | Closed | M | 59 | S | N | 11/28/2023 | 11/29/2023 | 12/19/2023 | 12/28/2023 | Unknown | 12/13/2023 | 5/28/2024 | 97 | REACHED MAX DURATION | 5/28/2024 | $827.04 | $19,848.96 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292312286620 | 3 | TX | Closed | F | 26 | S | N | 12/8/2023 | 12/9/2023 | 12/27/2023 | 1/4/2024 | Unknown | 12/23/2023 | 1/19/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/23/2024 | $540.72 | $2,162.88 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292401056348 | 5 | TX | Closed | F | 25 | S | N | 1/3/2024 | 1/4/2024 | 1/4/2024 | 1/16/2024 | Unknown | 1/18/2024 | 2/14/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 2/14/2024 | $523.68 | $2,094.72 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292401096642 | 11 | TX | Closed | F | 63 | S | N | 12/12/2023 | 12/13/2023 | 1/8/2024 | 1/11/2024 | Unknown | 12/27/2023 | 1/22/2024 | D4 | DEATH/NO BENEFITS DUE | 2/27/2024 | $658.56 | $5,080.32 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292401096643 | 11 | TX | Denied | F | 63 | S | N | 12/12/2023 | 12/13/2023 | 1/8/2024 | 1/11/2024 | DCLN-CLOSED DUPLICATE | 12/27/2023 | 12/13/2023 | 61 | OTHER | $658.56 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292402086234 | 0 | TX | Closed | F | 60 | S | N | 1/15/2024 | 1/16/2024 | 2/8/2024 | 2/28/2024 | Unknown | 1/30/2024 | 7/15/2024 | 97 | REACHED MAX DURATION | 7/15/2024 | $1,400.00 | $33,600.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292402086306 | 112464 | 0 | TX | Closed | F | 62 | S | N | 1/8/2024 | 1/29/2024 | 1/9/2024 | 2/8/2024 | 2/21/2024 | Unknown | 1/23/2024 | 1/28/2024 | 98 | RETURNED TO WORK | 2/21/2024 | $982.56 | $842.19 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292402136744 | 0 | TX | Closed | F | 35 | S | N | 5/8/2024 | 5/10/2024 | 2/13/2024 | 5/20/2024 | Unknown | 5/24/2024 | 6/20/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 6/20/2024 | $969.60 | $3,878.40 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292402216657 | 0 | TX | Closed | M | 30 | A | N | N | 1/17/2024 | 4/22/2024 | 1/18/2024 | 2/20/2024 | 2/29/2024 | Unknown | 2/1/2024 | 4/21/2024 | 98 | RETURNED TO WORK | 4/22/2024 | $1,400.00 | $16,200.00 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292402236954 | 2 | TX | Closed | M | 48 | A | N | 8/18/2023 | 10/16/2024 | 8/20/2023 | 2/22/2024 | 3/6/2024 | Unknown | 9/3/2023 | 10/14/2023 | 98 | RETURNED TO WORK | 3/6/2024 | $711.84 | $4,271.04 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292402266144 | 2 | TX | Closed | F | 47 | S | N | 1/19/2024 | 2/8/2024 | 1/22/2024 | 2/23/2024 | 3/1/2024 | Unknown | 2/5/2024 | 2/7/2024 | 98 | RETURNED TO WORK | 3/22/2024 | $590.40 | $1,265.14 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292402286499 | 5 | TX | Closed | F | 49 | S | N | N | 2/27/2024 | 4/15/2024 | 2/28/2024 | 2/27/2024 | 3/1/2024 | Unknown | 3/13/2024 | 4/14/2024 | 98 | RETURNED TO WORK | 3/26/2024 | $870.65 | $4,104.49 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292402286500 | 5 | TX | Denied | F | 49 | S | N | 2/27/2024 | 2/28/2024 | 2/27/2024 | 3/1/2024 | DCLN-CLOSED DUPLICATE | 3/13/2024 | 2/28/2024 | 61 | OTHER | $870.65 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403046009 | 0 | TX | Closed | F | 23 | S | N | N | 4/30/2024 | 5/1/2024 | 3/1/2024 | 5/6/2024 | Unknown | 5/15/2024 | 6/25/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 6/25/2024 | $485.76 | $2,914.56 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403066498 | 5 | TX | Denied | F | 49 | S | N | 2/26/2024 | 2/28/2024 | 3/6/2024 | 3/11/2024 | DCLN-CLOSED DUPLICATE | 3/13/2024 | 2/28/2024 | 61 | OTHER | $870.65 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403086805 | 41292336 | 6 | TX | Closed | F | 35 | S | N | 3/5/2024 | 3/6/2024 | 3/8/2024 | 3/26/2024 | Unknown | 3/20/2024 | 5/2/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 5/7/2024 | $614.40 | $3,861.95 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403156622 | 24 | TX | Closed | F | 63 | S | N | N | 4/4/2024 | 5/23/2024 | 4/5/2024 | 3/14/2024 | 4/22/2024 | Unknown | 4/19/2024 | 5/22/2024 | 98 | RETURNED TO WORK | 5/22/2024 | $1,186.32 | $4,846.96 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403196940 | 5 | TX | Closed | F | 31 | S | N | 3/15/2024 | 3/16/2024 | 3/18/2024 | 3/26/2024 | Unknown | 3/30/2024 | 5/11/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 5/14/2024 | $543.12 | $3,336.31 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403256531 | 2 | TX | Denied | F | 29 | S | N | 3/12/2024 | 3/13/2024 | 3/22/2024 | 4/2/2024 | DCLN-CLOSED DUPLICATE | 3/27/2024 | 3/13/2024 | 61 | OTHER | $537.84 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292403266680 | 2 | TX | Denied | F | 29 | S | N | 5/24/2024 | 5/27/2024 | 3/25/2024 | 7/11/2024 | DCLN-PRE-EXISTING CONDITION | 6/10/2024 | 5/27/2024 | 61 | OTHER | $547.69 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403266754 | 0 | TX | Closed | F | 63 | S | N | 3/16/2024 | 4/8/2024 | 3/18/2024 | 3/22/2024 | 5/9/2024 | Unknown | 4/1/2024 | 4/7/2024 | 02 | MED UPDATE/INFO NOT RECEIVED | 5/28/2024 | $982.56 | $982.56 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403276861 | 0 | TX | Closed | F | 38 | S | N | 4/25/2024 | 4/26/2024 | 3/26/2024 | 4/29/2024 | Unknown | 5/10/2024 | 6/26/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 6/26/2024 | $333.71 | $2,288.30 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292403276872 | 3 | TX | Denied | F | 23 | S | N | 3/20/2024 | 3/21/2024 | 3/26/2024 | 4/3/2024 | DCLN-CLOSED DUPLICATE | 4/4/2024 | 4/3/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | $523.68 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292404036670 | 0 | TX | Denied | F | 29 | S | N | 2/18/2024 | 2/19/2024 | 4/2/2024 | 4/9/2024 | DCLN-WAITING PRD NOT SATISFIED | 3/4/2024 | 2/20/2024 | 01 | NEED MEDICAL/UPDATE INFO | $492.00 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292404046806 | 4 | TX | Closed | F | 24 | S | N | 3/26/2024 | 4/17/2024 | 3/27/2024 | 4/3/2024 | 4/9/2024 | Unknown | 4/10/2024 | 4/16/2024 | 98 | RETURNED TO WORK | 4/23/2024 | $490.80 | $841.37 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292404056941 | 4 | TX | Closed | F | 31 | S | N | 6/13/2024 | 6/14/2024 | 4/4/2024 | 6/18/2024 | Unknown | 6/28/2024 | 7/25/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 7/30/2024 | $1,087.19 | $4,348.76 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292404156989 | 4 | TX | Closed | F | 45 | S | N | 3/20/2024 | 8/26/2024 | 3/21/2024 | 4/12/2024 | 4/29/2024 | Unknown | 4/4/2024 | 8/25/2024 | 98 | RETURNED TO WORK | 8/9/2024 | $902.27 | $14,371.69 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292404176238 | 8 | TX | Closed | F | 37 | S | N | 4/12/2024 | 4/13/2024 | 4/16/2024 | 5/5/2024 | Unknown | 4/27/2024 | 5/23/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 5/28/2024 | $1,400.00 | $5,400.