ESBD_455593_1761406163156_Attachment E - 5 Year Loss History.pdf

Deep East Texas Self Insurance Fund

Claimant Name Description

Stat Litg

Loss Age Juris

Loss Date Knowledge

Nature Of Injury Body Part

Claim Type Life Medical

Claim No. 20801474 Close d

32 1/5/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Henry, Tina N TX 1/5/2020 Multiple Head Injury N Paid Paid Reserve Incurred

Medical $427.74 $427.74 $0.00 $427.74

Other $8.50 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $436.24 $436.24 $0.00 $436.24

Inmate spit into employee's eyes and mouth causing bodily fluid exposure.

Claim No. 20834673 Close d

45 1/11/2020 Strain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Mitchum, Gregory N TX 11/15/2020 Multiple Lower Extremities

N Paid Paid Reserve Incurred

Medical $0.00 $0.00 $0.00 $0.00

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee strained his left calf and ankle while running down the hallway responding to a call.

Claim No. 20803280 Close d

28 1/13/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Sylvester, John N TX 1/13/2020 Multiple Lower Extremities

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Kicked by someone being arrested.

Claim No. 20803120 Close d

32 1/16/2020 Multiple physic Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Prado, Lucio N TX 1/16/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $690.04 $690.04 $0.00 $690.04

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $707.04 $707.04 $0.00 $707.04

Employee slipped and fell in food on the floor receiving a left wrist sprain and a buttocks contusion.

Claim No. 20805708 Close d

24 1/18/2020 Sprain Temporary Disability

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Lopez, Franki N TX 1/23/2020 Wrist, Right N Paid Paid Reserve Incurred

Detail Loss Run

Loss Date Between 1/1/2020 and 1/1/2021 Financials As Of 9/23/2025

Medical $1,309.06 $1,309.06 $0.00 $1,309.06

Indemnity $0.00 $0.00 $0.00 $0.00

Temporary Disability $11.62 $11.62 $0.00 $11.62

Other $34.00 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $1,354.68 $1,354.68 $0.00 $1,354.68

Employee was breaking up a fight between inmates and sprained her right wrist.

Claim No. 20804033 Close d

27 1/21/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Galvan, Melissa N TX 1/21/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $1,539.83 $1,539.83 $0.00 $1,539.83

Other $34.00 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $1,573.83 $1,573.83 $0.00 $1,573.83

Employee received a left hand, shoulder and back contusion during an altercation with an inmate.

Claim No. 20804002 Close d

35 1/22/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Ramirez Jr, Fernando N TX 1/22/2020 Finger(s) N Paid Paid Reserve Incurred

Medical $1,007.07 $1,007.07 $0.00 $1,007.07

Other $42.50 $42.50 $0.00 $42.50

Examiner: athornton Claim Total: $1,049.57 $1,049.57 $0.00 $1,049.57

Employee received a left index finger contusion during an altercation with an inmate.

Claim No. 20804286 Close d

38 1/23/2020 Strain Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

McCutcheon, Christopher

N TX 1/23/2020 Chest N Paid Paid Reserve Incurred

Medical $1,316.90 $1,316.90 $0.00 $1,316.90

Other $42.50 $51.00 $0.00 $51.00

Examiner: athornton Claim Total: $1,359.40 $1,367.90 $0.00 $1,367.90

During tactics training employee strained his left rib cage.

Claim No. 20804953 Close d

51 1/23/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Gomez, Delrin N TX 1/23/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Detail Loss Run

Medical $299.42 $299.42 $0.00 $299.42

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $316.42 $316.42 $0.00 $316.42

Tactic training 2 man tackle down in training class

Claim No. 20805950 Close d

58 1/24/2020 Strain Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Zuehlke, Jimmy N TX 1/24/2020 Lower Back Area:

Lumbar/Sacral

N Paid Paid Reserve Incurred

Medical $763.51 $763.51 $0.00 $763.51

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $780.51 $780.51 $0.00 $780.51

Employee moved a traffic sign and strained his lower back.

Claim No. 20804792 Close d

31 1/27/2020 Foreign body Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Booth, Shaun N TX 1/27/2020 Mouth N Paid Paid Reserve Incurred

Medical $1,491.93 $1,599.57 $0.00 $1,599.57

Other $119.00 $127.50 $0.00 $127.50

Examiner: athornton Claim Total: $1,610.93 $1,727.07 $0.00 $1,727.07

Medic put syringe too close to wound of person being arrested saline went in mouth and face.

Claim No. 20804956 Close d

37 1/27/2020 Foreign body Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Hayden, Ryan N TX 1/27/2020 Mouth N Paid Paid Reserve Incurred

Medical $1,048.46 $1,405.66 $0.00 $1,405.66

Other $34.00 $93.50 $0.00 $93.50

Examiner: athornton Claim Total: $1,082.46 $1,499.16 $0.00 $1,499.16

The medic used a syringe filled with saline solution, but was too close to the wound and depressed the plunger to hard too fast which caused the liquid to splash back into face and mouth.

Claim No. 20805003 Close d

32 1/28/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Anderson, Patrick N TX 1/28/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $694.49 $694.49 $0.00 $694.49

Other $25.50 $25.50 $0.00 $25.50

Detail Loss Run

Examiner: athornton Claim Total: $719.99 $719.99 $0.00 $719.99

Restraining prisoners 2 people fell on him

Claim No. 20805774 Close d

31 2/1/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Wilkins, Jeffrey N TX 2/1/2020 Lower Arm, Left N Paid Paid Reserve Incurred

Medical $773.85 $773.85 $0.00 $773.85

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $790.85 $790.85 $0.00 $790.85

Employee was involved in a MVA and received a left forearm contusion.

Claim No. 20805802 Close d

24 2/1/2020 Bites Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Amador, Stephen N TX 2/1/2020 Calf Right N Paid Paid Reserve Incurred

Medical $427.74 $427.74 $0.00 $427.74

Other $8.50 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $436.24 $436.24 $0.00 $436.24

Employee was bitten by a dog on the right calf while walking back to patrol car.

