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MTHCLLS <br /> <br />CLAIM <br />NUMBER CLAIMANT <br /> <br />339969 <br /> <br />342405 <br />346748 <br />349795 <br />351754 <br />352391 <br /> <br />354616 <br />3s63o6 _ ¢~.~. <br /> <br />TOTALS THIS <br /> <br />TOTAL <br /> <br /> WORKERS' COMPENSATION CLAIMS REPORT <br /> ABRIDOED : 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. 10/01/1996 TO 10/01/1997 <br /> <br />INJURY DESCRIPTION <br /> <br />DATE OF REPORT 10/01/97 <br /> <br /> DAYS DATE OF <br />OF TTD LOSS <br /> 0 12/11/96 <br /> 0 12/11/96 <br /> 0 12/12/96 <br /> 2 12/30/96 <br /> 0 01/17/97 <br /> 5 03/14/97 <br /> 0 05/02/97 <br /> 0 06/03/97 <br /> 0 06/11/97 <br /> 0 07/09/97 <br /> 0 07/21/97 <br /> 0 08/14/97 <br /> <br />........ PAID TO DATE ........ <br /> <br />MEDICAL <br /> 53.53 <br /> 0.00 <br /> 0.00 <br />790.38 <br /> 0.00 <br />460.83 <br /> 0 00 <br /> 0 00 <br />191 60 <br /> 0 00 <br /> 0 00 <br /> 0 00 <br /> <br />602 <br /> <br /> TOTAL CL A <br /> INDEM. EXPENSE RESERVE COST ST M <br /> 0.00 0.00 0.00 53.53 C Z1 <br />0.00 0.00 0.00 0.00 C D9 <br />0.00 0.00 0.00 0.00 C D9 <br />215.19 120.00 0.00 1125.57 C D9 <br />0.00 0.00 0.00 0.00 C D9 <br />495.43 367.49 11761.25 13085.00 0 D9 <br />0.00 50.00 0.00 50.00 C (]1 <br />0.00 50.00 0.00 50.00 C <br />0.00 55.00 103.40 350.00 O Z1 <br />0.00 50.00 550.00 600.00 O D9 <br />0.00 0.00 0.00 0.00 C Z1 <br />0.00 0.00 0.00 0.00 C Z1 <br /> <br />MED ONLY CLMS INDEM CLMS CLOSED DAYS <br /> <br />PAID PAID PAID TOTAL TOTAL <br /> <br />POLICY YEAR <br /> <br /># CLMS <br /> 12 <br /> <br />OPEN---CLSD OPEN---CLSD NO PAY OF TTD <br /> 2 3 I i 5 7 <br /> DISTRIBUTION OF RESERVES -> <br /> <br />MEDICAL INDE24NITY EXPENSE RESERVE COST <br />1496.34 710.62 692.49 <br />7797.57 4389.57 227.51 12414.65 15314.10 <br /> <br /> <br />