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292404186498 | 3 | TX | Closed | F | 31 | S | N | 4/4/2024 | 4/5/2024 | 4/17/2024 | 4/25/2024 | Unknown | 4/19/2024 | 5/31/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 6/4/2024 | $837.80 | $5,146.49 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292404186508 | 2 | TX | Denied | F | 32 | S | N | 3/19/2024 | 3/20/2024 | 4/17/2024 | 4/25/2024 | DCLN-CLOSED DUPLICATE | 4/3/2024 | 3/20/2024 | 61 | OTHER | $567.60 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292404236936 | 5 | TX | Suspended | F | 63 | S | N | 4/19/2024 | 4/22/2024 | 4/22/2024 | 5/30/2024 | 5/28/2024 | Unknown | 5/6/2024 | 7/21/2024 | 01 | NEED MEDICAL/UPDATE INFO | $1,400.00 | $15,400.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405016926 | 112253 | 1 | TX | Closed | F | 34 | S | N | 4/25/2024 | 4/26/2024 | 4/30/2024 | 5/15/2024 | Unknown | 5/10/2024 | 6/9/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 6/11/2024 | $1,400.00 | $6,200.00 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405036307 | 2521927 | 0 | TX | Pending | F | 23 | S | N | 6/19/2024 | 6/20/2024 | 5/3/2024 | PEND-NEED CLAIMANT INFORMATION | 7/4/2024 | 6/20/2024 | 01 | NEED MEDICAL/UPDATE INFO | $0.01 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405066405 | 4 | TX | Closed | F | 35 | S | N | 4/26/2024 | 5/1/2024 | 5/3/2024 | 5/20/2024 | Unknown | 5/15/2024 | 6/24/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 6/25/2024 | $469.80 | $2,751.68 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405066409 | 4 | TX | Denied | F | 38 | S | N | 4/24/2024 | 4/25/2024 | 5/8/2024 | 5/8/2024 | 5/26/2024 | DCLN-CLOSED DUPLICATE | 5/9/2024 | 6/5/2024 | 01 | NEED MEDICAL/UPDATE INFO | $667.44 | $1,716.27 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405076634 | 10 | TX | Closed | F | 30 | S | N | 5/3/2024 | 5/4/2024 | 5/6/2024 | 5/9/2024 | Unknown | 5/18/2024 | 6/14/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 6/18/2024 | $554.64 | $2,218.56 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405076729 | 1 | TX | Denied | F | 34 | S | N | 5/3/2024 | 5/8/2024 | 5/6/2024 | 5/9/2024 | DCLN-PRE-EXISTING CONDITION | 5/22/2024 | 5/8/2024 | 61 | OTHER | $467.32 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405136378 | 1 | TX | Open | F | 67 | S | N | N | 7/8/2024 | 9/8/2024 | 7/9/2024 | 5/10/2024 | 7/18/2024 | Unknown | 7/23/2024 | 9/3/2024 | 01 | NEED MEDICAL/UPDATE INFO | $1,036.56 | $5,034.72 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405226491 | 4 | TX | Closed | F | 29 | S | N | N | 7/1/2024 | 7/2/2024 | 5/21/2024 | 7/10/2024 | 5/28/2024 | Unknown | 7/16/2024 | 8/28/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 8/28/2024 | $498.71 | $3,134.75 | ||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405296108 | 5 | TX | Closed | M | 41 | A | N | 4/26/2024 | 5/17/2024 | 4/30/2024 | 5/28/2024 | 6/5/2024 | Unknown | 5/14/2024 | 5/16/2024 | 98 | RETURNED TO WORK | 6/5/2024 | $1,400.00 | $600.00 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405296150 | 110922 | 4 | TX | Closed | F | 37 | S | N | N | 5/9/2024 | 8/5/2024 | 5/13/2024 | 5/28/2024 | 6/4/2024 | Unknown | 5/27/2024 | 8/4/2024 | 98 | RETURNED TO WORK | 8/4/2024 | $1,143.30 | $11,433.00 | |
