RFP_5800_SLW3034_ATT_5_v1.pdf
PDF 341 KB Posted
- Attached to
- Worker's Compensation Medical Management Service
- Solicitation number
- RFP 5800 SLW3034
- Issued by
- Texas
About this file
This is a Loss Run Report from the City of Austin, a Texas municipality, documenting workers' compensation claims activity as of September 30, 2023. The report serves as an exhibit supporting a Request for Proposal for Worker's Compensation Medical Management Services and contains detailed claim records for the City of Austin and its Austin Energy department. The report captures claim information across multiple data fields including claimant information, dates of loss and claim reporting, claim status, jurisdiction, coverage types, litigation status, and claim outcomes. The document presents seven representative workers' compensation claims spanning from 1989 to 2016, with claim statuses ranging from denied to accepted to pending, and covering various injury types including motor vehicle incidents, falls, strains, and lacerations.
The Loss Run Report provides financial detail on claims including paid amounts, reserves, and incurred costs for historical claims under workers' compensation policies. Of the claims presented, several show minimal financial activity with zero payments and reserves across all categories, while older claims such as the 1989 motor vehicle accident claim demonstrate significant incurred costs totaling $19,502.18. The report identifies specific examiners and supervisors responsible for claim management and indicates that none of the sampled claims involved subrogation recovery actions. The data reflects the City of Austin's claims experience across policy years 1989, 2012, 2016, and 2022, establishing baseline information relevant to the procurement of comprehensive workers' compensation medical management services including physician panel administration, cost containment, case management, and pharmacy benefits management.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP_5800_SLW3034_PAC1_v2.pdf | ||
| RFP_5800_SLW3034_PAC2_v1.docx | DOCX document | |
| RFP_5800_SLW3033_PAC2_v1.docx | DOCX document | |
| RFP_5800_SLW3034_PAC1_v1.pdf | ||
| RFP_5800_SLW3034_ATT_3_v1.docx | DOCX document | |
| RFP_5800_SLW3034_ATT_1_v1.docx | DOCX document | |
| RFP_5800_SLW3034_ATT_2_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3034_ATT_6_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3034_ATT_4_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3034_0600_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3034_ADD_1_v1.pdf | ||
| RFP_5800_SLW3034_0600_v2.xlsx | XLSX spreadsheet |
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Text version
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z AA AB AC AD AE AF AG AH AI
Client#
Client
Name As of Date
Account
Name
Unit
Name
Formatted
File Number
Claimant Full
Name (Last Then
First)
Date of
Loss
Date Claim
Reported to Client
Date Claim
Reported to TPA
Date Claim
Opened
Date Claim
Closed
Date Claim
Reopened
Claim
Status
State Of
Jurisdiction
State Of
Loss
Line
Type
Line
Code
Coverage
Description Coverage Code
WC Claim
Type as of Query
As Of
Date
WC Claim
Type -
Financial
Definition Subtype
Claim
Substatus Loss Description
Event
Description
Examiner
Office
Name
Examiner
Supervisor's
Full Name
Examiner
Correspondence
Name Litigation Status (Yes/No)
Date in
Litigation
Date Of Attorney
Representation
Settlement
Type
Settlement
Date
Method of
Settlement
A000
CITY OF
AUSTIN
TRANSFERR
ED CLAIMS 9/30/2023
0000 - CITY
OF AUSTIN
TRANSFERRED
CLAIMS
0000 -
CITY OF
AUSTIN
TRANSF
ERRED
CLAIMS 99999 Romeo, Juliet 3/31/2022 3/31/2022 4/22/2022 4/25/2022 10/4/2022 C TX TX WC WC
Workers
Compensation WC MO MO Denied
Unknown work related injury as
I could not read the documents provided from the
Unknown work related injury as I could not read the documents provided from the Urgent clinic.
AUSTIN,
TX Mik Stevens Molly Boot No 0
A000
CITY OF
AUSTIN
TRANSFERR
ED CLAIMS 9/30/2023
0000 - CITY
OF AUSTIN
TRANSFERRED
CLAIMS
0000 -
CITY OF
AUSTIN
TRANSF
ERRED
CLAIMS 88888 Blacky, Joey 3/18/2022 5/3/2022 5/3/2022 5/3/2022 5/16/2022 C TX TX WC WC
Workers
Compensation WC MO MO Denied
Medical bill received only -manual entry Unknown
AUSTIN,
TX Mik Stevens Tevi White No 0
A000
CITY OF
AUSTIN
TRANSFERR
ED CLAIMS 9/30/2023
0000 - CITY
OF AUSTIN
TRANSFERRED
CLAIMS
0000-
TRANSF
ERRED
CLAIMS 77777 Audit, Medical 8/1/1989 8/1/1989 8/1/1989 8/1/1989 5/4/1994 C TX TX WC WC
Workers
Compensation WC IN MO Accepted
Motor Vehicle, NOC All Other
(Specific) Injuries, NOC Whole
Body
Motor Vehicle, NOC All Other
(Specific)
Injuries, NOC
Whole Body
AUSTIN,
TX Mik Stevens Tevi White Yes 0
A011
AUSTIN
ENERGY 9/30/2023
0011 - AUSTIN
ENERGY
0001-
PROFES
SIONAL 66666 Wobegone, Mike 4/26/2012 5/7/2012 5/7/2012 5/7/2012 I TX TX WC WC
Workers
Compensation WC IO IO Pending
Rt Little Finger Abrasioniw Fell
From The Dividing Wall While
Crossing Over It.
