Schedule I Sample 5 year Claims Report.xlsx

This file is a Long-Term Disability (LTD) Claims Report containing sample data from a state disability benefits program, likely administered by Michigan state government based on department references including the Department of Corrections, MDHHS (Michigan Department of Health and Human Services), and Civil Service Commission. The report documents disability claims processed over a five-year period with monthly tracking data for individual claimants.

The spreadsheet tracks comprehensive claims administration information including claimant demographics, employment details, claim processing timelines, benefit payments, and medical diagnoses. Key data fields include claim numbers, claimant names and identification, dates of hire and first absence, claim receipt and approval dates, benefit commencement dates, claim closure dates and reasons, length of disability periods, benefit amounts paid, and associated medical expenses including IME (Independent Medical Examination) and legal costs. The report captures claim status at various processing levels, denial and appeal information with associated dates and decisions, and fiscal year payment tracking. Medical diagnoses are coded using ICD-10 standards with both primary and secondary condition coding. Sample claims shown include various disability reasons ranging from pregnancy-related conditions and musculoskeletal injuries to more complex medical conditions, with benefit amounts varying based on disability duration and approved benefit periods. The data structure enables tracking of claim lifecycle from receipt through closure, including financial reconciliation of total incurred costs against paid benefits.