Claim No. 20805830 Close d

24 2/2/2020 Bites Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Amador, Stephen N TX 2/2/2020 Multiple Lower Extremities

N Paid Paid Reserve Incurred

Medical $789.54 $789.54 $0.00 $789.54

Other $8.50 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $798.04 $798.04 $0.00 $798.04

Employee was bitten by a dog on the right upper and lower leg while responding to a call and resident opened the door letting the dogs out.

Claim No. 20806792 Close d

50 2/11/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Smith, Jason N TX 2/11/2020 Finger(s) N Paid Paid Reserve Incurred

Medical $780.96 $780.96 $0.00 $780.96

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $797.96 $797.96 $0.00 $797.96

Employee was closing cell door when heard his finger pop receiving a left index finger contusion.

Detail Loss Run

Claim No. 20807190 Close d

52 2/12/2020 Unknown Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Wasko, Matthey N TX 2/12/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Avoiding a auto accident. Vehicle struck a rock pile.

Claim No. 20807234 Close d

25 2/14/2020 Strain Temporary Disability

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Moore, Reginald N TX 2/14/2020 Lower Back Area:

Lumbar/Sacral

N Paid Paid Reserve Incurred

Medical $3,286.19 $3,286.19 $0.00 $3,286.19

Indemnity $0.04 $0.04 $0.00 $0.04

Temporary Disability $471.69 $277.49 $0.00 $277.49

Other $170.00 $170.00 $0.00 $170.00

Examiner: athornton Claim Total: $3,927.92 $3,733.72 $0.00 $3,733.72

Employee received a lumbar strain during an altercation with an inmate.

Claim No. 20807248 Close d

39 2/14/2020 Strain Temporary Disability

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Kelly, William N TX 2/15/2020 Knee, Right N Paid Paid Reserve Incurred

Medical $939.73 $939.73 $0.00 $939.73

Indemnity $0.05 $0.00 $0.00 $0.00

Temporary Disability $324.59 $324.59 $0.00 $324.59

Other $42.50 $42.50 $0.00 $42.50

Examiner: athornton Claim Total: $1,306.87 $1,306.82 $0.00 $1,306.82

Employee strained his right knee during physical exercise training.

Claim No. 20807908 Close d

25 2/18/2020 Multiple physic Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Bosley, Preston N TX 2/18/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Fell attempting to restrain a resident in the facility.

Claim No. 20808293 Close d

37 2/26/2020 Syncope/Loss of Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Detail Loss Run

Watkins, Ryan N TX 2/26/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $4,886.53 $4,886.53 $0.00 $4,886.53

Other $42.50 $51.00 $0.00 $51.00

Examiner: athornton Claim Total: $4,929.03 $4,937.53 $0.00 $4,937.53

Employee was sitting at desk and turned his head and fainted out of chair onto the floor.

Claim No. 20810779 Close d

50 3/2/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Follis, Shannon N TX 3/2/2020 Knee N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Lost balance on rocky median, slipped & fell in parking lot. Landed in kneeling position hands & knees.

Claim No. 20810774 Close d

34 3/3/2020 Sprain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Skruhak, Deborah N TX 3/3/2020 Multiple Lower Extremities

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Leaving work to go vote, stepping down from sidewalk rolled her ankle on small rocks/uneven payment.

Claim No. 20809262 Close d

24 3/3/2020 Fracture Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Brace, Jose N TX 3/4/2020 Multiple Head Injury N Paid Paid Reserve Incurred

Medical $1,846.54 $2,063.54 $0.00 $2,063.54

Indemnity $0.00 $0.00 $0.00 $0.00

Temporary Disability $46.24 $0.00 $0.00 $0.00

Other $59.50 $76.50 $0.00 $76.50

Examiner: athornton Claim Total: $1,952.28 $2,140.04 $0.00 $2,140.04

Employee received a fractured jaw and a possible lose tooth during an altercation with an inmate.

Claim No. 20809446 Close d

59 3/3/2020 Contusion Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Duguid, Todd N TX 3/4/2020 Elbow, Right N Paid Paid Reserve Incurred

Medical $6,695.17 $7,000.02 $0.00 $7,000.02

Other $161.50 $187.00 $0.00 $187.00

Examiner: athornton Claim Total: $6,856.67 $7,187.02 $0.00 $7,187.02

Detail Loss Run

Employee received a right elbow contusion when he struck another employee's elbow during tactics training.

Claim No. 20809469 Close d

22 3/4/2020 Sprain Temporary Disability

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Gattis, Shelby N TX 3/4/2020 Shoulder, Left N Paid Paid Reserve Incurred

Medical $1,189.89 $1,189.89 $0.00 $1,189.89

Indemnity $0.00 $0.00 $0.00 $0.00

Temporary Disability $258.22 $258.22 $0.00 $258.22

Other $42.50 $42.50 $0.00 $42.50

Examiner: athornton Claim Total: $1,490.61 $1,490.61 $0.00 $1,490.61

Employee received a left shoulder sprain during trainging with another employee.

Claim No. 20810773 Close d

54 3/10/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Mendoza, Melissa N TX 3/10/2020 Skull N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Overhead cabinet lid came down & hit her on the head.

Claim No. 20810115 Close d

33 3/11/2020 Strain Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Ubaldo Jr, Martin N TX 3/11/2020 Lower Back Area:

Lumbar/Sacral

N Paid Paid Reserve Incurred

Medical $817.93 $193.48 $0.00 $193.48

Other $221.00 $272.00 $0.00 $272.00

Examiner: athornton Claim Total: $1,038.93 $465.48 $0.00 $465.48

Employee strained his low back while bending over and stood up.