Rt Little Finger
Abrasioniw Fell
From The
Dividing Wall
While Crossing
Over It.
Seperates The
Two
AUSTIN,
TX Mik Stevens Deb Woodbe No 0
A011
AUSTIN
ENERGY 9/30/2023
0011 - AUSTIN
ENERGY
0001-
PROFES
SIONAL 55555 Winkers, Kevin 5/24/2012 5/30/2012 5/30/2012 5/30/2012 I TX TX WC WC
Workers
Compensation WC IO IO Pending
Rt Knee Strainiw Was In Pole
Climbing School And While On
The Pole His Repositio
Rt Knee
Strainiw Was In
Pole Climbing
School And
While On The
Pole His
Repositioned
His
SAN
ANTONIO,
TX Mik Stevens Deb Woodbe No 0
A011
AUSTIN
ENERGY 9/30/2023
0011 - AUSTIN
ENERGY
0001-
PROFES
SIONAL 44444 Scott, Betty 3/4/2016 3/7/2016 3/8/2016 3/8/2016 I TX TX WC WC
Workers
Compensation WC IO IO Pending
IW was walking and stepped on a rock. The rock rolled causing him to fall, hitt
IW was walking and stepped on a rock. The rock rolled causing him to fall, hitting the ground on his right knee and hands
SAN
ANTONIO,
TX Mik Stevens Deb Woodbe No 0
CITY OF AUSTIN
EXHIBIT E - LOSS RUN REPORT
AJ AK AL AM AN AO AP AQ AR AS AT AU AV AW AX AY AZ BA BB BC BD BE BF BG BH BI BJ BK BL BM BN BO BP BQ BR BS BT
Subrogation
Status
(Yes/No)
Cause
Description
(Interaction) Result/Nature Description
Target/Part of Body
Description
Last
Payment
Date
Days
Since Last
Payment
Claim
Paid -
Ind/Loss
Claim
Paid –
Medical
Claim
Paid -
Expense
Claim
Paid -
Total
Claim
Future
Reserve -
Ind/Loss
Claim
Future
Reserve –
Medical
Claim
Future
Reserve –
Expense
Claim
Future
Reserve –
Total
Claim
Incurred -
Ind/Loss
Claim
Incurred
– Medical
Claim
Incurred
Expense
Claim
Incurred -
Total
Claim
Recovery -
Ind/Loss
Claim
Recovery -
Expense
Claim
Recovery
– Medical
Claim
Recovery
– Total
Policy -
Policy
Number
Plan -
Carrier
Name
Policy -
Inception
Date
Policy -
Expiration
Date
Plan
Number
Structure Level
Name 01
Structure Level
Name 02
Structure Level
Name 03
Structure Level
Name 04
Structure Level
Name 05 Client Name
Client
Number
Account
Number
Unit
Number
N
Other Injury
NEC All Other (Specific) Injuries, NOC
Multiple
Body Parts 44806 393 0 0 9.45 9.45 0 0 0 0 0 0 9.45 9.45 0 0 0 0 WC2022 44470 44834 1 City of Austin
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS City of Austin 7830 78300001 1
N
Other Injury
NEC No Physical Injury
Low Back
Area (Incl.
Lumbar &
Lumbo-
Sacral) 44694 505 0 0 9.45 9.45 0 0 0 0 0 0 9.45 9.45 0 0 0 0 WC2022 44470 44834 1 City of Austin
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS City of Austin 7830 78300001 1
N
Motor
Vehicle, NOC All Other (Specific) Injuries, NOCWhole Body 36571 8628 0 0 19502.18 19502.18 0 0 0 0 0 0 19502.18 19502.18 0 0 0 0 WC1989 32417 32781 1 City of Austin
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS
0000 - CITY OF
AUSTIN
TRANSFERRED
CLAIMS
0000-
TRANSFERRED
CLAIMS
0000-
TRANSFERRED
CLAIMS City of Austin 7830 78300001 2
N
Fall/Slip
From a
Different
Level Laceration Finger(s) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WC2012 40817 41182 1 City of Austin
0011 - AUSTIN
ENERGY 1110-ENERGY
1100-ELECTRIC
OPERATING
0001-
PROFESSIONAL City of Austin 7830 78300011 2
N
Strain or
Injury By, NOC Strain or Tear Knee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WC2012 40817 41182 1 City of Austin
0011 - AUSTIN
ENERGY 1110-ENERGY
1100-ELECTRIC
OPERATING
0001-
PROFESSIONAL City of Austin 7830 78300011 2
N Twisting Strain or Tear Knee 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WC2016 42278 42643 1 City of Austin
0011 - AUSTIN
ENERGY 1110-ENERGY
1100-ELECTRIC
OPERATING
0001-
PROFESSIONAL City of Austin 7830 78300011 2
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