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 Request for Proposals (RFP) issued by the Travis County Healthcare District d/b/a Central Health for basic life & AD&D, voluntary life & AD&D, employer paid short-term disability, voluntary short-term disability, and employer paid long-term disability insurance coverage for approximately 1,900 Central Health employees. The RFP seeks qualified vendors to provide these benefits, with the goal of offering high-quality and valuable benefits at affordable pricing. The RFP provides a procurement schedule with a proposal due date of November 14, 2024, and allows for a one-time open enrollment for all employees with no underwriting up to the guarantee issue amount. Central Health is seeking to bundle the life and disability coverages with the same vendor, but will contract with separate vendors if that is most advantageous. The initial contract term is two years, with optional four one-year renewal periods.
The RFP does not mention any set-aside designations or restrictions on the types of organizations that can respond. There are no listed incumbent vendors or current contractors, and no specific details on existing infrastructure or technology that requires integration. The RFP does not provide any information on possible award values or budget ranges, though the historical claims data and premium information suggests this is a significant employee benefits contract for the Travis County Healthcare District.
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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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