Laserfiche WebLink
MTHCLLS <br /> <br />CLAIM <br />NUMBER CLAIMANT <br />306490 C <br />310207 <br /> <br />316702 <br />3~9586 <br /> <br />3212~3 <br />328388 <br />3287S3 <br />331431 <br />3344o4 <br /> <br />TOTALS THIS TOTAL <br /> <br />\qq~ -IqqL~ <br /> <br /> WORKERS' COMPENSATION CLAIMS REPORT <br /> ABRIDGED : ALL CLAIM DETAIL FOR POLICY YEARS WITH OPEN CLAIMS <br />CLAIMS REPORT FOR ELK RIVER, ELK RIVER <br />GROUP NO. 02 ACCT # 000513 POLICY YR. 10/01/1995 TO 10/01/1996 <br /> <br />INJURY DESCRIPTION <br /> <br />liED ONLY CLMS IBIDEM <br /> <br />DAYS DATE OF <br />OF TTD LOSS MEDICAL <br />o 10/05/95 o.oo <br />0 11/14/95 166.08 <br />0 11/27/95 0.00 <br />0 01/05/96 0.00 <br />0 03/04/96 0.00 <br />0 03/18/96 0.o0 <br />0 03/24/96 1690.06 <br />0 03/27/96 1998.49 <br />0 06/19/96 134.69 <br />o 07/03/96 o.oo <br />o 08/05/96 o.oo <br />0 08/07/96 0.00 <br />0 09/14/96 0.00 <br /> <br />DATE OF REPORT 10/01/96 <br /> <br />........ PAID TO DATE ........ <br /> <br />INDEM. EXPENSE RESERVE <br />0.00 0.00 0.00 <br />0.00 0.00 0.00 <br />0.00 0.00 0.00 <br />0.00 0.00 0.00 <br />0.00 0.00 0.00 <br />0.00 0.00 0.00 <br />0.00 5.34 1354.60 <br />0.00 14.88 1036.63 <br />0.00 0.00 340.31 <br />0.00 0.00 375.00 <br />0.00 0.00 350.00 <br />0.00 0.00 250.00 <br />0.00 0.00 850.00 <br /> <br /> CLMS CLOu=u DAYS PAID PAID PAID <br /> OPEN---CLSD NO PAY OF TTD MEDICAL INDEMNITY EXPENSE <br /> <br /> 0 0 5 0 3989.32 0.00 20.22 <br /> <br />DISTRIBUTION OF RESERVES -> 4126.76 0.00 429.78 <br /> <br />TOTAL <br /> <br />525 <br /> <br />TOTAL CL A <br />COST ST M <br />o.00 C P5 <br />166.08 C P5 <br />0.00 C P5 <br />0.00 C P5 <br />0.00 C P5 <br />0.00 C P5 <br />3050.00 0 P5 <br />3050.00 0 PS <br />475.00 0 P5 <br />375.00 0 PS <br />350.00 O PS <br />250.00 0 P5 <br />850.00 O P5 <br /> <br />TOTAL <br /> <br />POLICY YEAR # CLMS OPEN---CT'SD <br /> 13 7 I <br /> <br />RESERVE <br />4556.54 <br /> <br /> COST <br />8566.08 <br /> <br /> <br />