Claim No. 20810700 Close d

21 3/14/2020 Strain Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Blundell, Kayleigh N TX 3/15/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $1,315.89 $1,315.89 $0.00 $1,315.89

Other $51.00 $68.50 $0.00 $68.50

Examiner: athornton Claim Total: $1,366.89 $1,384.39 $0.00 $1,384.39

Employee received a strain to her neck and knees during SERT training.

Claim No. 20810670 Close d

35 3/16/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Detail Loss Run

Burkhart, Virgil N TX 3/16/2020 Brain N Paid Paid Reserve Incurred

Claim Total: $0.00 $0.00 $0.00 $0.00

Chair fell from under him

Claim No. 20810952 Close d

39 3/20/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Fraga, Amy N TX 3/20/2020 Elbow, Right N Paid Paid Reserve Incurred

Medical $528.78 $528.78 $0.00 $528.78

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $545.78 $545.78 $0.00 $545.78

Employee tripped and fell in lunchroom receiving a right elbow contusion.

Claim No. 20812671 Close d

26 3/28/2020 Strain Minor PD Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Palomo, Abraham N TX 4/7/2020 Lower Back Area:

Lumbar/Sacral

N Paid Paid Reserve Incurred

Medical $2,662.61 $3,178.07 $0.00 $3,178.07

Indemnity $0.00 $0.00 $0.00 $0.00

Permanent Disability $0.00 $10,185.00 $0.00 $10,185.00

Other $187.00 $204.00 $0.00 $204.00

Examiner: athornton Claim Total: $2,849.61 $13,567.07 $0.00 $13,567.07

Employee jumped down from 6 foot fence post straining his low back after arresting suspect.

Claim No. 20812354 Close d

30 4/3/2020 Multiple physic Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Hargrove Pierce, Reginald

N TX 4/3/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $1,626.29 $1,698.13 $0.00 $1,698.13

Other $59.50 $85.00 $0.00 $85.00

Examiner: athornton Claim Total: $1,685.79 $1,783.13 $0.00 $1,783.13

Employee slipped and fell in water on the floor receiving a head concussion and right elbow and left knee contusion.

Claim No. 20812694 Close d

45 4/3/2020 Abrasion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Cranston, Raymond N TX 4/3/2020 Hand, Left N Paid Paid Reserve Incurred

Detail Loss Run

Claim Total: $0.00 $0.00 $0.00 $0.00

Employee received a left hand abrasion/scratch during an altercation with an inmate.

Claim No. 20812320 Close d

49 4/4/2020 Laceration Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Morales, Alfred N TX 4/4/2020 Thumb, Right N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee received a right thumb laceration during an altercation with an inmate.

Claim No. 20812314 Close d

63 4/5/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

McCoy, Martha N TX 4/5/2020 Multiple Lower Extremities

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee tripped and fell in hallway receiving a contusion to her legs and knees.

Claim No. 20812575 Close d

45 4/9/2020 Abrasion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

McDonald, Mark N TX 4/9/2020 Finger(s) N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Door closed on employee's right index and ring finger causing an abrasion/scratch.

Claim No. 20813221 Close d

35 4/18/2020 Concussion Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Miller, Zachary N TX 4/18/2020 Multiple Body Systems & Body Parts

N Paid Paid Reserve Incurred

Medical $6,524.74 $6,524.74 $0.00 $6,524.74

Other $85.00 $85.00 $0.00 $85.00

Examiner: athornton Claim Total: $6,609.74 $6,609.74 $0.00 $6,609.74

Employee received a head concussion when he was too close to blast during a SWAT breach into an apartment.

Claim No. 20813040 Close d

32 4/19/2020 Multiple physic Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Adams, Christopher N TX 4/19/2020 Multiple Lower Extremities

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee was arresting a combative suspect receiving abrasions to both knees and a right inner thigh bite.

Claim No. 20813683 Close d

30 4/22/2020 Bites Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Detail Loss Run

Hargrove Pierce, Reginald

N TX 4/22/2020 Finger(s) N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Upset inmate bit employee on the left middle and ring fingers.

Claim No. 20813874 Close d

40 4/27/2020 Sprain Temporary Disability

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Sembera, Kristin N TX 4/27/2020 Ankle, Right N Paid Paid Reserve Incurred

Medical $328.12 $545.28 $0.00 $545.28

Indemnity $0.00 $0.00 $0.00 $0.00

Temporary Disability $32.50 $32.50 $0.00 $32.50

Other $42.50 $68.00 $0.00 $68.00

Examiner: athornton Claim Total: $403.12 $645.78 $0.00 $645.78

Employee was running in a residence yard and stepped in a hole spraining her right ankle.

Claim No. 20814172 Close d

51 4/28/2020 Bites Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Hensley, Rita N TX 4/28/2020 Multiple Upper Extremities

N Paid Paid Reserve Incurred

Medical $1,009.80 $1,207.01 $0.00 $1,207.01

Other $17.00 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $1,026.80 $1,241.01 $0.00 $1,241.01

Employee was picking up a stray cat when it bit her on the left wrist and index finger.

Claim No. 20813930 Close d

34 4/28/2020 Sprain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Figueroa Torres, Edgar

N TX 4/28/2020 Ankle, Right N Paid Paid Reserve Incurred

Medical $679.28 $801.68 $0.00 $801.68

Other $25.50 $42.50 $0.00 $42.50

Examiner: athornton Claim Total: $704.78 $844.18 $0.00 $844.18

Employee received a right ankle sprain during an altercation with an inmate.

Claim No. 20813920 Close d

31 4/28/2020 Strain Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

De Leon, Rodrigo N TX 4/28/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Detail Loss Run

Employee was involved in a MVA and received a neck and right shoulder strain.

Claim No. 20814197 Close d

47 4/30/2020 Strain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Kirchner, Jason N TX 4/30/2020 Knee, Right N Paid Paid Reserve Incurred

Medical $32.19 $438.28 $0.00 $438.28

Other $34.00 $59.50 $0.00 $59.50

Examiner: athornton Claim Total: $66.19 $497.78 $0.00 $497.78

Employee received a right knee strain during an altercation with an inmate.