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292405298065 | 0 | TX | Pending | F | 0 | S | N | 8/22/2024 | 11/19/2024 | 8/26/2024 | 5/29/2024 | Unknown | $0.00 | ||||||||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406036665 | 2 | TX | Denied | F | 29 | S | N | 5/24/2024 | 5/27/2024 | 5/31/2024 | 6/19/2024 | DCLN-PRE-EXISTING CONDITION | 6/10/2024 | 6/27/2024 | 61 | OTHER | $547.68 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406056013 | 0 | TX | Closed | F | 41 | S | N | 5/13/2024 | 5/14/2024 | 6/4/2024 | 6/7/2024 | Unknown | 5/28/2024 | 7/9/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 7/9/2024 | $1,400.00 | $8,600.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406056031 | 7 | TX | Closed | F | 40 | S | N | 5/31/2024 | 6/1/2024 | 6/4/2024 | 7/17/2024 | Unknown | 6/15/2024 | 7/28/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 7/30/2024 | $1,400.00 | $8,800.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406066120 | 4 | TX | Closed | F | 34 | S | N | 7/8/2024 | 7/9/2024 | 6/5/2024 | 7/16/2024 | Unknown | 7/23/2024 | 8/10/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 8/13/2024 | $615.94 | $1,671.84 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406106543 | 0 | TX | Suspended | F | 48 | S | N | N | 7/24/2024 | 7/25/2024 | 6/7/2024 | 7/25/2024 | Unknown | 8/8/2024 | 8/23/2024 | 01 | NEED MEDICAL/UPDATE INFO | $606.96 | $1,387.33 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406106586 | 0 | TX | Pending | F | 24 | S | N | 8/27/2024 | 8/28/2024 | 6/7/2024 | PEND-NEED CLAIMANT INFORMATION | 9/11/2024 | 8/28/2024 | 07 | NEED OTHER INFO | $510.00 | $0.00 | ||||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406126873 | 6 | TX | Closed | F | 28 | S | N | 6/6/2024 | 6/7/2024 | 6/11/2024 | 6/18/2024 | Unknown | 6/21/2024 | 8/1/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | 8/6/2024 | $607.68 | $3,567.95 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406186620 | 2 | TX | Denied | F | 29 | S | N | N | 7/30/2024 | 8/13/2024 | 7/31/2024 | 6/18/2024 | 8/19/2024 | DCLN-WAITING PRD NOT SATISFIED | 8/14/2024 | 8/12/2024 | 98 | RETURNED TO WORK | $467.04 | $0.00 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292406196759 | 5 | TX | Open | F | 56 | S | N | N | 5/10/2024 | 5/11/2024 | 6/18/2024 | 7/18/2024 | EXCEEDS AUTHORITY | 5/25/2024 | 7/1/2024 | 92 | MODIFIED RTW | 8/5/2024 | $911.04 | $1,952.23 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406216061 | 4 | TX | Denied | F | 28 | S | N | 9/15/2023 | 9/17/2023 | 6/20/2024 | 6/28/2024 | DCLN-CLOSED DUPLICATE | 10/1/2023 | 9/17/2023 | 61 | OTHER | $567.60 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292406246176 | 1 | TX | Closed | F | 56 | S | N | 5/7/2024 | 6/10/2024 | 5/8/2024 | 6/21/2024 | 7/8/2024 | Unknown | 5/22/2024 | 6/9/2024 | 98 | RETURNED TO WORK | 7/8/2024 | $482.40 | $1,309.37 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407106799 | 4 | TX | Denied | F | 29 | S | N | 7/1/2024 | 7/2/2024 | 7/9/2024 | 7/15/2024 | DCLN-CLOSED DUPLICATE | 7/16/2024 | 7/2/2024 | 61 | OTHER | $498.72 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407106821 | 0 | TX | Denied | F | 32 | S | N | 6/21/2024 | 6/24/2024 | 7/9/2024 | 7/12/2024 | DCLN-PRE-EXISTING CONDITION | 7/8/2024 | 6/24/2024 | 61 | OTHER | $1,400.00 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292407106836 | 0 | TX | Denied | F | 26 | S | N | 7/8/2024 | 7/9/2024 | 7/9/2024 | 7/21/2024 | DCLN-PRE-EXISTING CONDITION | 7/23/2024 | 7/9/2024 | 61 | OTHER | $792.00 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407126208 | 3 | TX | Denied | F | 31 | S | N | 7/15/2024 | 7/16/2024 | 7/11/2024 | 8/8/2024 | DCLN-PRE-EXISTING CONDITION | 7/30/2024 | 7/16/2024 | 61 | OTHER | $537.11 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407156329 | 2 | TX | Open | F | 24 | S | N | 7/12/2024 | 7/13/2024 | 7/12/2024 | 8/7/2024 | Unknown | 7/27/2024 | 9/6/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | $535.20 | $2,293.71 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407156333 | 4 | TX | Denied | F | 29 | S | N | 7/9/2024 | 7/10/2024 | 7/12/2024 | 8/1/2024 | 8/23/2024 | DCLN-MISCELLANEOUS | 7/24/2024 | 7/10/2024 | 61 | OTHER | $498.72 | $933.31 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407156345 | 2 | TX | Open | F | 37 | S | N | 7/11/2024 | 9/6/2024 | 7/12/2024 | 7/12/2024 | 8/2/2024 | Unknown | 7/26/2024 | 9/5/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | $1,400.00 | $5,400.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407156348 | 9 | TX | Open | F | 55 | S | N | 7/10/2024 | 7/11/2024 | 7/12/2024 | 7/24/2024 | Unknown | 7/25/2024 | 9/4/2024 | 91 | POSSIBLE RTW | $730.32 | $3,338.61 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407166491 | 5 | TX | Open | F | 67 | S | N | 6/10/2024 | 9/18/2024 | 6/11/2024 | 7/15/2024 | 7/18/2024 | Unknown | 6/25/2024 | 9/17/2024 | 91 | POSSIBLE RTW | $1,211.54 | $10,730.78 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407176622 | 4 | TX | Closed | F | 53 | S | N | 6/3/2024 | 7/1/2024 | 6/4/2024 | 7/16/2024 | 7/29/2024 | Unknown | 6/18/2024 | 6/30/2024 | 98 | RETURNED TO WORK | 7/29/2024 | $1,400.00 | $2,600.00 | |||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407236187 | 3 | TX | Open | F | 26 | S | N | N | 7/31/2024 | 8/1/2024 | 7/22/2024 | 8/8/2024 | Unknown | 8/15/2024 | 9/27/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | $493.68 | $775.78 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407236268 | 2 | TX | Denied | F | 28 | S | N | 7/15/2024 | 7/16/2024 | 7/23/2024 | 8/11/2024 | DCLN-PRE-EXISTING CONDITION | 7/30/2024 | 7/16/2024 | 61 | OTHER | $578.16 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407236270 | 3 | TX | Denied | F | 24 | S | N | 6/20/2024 | 6/21/2024 | 7/23/2024 | 8/29/2024 | DCLN-PRE-EXISTING CONDITION | 7/5/2024 | 6/21/2024 | 61 | OTHER | $524.40 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407236275 | 0 | TX | Open | F | 32 | S | N | 8/14/2024 | 8/15/2024 | 7/23/2024 | 8/26/2024 | Unknown | 8/29/2024 | 9/25/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | $1,062.70 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407296822 | 3 | TX | Pending | F | 31 | S | N | 7/12/2024 | 7/13/2024 | 7/26/2024 | PEND-NEED MEDICAL INFORMATION | 7/27/2024 | 8/24/2024 | 09 | NO ADDIT'L BENEFIT PAYABLE | $627.60 | $0.00 | ||||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407306015 | 3 | TX | Denied | F | 26 | S | N | N | 7/30/2024 | 8/1/2024 | 7/29/2024 | 8/1/2024 | DCLN-CLOSED DUPLICATE | 8/15/2024 | 8/1/2024 | 61 | OTHER | $493.68 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407306973 | 10 | TX | Open | F | 47 | S | N | 8/13/2024 | 8/14/2024 | 7/29/2024 | 8/29/2024 | Unknown | 8/28/2024 | 9/25/2024 | 01 | NEED MEDICAL/UPDATE INFO | $1,001.65 | $0.00 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292407316210 | 4 | TX | Open | F | 26 | A | N | 7/19/2024 | 7/20/2024 | 7/30/2024 | 8/7/2024 | Unknown | 8/3/2024 | 9/22/2024 | 91 | POSSIBLE RTW | $537.36 | $1,765.61 | |||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292408016293 | 4 | TX | Denied | F | 65 | S | N | 7/23/2024 | 8/5/2024 | 7/24/2024 | 7/31/2024 | 8/8/2024 | DCLN-WAITING PRD NOT SATISFIED | 8/7/2024 | 8/4/2024 | 91 | POSSIBLE RTW | $609.19 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 292408136463 | 5 | TX | Denied | F | 56 | S | N | N | 5/10/2024 | 5/20/2024 | 8/12/2024 | 8/25/2024 | DCLN-CLOSED DUPLICATE | 6/3/2024 | 5/21/2024 | 61 | OTHER | $911.04 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292408136507 | 35602459 | 9 | TX | Open | F | 31 | S | N | 8/16/2024 | 8/19/2024 | 8/12/2024 | 8/28/2024 | Unknown | 9/2/2024 | 10/13/2024 | 91 | POSSIBLE RTW | $607.68 | $0.00 | ||||
| 8/29/2024 | 9/1/2023 | 8/31/2024 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292408266948 | 0 | TX | Pending | M | 0 | S | N | 8/2/2024 | 8/26/2024 | Unknown | $0.00 | ||||||||||||
| Total Claims for Customer 5924797 : 128 | Sum of Gross Benefit for Customer 5924797 : $456,790.07 | ||||||||||||||||||||||||||||||||
| 9/4/2024 10:09:53 PM | Page 3 of 3 |
STD LTD Claim Status
| TRAVIS COUNTY HEALTHCARE DISTRICT | ||
| Claim Status Detail | ||
| Data as of: 09/28/2023 | From: 01/01/2023 | To: 09/30/2023 |
| Customer: 5924797 | ||
| Report Parameters: | ||
| Customer Number: | 5924797 | |
| Group / Report: | All |
Subcode: All
Branch / Paypoint: All
| Coverage Type: | L, S | |
| Organized By: | Customer Number | |
| ***If this is the only page you received please return to Edit this Report Package and review your parameter selections from the 'Re-run the Report Package Wizard' option. | ||
| 10/10/2023 3:43:42 PM | Page 1 of 3 |
| TRAVIS COUNTY HEALTHCARE DISTRICT | ||
| Claim Status Detail | ||
| Long Term Disability | ||
| Data as of: 09/28/2023 | From: 01/01/2023 | To: 09/30/2023 |
| Customer: 5924797 |
| As of Date | From Date | To Date | Customer Name | Customer Number | Report Number | Subcode | Paypoint | Plan Code | Coverage Type | Claim Number | Employee ID | Years Of Service | State Worked | Claim Status | Gender | Claimant Age - Years | Acc/Sick | Occ/Non-Occ | WC Filed | Last Day Worked | Return to Work Date | Disability Date | Received Date | Approved Date | Denied Date | Inactive Reason Description | Benefit Start Date | Claim End Date | Claim End Code | Claim End Description | Closed Date | Base Benefit | Cumulative Gross Benefit |
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 701806041090 | 1 | TX | Open | F | 40 | S | N | N | 11/22/2017 | 11/26/2017 | 6/4/2018 | 6/6/2018 | Unknown | 5/27/2018 | 1/22/2042 | 97 | REACHED MAX DURATION | 3/3/2021 | $1,740.96 | $46,017.69 | |||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 722206061773 | 16 | TX | Open | F | 61 | S | N | N | 1/14/2022 | 1/17/2022 | 6/6/2022 | 7/28/2022 | Unknown | 7/18/2022 | 7/17/2024 | 13 | UNDER INVESTIGATION | $2,692.56 | $37,695.84 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 722208171733 | 5 | TX | Open | F | 61 | S | N | N | 3/25/2022 | 3/26/2022 | 8/17/2022 | 9/26/2022 | Unknown | 9/24/2022 | 9/23/2024 | 13 | UNDER INVESTIGATION | $4,954.49 | $28,277.88 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 722307120713 | 5 | TX | Open | F | 61 | S | N | N | 1/4/2023 | 2/14/2023 | 7/12/2023 | 8/18/2023 | Unknown | 8/15/2023 | 8/16/2025 | 01 | NEED MEDICAL/UPDATE INFO | $3,407.05 | $3,407.05 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 732004130405 | 0 | TX | Open | F | 56 | S | N | N | 10/16/2019 | 10/17/2019 | 4/13/2020 | 6/24/2020 | Unknown | 5/6/2020 | 9/17/2028 | 97 | REACHED MAX DURATION | $5,941.03 | $152,811.23 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 732303280925 | 6 | TX | Open | F | 35 | S | N | N | 11/8/2022 | 11/9/2022 | 3/28/2023 | 5/9/2023 | Unknown | 5/10/2023 | 5/9/2025 | 13 | UNDER INVESTIGATION | $6,000.00 | $24,000.00 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Long Term Disability | 742204250068 | 1 | TX | Open | F | 60 | S | N | N | 8/12/2021 | 8/13/2021 | 4/25/2022 | 5/13/2022 | Unknown | 2/25/2022 | 2/24/2024 | 13 | UNDER INVESTIGATION | $3,396.22 | $58,664.48 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 000 | Long Term Disability | 742309061267 | 1 | TX | Open | F | 59 | S | N | N | 4/19/2023 | 4/20/2023 | 9/6/2023 | 9/11/2023 | Unknown | 10/19/2023 | 10/18/2025 | 13 | UNDER INVESTIGATION | $3,408.08 | $0.00 | ||||
| Total Claims for Customer 5924797 : 8 | Sum of Gross Benefit for Customer 5924797 : $350,874.17 | ||||||||||||||||||||||||||||||||
| 10/10/2023 3:43:42 PM | Page 2 of 3 |
| TRAVIS COUNTY HEALTHCARE DISTRICT | ||
| Claim Status Detail | ||
| Short Term Disability | ||
| Data as of: 09/28/2023 | From: 01/01/2023 | To: 09/30/2023 |
| Customer: 5924797 |
| As of Date | From Date | To Date | Customer Name | Customer Number | Report Number | Subcode | Paypoint | Plan Code | Coverage Type | Claim Number | Employee ID | Years Of Service | State Worked | Claim Status | Gender | Claimant Age - Years | Acc/Sick | Occ/Non-Occ | WC Filed | Last Day Worked | Return to Work Date | Disability Date | Received Date | Approved Date | Denied Date | Inactive Reason Description | Benefit Start Date | Claim End Date | Claim End Code | Claim End Description | Closed Date | Base Benefit | Cumulative Gross Benefit |
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 202212298023 | 1 | TX | Closed | F | 25 | S | N | 12/23/2022 | 12/26/2022 | 12/29/2022 | 1/4/2023 | Unknown | 1/9/2023 | 2/26/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 2/28/2023 | $463.91 | $3,247.37 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 212211108358 | 5 | TX | Closed | F | 46 | S | N | N | 11/29/2022 | 1/17/2023 | 11/30/2022 | 11/10/2022 | 12/3/2022 | Unknown | 12/14/2022 | 1/15/2023 | 16 | FAILED TO RTW-FIT FOR DUTY | 1/10/2023 | $659.04 | $3,106.90 | ||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 222309068356 | 0 | TX | Pending | F | 27 | S | N | 8/31/2023 | 9/1/2023 | 9/6/2023 | 9/8/2023 | PEND-NEED MEDICAL INFORMATION | 9/15/2023 | 9/1/2023 | 01 | NEED MEDICAL/UPDATE INFO | $510.00 | $0.00 | |||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 232305228405 | 1 | TX | Denied | F | 59 | S | N | 4/19/2023 | 4/20/2023 | 5/22/2023 | 6/2/2023 | 6/2/2023 | DCLN-CLOSED DUPLICATE | 5/4/2023 | 4/20/2023 | 61 | OTHER | $786.48 | $0.00 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 252210058926 | 2 | TX | Closed | F | 33 | S | N | N | 12/9/2022 | 3/6/2023 | 12/11/2022 | 10/5/2022 | 12/16/2022 | Unknown | 12/25/2022 | 1/21/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/24/2023 | $1,400.00 | $5,600.00 | ||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 252210288841 | 9 | TX | Closed | F | 48 | S | N | N | 11/8/2022 | 2/6/2023 | 11/9/2022 | 10/28/2022 | 11/9/2022 | Unknown | 11/23/2022 | 1/1/2023 | 63 | NO RTW DATE FROM CUSTOMER | 1/25/2023 | $576.00 | $3,291.43 | ||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0003 | 0001 | 000 | Short Term Disability | 252303078637 | 5 | TX | Closed | F | 61 | S | N | 1/4/2023 | 2/14/2023 | 3/7/2023 | 4/21/2023 | Unknown | 2/28/2023 | 8/14/2023 | 97 | REACHED MAX DURATION | 8/15/2023 | $786.24 | $18,869.76 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 262212068256 | 1 | TX | Closed | F | 32 | S | N | N | 12/2/2022 | 1/31/2023 | 12/5/2022 | 12/6/2022 | 1/20/2023 | Unknown | 12/19/2022 | 1/29/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/31/2023 | $459.84 | $2,759.04 | ||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 262309138637 | 6 | TX | Open | F | 28 | S | N | 9/8/2023 | 10/24/2023 | 9/9/2023 | 9/13/2023 | 9/18/2023 | Unknown | 9/23/2023 | 10/20/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | $592.80 | $169.37 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292207256301 | 8 | TX | Closed | F | 38 | S | N | N | 9/14/2022 | 12/26/2022 | 9/15/2022 | 7/22/2022 | 9/17/2022 | Unknown | 9/29/2022 | 12/25/2022 | 98 | RETURNED TO WORK | 1/9/2023 | $1,050.96 | $10,509.60 | ||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292210066362 | 21 | TX | Closed | F | 29 | S | N | 12/1/2022 | 12/2/2022 | 10/5/2022 | 12/4/2022 | Unknown | 12/16/2022 | 1/29/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/31/2023 | $432.00 | $2,718.29 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292210316879 | 0 | TX | Denied | F | 26 | S | N | 10/17/2022 | 10/19/2022 | 10/28/2022 | 1/27/2023 | DCLN-INITIAL DENIAL | 11/2/2022 | 10/19/2022 | 01 | NEED MEDICAL/UPDATE INFO | $485.76 | $0.00 | |||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292211096956 | 3 | TX | Closed | F | 32 | S | N | 1/10/2023 | 1/12/2023 | 11/8/2022 | 1/19/2023 | Unknown | 1/26/2023 | 2/21/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 2/21/2023 | $1,400.00 | $5,400.00 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292211116314 | 4 | TX | Closed | F | 27 | S | N | 11/9/2022 | 11/10/2022 | 11/10/2022 | 11/17/2022 | Unknown | 11/24/2022 | 1/10/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/10/2023 | $510.00 | $3,497.14 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292211156539 | 6 | TX | Closed | F | 46 | S | N | 11/10/2022 | 3/6/2023 | 11/16/2022 | 11/14/2022 | 11/18/2022 | Unknown | 11/30/2022 | 3/5/2023 | 98 | RETURNED TO WORK | 3/14/2023 | $1,137.60 | $15,441.72 | |||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292211186151 | 15 | TX | Closed | F | 56 | S | N | N | 12/9/2022 | 1/9/2023 | 12/12/2022 | 12/13/2022 | 12/14/2022 | Unknown | 12/26/2022 | 1/8/2023 | 98 | RETURNED TO WORK | 1/8/2023 | $737.28 | $1,474.56 | ||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292211296718 | 0 | TX | Closed | F | 20 | S | N | 10/24/2022 | 1/23/2023 | 10/25/2022 | 11/28/2022 | 12/14/2022 | Unknown | 11/8/2022 | 12/22/2022 | 17 | MED DOES NOT SUPPORT DISAB | 1/24/2023 | $510.00 | $3,278.57 | |||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292212146854 | 4 | TX | Closed | F | 42 | S | N | 12/30/2022 | 1/3/2023 | 12/13/2022 | 1/10/2023 | Unknown | 1/17/2023 | 2/27/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 2/28/2023 | $1,400.00 | $8,400.00 | ||||
| 9/28/2023 | 1/1/2023 | 9/30/2023 | TRAVIS COUNTY HEALTHCARE DISTRICT | 5924797 | 5924797 | 0004 | 0001 | 002 | Short Term Disability | 292212156968 | 1 | TX | Closed | F | 35 | S | N | N | 12/12/2022 | 12/13/2022 | 12/14/2022 | 12/21/2022 | Unknown | 12/27/2022 | 1/23/2023 | 09 | NO ADDIT'L BENEFIT PAYABLE | 1/24/2023 | $576.00 | $2,304.00 |
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