Claim No. 20814264 Close d

35 4/30/2020 Sprain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Little, John N TX 4/30/2020 Ankle, Right N Paid Paid Reserve Incurred

Medical $801.60 $801.60 $0.00 $801.60

Other $34.00 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $835.60 $835.60 $0.00 $835.60

Employee received a right ankle sprain during an altercation with an inmate.

Claim No. 20814938 Close d

26 5/10/2020 Multiple physic Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Ramirez, Jina N TX 5/10/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $241.28 $313.12 $0.00 $313.12

Other $17.00 $42.50 $0.00 $42.50

Examiner: athornton Claim Total: $258.28 $355.62 $0.00 $355.62

Employee received a chest contusion and a right upper arm abrasion during an altercation with an inmate.

Claim No. 20815970 Close d

59 5/18/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Alvarez, Henry N TX 5/18/2020 Knee, Right N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee missed a step going down stairs and fell down receiving a right knee contusion.

Claim No. 20816922 Close d

47 6/1/2020 Abrasion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Bottoms, Gary N TX 6/1/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Detail Loss Run

Employee was on motorcycle during training when brakes locked up causing employee to fall receiving abrasion/scratches to his hands, forearms, elbows, left shoulder, left knee and hip.

Claim No. 20817059 Close d

24 6/4/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Velasco, David N TX 6/4/2020 Other Facial Soft Tissue

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee was trying to help metal inmate dress and was hit on the right cheek causing a contusion.

Claim No. 20818618 Close d

38 6/4/2020 Contusion Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Murken, Andrew N TX 6/17/2020 Wrist, Left N Paid Paid Reserve Incurred

Medical $0.00 $14.67 $0.00 $14.67

Other $8.50 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $8.50 $31.67 $0.00 $31.67

Employee was working in computer room when a switch fell on his left wrist causing a contusion.

Claim No. 20817680 Close d

37 6/9/2020 Allergic Reacti Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Torres, Michael N TX 6/9/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $21.40 $290.24 $0.00 $290.24

Other $17.00 $42.50 $0.00 $42.50

Examiner: athornton Claim Total: $38.40 $332.74 $0.00 $332.74

Employee received a rash on his face, neck and right shoulder while cutting down pecan trees.

Claim No. 20818031 Close d

25 6/11/2020 Sprain Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Gutierrez, Jae N TX 6/11/2020 Knee, Right N Paid Paid Reserve Incurred

Medical $2,309.13 $3,389.09 $0.00 $3,389.09

Other $76.50 $127.50 $0.00 $127.50

Examiner: athornton Claim Total: $2,385.63 $3,516.59 $0.00 $3,516.59

Employee received a right knee sprain during an altercation with an inmate.

Claim No. 20817912 Close d

30 6/11/2020 Abrasion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Zesati, Juan N TX 6/11/2020 Lower Arm, Left N Paid Paid Reserve Incurred

Detail Loss Run

Employee was performing training exercise on police motorcycle when he lost control falling off the vehicle receiving an abrasion on his left forearm.

Claim No. 20818464 Close d

31 6/15/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Skruhak, Chris N TX 6/15/2020 Face N Paid Paid Reserve Incurred

Medical $1,158.53 $1,158.53 $0.00 $1,158.53

Other $25.50 $25.50 $0.00 $25.50

Examiner: athornton Claim Total: $1,184.03 $1,184.03 $0.00 $1,184.03

Employee received a jaw contusion and a right shoulder sprain during an altercation with an inmate.

Claim No. 20818504 Close d

24 6/15/2020 Strain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Parten, John N TX 6/15/2020 Multiple Trunk N Paid Paid Reserve Incurred

Medical $1,086.89 $1,086.89 $0.00 $1,086.89

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $1,103.89 $1,103.89 $0.00 $1,103.89

Employee received a lumbar and thoracic strain during an altercation with an inmate.

Claim No. 20818511 Close d

21 6/15/2020 Laceration Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Ayala, Maximo N TX 6/15/2020 Lower Arm, Right N Paid Paid Reserve Incurred

Medical $399.12 $604.30 $0.00 $604.30

Other $8.50 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $407.62 $638.30 $0.00 $638.30

Employee pushed open door when object fell on employee causing a right forearm laceration.

Claim No. 20818520 Close d

21 6/15/2020 Strain Temporary Disability

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Blundell, Kayleigh N TX 6/15/2020 Knee, Left N Paid Paid Reserve Incurred

Medical $1,459.77 $1,459.77 $0.00 $1,459.77

Indemnity $0.00 $0.00 $0.00 $0.00

Temporary Disability $29.64 $29.64 $0.00 $29.64

Other $76.50 $76.50 $0.00 $76.50

Detail Loss Run

Claim Total: $1,565.91 $1,565.91 $0.00 $1,565.91

Employee received a left knee strain during an altercation with an inmate.

Claim No. 20819229 Close d

40 6/21/2020 Heatstroke Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Torres, Ronny N TX 6/21/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee was working outside and was overcome with heat exhaustion.

Claim No. 20819246 Close d

52 6/21/2020 Laceration Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Chance, Michael N TX 6/21/2020 Forehead N Paid Paid Reserve Incurred

Medical $1,059.94 $1,167.58 $0.00 $1,167.58

Other $51.00 $68.00 $0.00 $68.00

Examiner: athornton Claim Total: $1,110.94 $1,235.58 $0.00 $1,235.58

Recovery: $1,110.94 Net Incurred: $124.64

Employee was involved in a MVA and received a forehead laceration.

Claim No. 20820411 Close d

26 6/21/2020 COVID-19 Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Hayles, Matthew N TX 6/21/2020 Multiple Body Systems & Body Parts

N Paid Paid Reserve Incurred

Medical $197.21 $782.77 $0.00 $782.77

Other $17.00 $59.50 $0.00 $59.50

Examiner: athornton Claim Total: $214.21 $842.27 $0.00 $842.27

Employee tested positive for COVID 19. Claim accepted.

Claim No. 20819588 Close d

26 6/24/2020 Bites Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Pinillo, Alexander N TX 6/24/2020 Calf Left N Paid Paid Reserve Incurred

Medical $221.66 $221.66 $0.00 $221.66

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $238.66 $238.66 $0.00 $238.66

Employee was bitten on the left calf by a dog.

Claim No. 20819726 Close d

33 6/28/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Detail Loss Run

Ronquillo, Thomas N TX 6/28/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Claim Total: $0.00 $0.00 $0.00 $0.00

Employee received a left thigh and stomach contusion during an altercation with an inmate.

Claim No. 20820530 Close d

78 6/29/2020 Strain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Haley, Janet N TX 6/30/2020 Thumb, Right N Paid Paid Reserve Incurred

Medical $246.83 $246.83 $0.00 $246.83

Other $34.00 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $280.83 $280.83 $0.00 $280.83

Employee strained her right thumb lifting a heavy pot.

Claim No. 20821583 Close d

49 7/9/2020 Syncope Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Brown, Eric N TX 7/9/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $658.73 $658.73 $0.00 $658.73

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $675.73 $675.73 $0.00 $675.73

Employee became dizzy and elevated blood pressure.

Claim No. 20820999 Close d

30 7/11/2020 Strain Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

McFarland, Rachel N TX 7/11/2020 Lower Back Area:

Lumbar/Sacral

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee strained her low back while transferring inmate from bunk to wheelchair.

Claim No. 20821094 Close d

29 7/11/2020 Strain Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Vega, Andres N TX 7/11/2020 Thigh, Left N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Chasing subjects on foot, tripped on a curb causing a strain in left hamstring.

Claim No. 20820984 Close d

63 7/12/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

McCoy, Martha N TX 7/12/2020 Knee N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Detail Loss Run

Employee's glasses fogged up from wearing mask causing her to fall on her knees receiving a contusion.

Claim No. 20821153 Close d

52 7/13/2020 Sprain Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Roch, Kenneth N TX 7/13/2020 Shoulder, Left N Paid Paid Reserve Incurred

Medical $1,479.10 $2,529.33 $0.00 $2,529.33

Indemnity $0.00 $0.00 $0.00 $0.00

Temporary Disability $2.60 $0.00 $0.00 $0.00

Other $59.50 $102.00 $0.00 $102.00

Examiner: athornton Claim Total: $1,541.20 $2,631.33 $0.00 $2,631.33

Employee sprained his left shoulder while trying to restrain a stray dog he was carrying.

Claim No. 20821815 Close d

43 7/17/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Espinoza Montemayor, Rebecca

N TX 7/17/2020 Finger(s) N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Door closed on employee's right index finger causing a contusion.

Claim No. 20821708 Close d

23 7/18/2020 Contusion Temporary Disability

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Arellano, Jacob N TX 7/18/2020 Elbow, Right N Paid Paid Reserve Incurred

Medical $0.00 $563.16 $0.00 $563.16

Indemnity $0.00 $0.00 $0.00 $0.00

Temporary Disability $15.19 $14.62 $0.00 $14.62

Other $0.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $15.19 $594.78 $0.00 $594.78

Employee received a right elbow contusion during an altercation with an inmate.

Claim No. 20821985 Close d

37 7/18/2020 Strain Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Hayden, Ryan N TX 7/19/2020 Knee, Right N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee strained right knee jumping down from 6 ft wall.

Detail Loss Run

Claim No. 20821974 Close

46 7/22/2020 Abrasion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Russell, Maria N TX 7/22/2020 Other Facial Soft Tissue

N Paid Paid Reserve Incurred

Medical $0.00 $331.90 $0.00 $331.90

Other $0.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $0.00 $348.90 $0.00 $348.90

Employee was struck on the face with an open hand by an inmate causing an abrasion.

Claim No. 20823388 Close d

29 8/5/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Thomas, Bryan N TX 8/5/2020 Hand, Right N Paid Paid Reserve Incurred

Medical $679.28 $679.28 $0.00 $679.28

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $696.28 $696.28 $0.00 $696.28

Employee received a right hand contusion during an altercation with an inmate.

Claim No. 20824036 Close d

30 8/9/2020 Bites Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Hargrove Pierce, Reginald

N TX 8/9/2020 Finger(s) N Paid Paid Reserve Incurred

Medical $192.89 $192.89 $0.00 $192.89

Other $8.50 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $201.39 $201.39 $0.00 $201.39

Employee was bitten on the left index finger while trying to restrain an inmate.

Claim No. 20823933 Close d

23 8/11/2020 Dislocation Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Patton, Zachary N TX 8/11/2020 Thumb, Right N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee received a right thumb dislocation during an altercation with an inmate.

Claim No. 20823975 Close d

35 8/11/2020 Rupture Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Ramirez Jr, Fernando N TX 8/11/2020 Knee, Left N Paid Paid Reserve Incurred

Medical $16,878.52 $20,599.44 $0.00 $20,599.44

Detail Loss Run

Indemnity $0.00 $0.00 $0.00 $0.00

Other $85.00 $119.00 $0.00 $119.00

Examiner: athornton Claim Total: $16,963.52 $20,718.44 $0.00 $20,718.44

Employee tripped and fell on the floor receiving a left patellar tendon rupture.

Claim No. 20824205 Close d

25 8/11/2020 Abrasion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Garcia, Isaiah N TX 8/11/2020 Other Facial Soft Tissue

N Paid Paid Reserve Incurred

Medical $528.78 $528.78 $0.00 $528.78

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $545.78 $545.78 $0.00 $545.78

Employee received a face abrasion during an altercation with an inmate.

Claim No. 20825554 Close d

42 8/13/2020 Burn Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Wendt, Ryan N TX 8/28/2020 Multiple Lower Extremities

N Paid Paid Reserve Incurred

Medical $168.60 $168.60 $0.00 $168.60

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $185.60 $185.60 $0.00 $185.60

Chemical splashed on employee causing a chemical burn to his legs and feet.

Claim No. 20824389 Close d

29 8/14/2020 Sprain Minor PD Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Sierra, Christa N TX 8/14/2020 Knee, Left N Paid Paid Reserve Incurred

Medical $31,123.48 $36,849.79 $0.00 $36,849.79

Indemnity $0.91 $0.91 $0.00 $0.91

Permanent Disability $0.00 $3,387.80 $0.00 $3,387.80

Temporary Disability $7,890.89 $10,675.91 $0.00 $10,675.91

Other $229.50 $399.50 $0.00 $399.50

Examiner: athornton Claim Total: $39,244.78 $51,313.91 $0.00 $51,313.91

Employee received a left knee sprain during an altercation with an inmate.

Detail Loss Run

Claim No. 20824849 Close

60 8/18/2020 Burn Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Gonzales, Craig N TX 8/18/2020 Thigh, Right N Paid Paid Reserve Incurred

Medical $681.79 $681.79 $0.00 $681.79

Other $25.50 $25.50 $0.00 $25.50

Examiner: athornton Claim Total: $707.29 $707.29 $0.00 $707.29

Solution spilled out on employees pants causing a chemical burn to his right thigh area.

Claim No. 20824621 Close d

31 8/19/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Skruhak, Chris N TX 8/19/2020 Eye, Right N Paid Paid Reserve Incurred

Medical $647.62 $647.62 $0.00 $647.62

Other $25.50 $25.50 $0.00 $25.50

Examiner: athornton Claim Total: $673.12 $673.12 $0.00 $673.12

Inmate spit into employee's eyes causing bodily fluid exposure.

Claim No. 20824953 Close d

45 8/20/2020 Multiple physic Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Wahlert, Brian Y TX 8/21/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $4,484.01 $5,237.48 $0.00 $5,237.48

Indemnity $0.00 $0.00 $0.00 $0.00

Other $127.50 $170.00 $0.00 $170.00

Examiner: athornton Claim Total: $4,611.51 $5,407.48 $0.00 $5,407.48

Employee was involved in a MVA and received a neck strain, a left wrist and left knee contusion.

Claim No. 20827246 Close d

41 8/20/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Brown, Travis N TX 8/20/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $86.84 $86.84 $0.00 $86.84

Other $8.50 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $95.34 $95.34 $0.00 $95.34

Employee ran into a communications box with motorgrader.

Claim No. 20824868 Close d

22 8/21/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Detail Loss Run

Sierra, Evan N TX 8/21/2020 Knee, Right N Paid Paid Reserve Incurred

Claim Total: $0.00 $0.00 $0.00 $0.00

Employee slipped and fell in water on the floor receiving a right knee contusion.

Claim No. 20826780 Close d

78 8/25/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Haley, Janet N TX 9/1/2020 Chest N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Reaching for banana and the entire box of bananas fell down on her chest.

Claim No. 21845373 Close d

51 8/27/2020 COVID-19 Death Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

De La Rosa, Manuel Y TX 8/27/2020 Multiple Body Systems & Body Parts

N Paid Paid Reserve Incurred

Legal $0.00 $2,961.05 $0.00 $2,961.05

Examiner: jdye Claim Total: $0.00 $2,961.05 $0.00 $2,961.05

Employee was exposed to COVID 19.

Claim No. 20826129 Close d

68 9/3/2020 Concussion Temporary Disability

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Casarez Jr, Severo N TX 9/3/2020 Brain N Paid Paid Reserve Incurred

Medical $4,707.32 $7,688.75 $0.00 $7,688.75

Indemnity $0.00 $0.00 $0.00 $0.00

Temporary Disability $5,342.93 $5,342.93 $0.00 $5,342.93

Other $85.00 $233.00 $0.00 $233.00

Examiner: athornton Claim Total: $10,135.25 $13,264.68 $0.00 $13,264.68

Employee fell backwards after string he was pulling broke causing a left shoulder and head contusion.

Claim No. 20826565 Close d

41 9/4/2020 Bites Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Alvarez Pinales, Victor N TX 9/4/2020 Hand, Right N Paid Paid Reserve Incurred

Medical $273.84 $273.84 $0.00 $273.84

Other $8.50 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $282.34 $282.34 $0.00 $282.34

Employee received a right hand bite during an altercation with an inmate.

Detail Loss Run

Claim No. 20826781 Close

29 9/4/2020 Abrasion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Thomas, Bryan N TX 9/4/2020 Wrist N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Handling an arrestee when fell to the ground and bruised right arm, bite attempt made on left arm/skin not broken

Claim No. 20826693 Close d

22 9/8/2020 Laceration Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Castillo Jr, Jose N TX 9/8/2020 Ear, Right N Paid Paid Reserve Incurred

Medical $421.14 $421.14 $0.00 $421.14

Other $8.50 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $429.64 $429.64 $0.00 $429.64

Employee was extracting suspect from vehicle and cut his right ear on broken out window.

Claim No. 20826701 Close d

31 9/8/2020 Laceration Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

DeLeon, Rodrigo N TX 9/8/2020 Elbow, Left N Paid Paid Reserve Incurred

Medical $1,023.90 $1,451.64 $0.00 $1,451.64

Other $42.50 $51.00 $0.00 $51.00

Examiner: athornton Claim Total: $1,066.40 $1,502.64 $0.00 $1,502.64

Employee was extracting suspect from vehicle and cut his left elbow on broken out window.

Claim No. 20826703 Close d

29 9/8/2020 Laceration Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Terreo, Travis N TX 9/8/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $313.12 $313.12 $0.00 $313.12

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $330.12 $330.12 $0.00 $330.12

Employee was extracting suspect from vehicle and cut his hands and right knee on broken out window.

Claim No. 20827025 Close d

32 9/12/2020 Strain Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Booth, Shaun N TX 9/12/2020 Lower Back Area:

Lumbar/Sacral

N Paid Paid Reserve Incurred

Medical $1,660.50 $1,908.76 $0.00 $1,908.76

Detail Loss Run

Other $51.00 $59.50 $0.00 $59.50

Claim Total: $1,711.50 $1,968.26 $0.00 $1,968.26

Employee was involved in a MVA and received a low back strain.

Claim No. 20827046 Close d

32 9/12/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Dodson, Preston N TX 9/12/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $348.92 $348.92 $0.00 $348.92

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $365.92 $365.92 $0.00 $365.92

Employee was involved in a MVA with no physical injury.

Claim No. 20827491 Close d

52 9/16/2020 Multiple physic Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Matthews, Wesley N TX 9/16/2020 Elbow, Right N Paid Paid Reserve Incurred

Medical $1,226.33 $1,705.64 $0.00 $1,705.64

Other $85.00 $246.50 $0.00 $246.50

Examiner: athornton Claim Total: $1,311.33 $1,952.14 $0.00 $1,952.14

Employee was talking on the phone and missed last step causing him to fall receiving a right elbow sprain/fracture.

Claim No. 20827498 Close d

26 9/17/2020 Strain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Hernandez, Eddie N TX 9/17/2020 Upper Back Area:

Thoracic Area

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee strained his upper back while closing tailgate with one hand.

Claim No. 20827800 Close d

42 9/19/2020 Strain Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Gamble, David N TX 9/19/2020 Knee, Left N Paid Paid Reserve Incurred

Medical $806.36 $5,598.98 $0.00 $5,598.98

Other $42.50 $178.50 $0.00 $178.50

Examiner: athornton Claim Total: $848.86 $5,777.48 $0.00 $5,777.48

Employee received a left knee strain while arresting a suspect.

Claim No. 20828308 Close d

48 9/27/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Detail Loss Run

Rodriguez, Frank N TX 9/27/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $758.79 $758.79 $0.00 $758.79

Other $25.50 $25.50 $0.00 $25.50

Examiner: athornton Claim Total: $784.29 $784.29 $0.00 $784.29

Inmate threw bodily fluid on employee causing bodily fluid exposure.

Claim No. 20828694 Close d

40 9/29/2020 Strain Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Nichols, Terrance N TX 9/29/2020 Shoulder, Left N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee received a left shoulder/arm strain during an altercation with an inmate.

Claim No. 20828816 Close d

62 10/1/2020 Fracture Minor PD Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Stechschulte, Alan Y TX 10/1/2020 Ankle, Right N Paid Paid Reserve Incurred

Medical $6,873.13 $72,816.92 $0.00 $72,816.92

Indemnity $0.00 $0.00 $0.00 $0.00

Permanent Disability $0.00 $20,826.49 $0.00 $20,826.49

Temporary Disability $5,800.08 $34,134.03 $0.00 $34,134.03

Other $212.50 $694.50 $0.00 $694.50

Legal $0.00 $17,886.50 $0.00 $17,886.50

Examiner: athornton Claim Total: $12,885.71 $146,358.44 $0.00 $146,358.44

Employee fell off distributor truck and fractured his right ankle.

Claim No. 20830036 Close d

38 10/13/2020 Laceration Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Drexler, Michael N TX 10/13/2020 Thigh, Right N Paid Paid Reserve Incurred

Medical $0.00 $365.26 $0.00 $365.26

Other $0.00 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $0.00 $373.76 $0.00 $373.76

Employee cut right thigh while throwing away piece of culvert.

Claim No. 20830068 Close d

51 10/14/2020 Strain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Detail Loss Run

Hensley, Rita N TX 10/14/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $885.00 $885.00 $0.00 $885.00

Other $17.00 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $902.00 $902.00 $0.00 $902.00

Employee was involved in a MVA and received a neck, back and shoulder strain.

Claim No. 20830064 Close d

26 10/15/2020 Sprain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Larson, Joshua N TX 10/15/2020 Ankle, Right N Paid Paid Reserve Incurred

Medical $915.11 $1,033.51 $0.00 $1,033.51

Other $25.50 $42.50 $0.00 $42.50

Examiner: athornton Claim Total: $940.61 $1,076.01 $0.00 $1,076.01

Employee stepped wrong going down steps spraining his right ankle while escorting suspect.

Claim No. 20830815 Close d

32 10/19/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Pozuc, John N TX 10/19/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $0.00 $433.08 $0.00 $433.08

Other $0.00 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $0.00 $441.58 $0.00 $441.58

Employee was rendering aid to suspect with a gunshot wound causing bodily fluid/blood exposure.

Claim No. 20830820 Close d

31 10/19/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Rodgers, Justin N TX 10/19/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $0.00 $433.08 $0.00 $433.08

Other $0.00 $25.50 $0.00 $25.50

Examiner: athornton Claim Total: $0.00 $458.58 $0.00 $458.58

Employee was rendering aid to suspect with a gunshot wound causing bodily fluid/blood exposure.

Claim No. 20830599 Close d

33 10/20/2020 Bites Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Brady, Patrick N TX 10/20/2020 Hand, Left N Paid Paid Reserve Incurred

Medical $398.40 $856.05 $0.00 $856.05

Detail Loss Run

Other $17.00 $51.00 $0.00 $51.00

Claim Total: $415.40 $907.05 $0.00 $907.05

Employee was bitten by a dog on left hand when he approached residence front yard.

Claim No. 20830994 Close d

31 10/24/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

DeLeon, Rodrigo N TX 10/24/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Medical $0.00 $122.64 $0.00 $122.64

Other $0.00 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $0.00 $131.14 $0.00 $131.14

Employee was helping EMS with victim causing blood/bodily fluid exposure.

Claim No. 20832167 Close d

57 10/30/2020 Strain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

McGill, Jeffery N TX 11/3/2020 Lower Back Area:

Lumbar/Sacral

N Paid Paid Reserve Incurred

Medical $0.00 $295.43 $0.00 $295.43

Other $0.00 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $0.00 $303.93 $0.00 $303.93

Employee strained his low back lifting a chair over a desk.

Claim No. 20831907 Close d

51 11/2/2020 Multiple physic Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Ramirez, Roger N TX 11/2/2020 Multiple Body Parts N Paid Paid Reserve Incurred

Other $8.50 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $8.50 $34.00 $0.00 $34.00

Employee was involved in a MVA and received a neck strain and concussion

Claim No. 20832459 Close d

24 11/7/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Parten, John N TX 11/7/2020 Knee, Right N Paid Paid Reserve Incurred

Medical $0.00 $229.14 $0.00 $229.14

Other $0.00 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $0.00 $237.64 $0.00 $237.64

Employee received a right knee contusion during an altercation with an inmate.

Detail Loss Run

Claim No. 20833719 Close

25 11/13/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

McDuffie, Dacia N TX 11/13/2020 Other Facial Soft Tissue

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee received a face contusion during an altercation with an inmate.

Claim No. 20833057 Close d

22 11/14/2020 Strain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Vasquez, Jonah N TX 11/14/2020 Upper Back Area:

Thoracic Area

N Paid Paid Reserve Incurred

Medical $0.00 $175.61 $0.00 $175.61

Other $0.00 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $0.00 $184.11 $0.00 $184.11

Employee received a upper back strain during an altercation with an inmate.

Claim No. 20833527 Close d

22 11/17/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Wright, Darren N TX 11/17/2020 Multiple Head Injury N Paid Paid Reserve Incurred

Medical $118.84 $743.79 $0.00 $743.79

Other $8.50 $25.50 $0.00 $25.50

Examiner: athornton Claim Total: $127.34 $769.29 $0.00 $769.29

Inmate spit into employee's eyes and mouth causing bodily fluid exposure.

Claim No. 20833563 Close d

24 11/17/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Halvorson, Cody N TX 11/17/2020 Multiple Head Injury N Paid Paid Reserve Incurred

Medical $118.84 $743.79 $0.00 $743.79

Other $8.50 $25.50 $0.00 $25.50

Examiner: athornton Claim Total: $127.34 $769.29 $0.00 $769.29

Inmate spit into employee's eyes and mouth causing bodily fluid exposure.

Claim No. 20833521 Close d

28 11/19/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Soliz, Matthew N TX 11/19/2020 Chest N Paid Paid Reserve Incurred

Medical $0.00 $610.14 $1,158.70 $1,768.84

Detail Loss Run

Other $0.00 $18.00 $1,000.00 $1,018.00

Claim Total: $0.00 $628.14 $2,158.70 $2,786.84

Employee received a rib contusion during a takedown training maneuver with an employee.

Claim No. 20833718 Close d

27 11/19/2020 Sprain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

McCoy, Aaron N TX 11/20/2020 Ankle, Right N Paid Paid Reserve Incurred

Medical $209.67 $1,046.39 $0.00 $1,046.39

Other $8.50 $17.00 $0.00 $17.00

Examiner: athornton Claim Total: $218.17 $1,063.39 $0.00 $1,063.39

Employee sprained his right ankle while going down stairs on uneven steps.

Claim No. 20834201 Close d

34 11/26/2020 Sprain Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Naranjo, Andrea N TX 11/26/2020 Knee, Right N Paid Paid Reserve Incurred

Medical $0.00 $580.58 $0.00 $580.58

Other $0.00 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $0.00 $589.08 $0.00 $589.08

Slipped on wet floor and landed on right knee

Claim No. 20834411 Close d

58 12/1/2020 Contusion Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

De La Rosa, Keith N TX 12/1/2020 Hand, Right N Paid Paid Reserve Incurred

Medical $0.00 $325.39 $0.00 $325.39

Other $0.00 $8.50 $0.00 $8.50

Examiner: athornton Claim Total: $0.00 $333.89 $0.00 $333.89

Dump truck handle hit employee on the right hand causing a contusion.

Claim No. 20835881 Close d

37 12/15/2020 Fracture Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Speckels, Dustin N TX 12/15/2020 Finger(s) N Paid Paid Reserve Incurred

Medical $0.00 $1,302.56 $0.00 $1,302.56

Other $0.00 $68.00 $0.00 $68.00

Examiner: athornton Claim Total: $0.00 $1,370.56 $0.00 $1,370.56

Detail Loss Run

Employee fell while arresting suspect receiving a left 4th metatarsal fracture.

Claim No. 20836022 Close d

35 12/17/2020 No Physical Inj Medical Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Fonseca, James N TX 12/17/2020 Multiple Head Injury N Paid Paid Reserve Incurred

Medical $0.00 $478.45 $0.00 $478.45

Other $0.00 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $0.00 $512.45 $0.00 $512.45

Inmate threw unknown liquid into employee's eyes and mouth causing bodily fluid exposure.

Claim No. 21837895 Close d

29 12/26/2020 Contusion Record Only Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Thomas, Bryan N TX 12/26/2020 Other Facial Soft Tissue

N Paid Paid Reserve Incurred

Examiner: athornton Claim Total: $0.00 $0.00 $0.00 $0.00

Employee received a left jaw contusion during an altercation with an inmate.

Claim No. 20836830 Close d

37 12/28/2020 Contusion Indemnity - No Lost Time

Activity Paid 1/1/2020--1/1/2021 Totals Through 9/23/2025

Hayden, Ryan N TX 12/28/2020 Chest N Paid Paid Reserve Incurred

Medical $0.00 $1,277.07 $0.00 $1,277.07

Other $0.00 $34.00 $0.00 $34.00

Examiner: athornton Claim Total: $0.00 $1,311.07 $0.00 $1,311.07

Employee fell while chasing a suspect receiving a right rib contusion.

Claim No. 21837263 Close d

33 12/31/2020 Multiple physic Medical Only Activity…