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IqR "l .-- I q <br /> <br />SEP 1 0 <br /> <br />MTHCLLS <br /> <br />CLAIM <br />NUMBER CLAIMANT <br />900407 <br />900598 <br />900952 <br /> <br />901115 <br />9ozo87 <br />901088 <br />901089 ¢ ~'~.~ <br />901090 <br />901091 <br />901092 <br />901703 <br />902065 <br />902771 <br />902580 <br />902712 <br />902824 <br />902976 <br /> <br />903735 <br />903967 <br /> <br />TOTALS THIS <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. 10/01/1997 TO 10/01/1998 <br /> <br />INJURY DESCRIPTION <br /> <br />To~AL MEo o~Y c~s' <br /> <br />DATE OF REPORT 09/01/98 <br /> <br />DAYS DATE OF ........ PAID TO DATE ........ <br />OF TTD LOSS MEDICAL INDEM. EXPENSE <br /> 0 10/09/97 134.25 0.00 0.00 <br /> 0 10/13/97 56.50 0.00 0.00 <br /> 0 11/18/97 148.68 0.00 50.00 <br /> 0 12/02/97 0.00 0.00 50.00 <br /> 2 12/11/97 519.37 245.55 361.92 <br /> 0 12/14/97 0.00 0.00 50.00 <br /> 0 12/14/97 0.00 0.00 50.00 <br /> 0 12/14/97 0.00 0.00 0.00 <br /> 0 12/14/97 0.00 0.00 0.00 <br /> 0 12/14/97 0.00 0.00 0.00 <br /> 0 12/14/97 0.00 0.00 50.00 <br /> 0 02/05/98 130.84 0.00 50.00 <br /> 0 03/18/98 0.00 0.00 0.00 <br /> 0 04/22/98 101.10 0.00 0.00 <br /> 0 05/11/98 0.00 0.00 0.00 <br /> 0 05/20/98 184.58 0.00 0.00 <br /> 0 05/28/98 0.00 0.00 50.00 <br /> 0 06/04/98 990.37 0.00 50.00 <br /> 0 07/02/98 0.00 0.00 0.00 <br /> 0 07/31/98 101.70 0.00 0.00 <br /> 0 08/27/98 0.00 0.00 0.00 <br /> <br />RESERVE <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 0.00 <br /> 169.16 <br /> 600.00 <br /> 448.90 <br /> 0.00 <br />815.42 <br />0.00 <br />1059.63 <br />350.00 <br />198.30 <br />2600.00 <br /> <br />TOTAL <br />COST <br />134.25 <br />56.50 <br />198.68 <br />50.00 <br />1126.84 <br />50.00 <br />50.00 <br />0.00 <br />0.00 <br />0.00 <br />50.00 <br />350.00 <br />600.00 <br />550.00 <br />0.00 <br />1000.00 <br />50.00 <br />2100.00 <br />350.00 <br />300.00 <br />2600.00 <br /> <br />58O <br /> <br />CL A <br />ST M <br />C Z1 <br />C Zl <br />C Z1 <br />C Zl <br />C D9 <br />C Zl <br />C Z1 <br />C ~.1 <br />C Z1 <br />C Z1 <br />C Z1 <br />0 Z1 <br />0 Z1 <br />0 Z1 <br />C Zl <br />O Z1 <br />C Zl <br />O Z1 <br />O Z1 <br />0 D9 <br />0 Z1 <br /> <br />CLMS CLOSED DAYS <br /> <br />PAID PAID PAID TOTAL TOTAL <br /> <br />POLICY YEAR ~ CLMS OPEN---CLSD <br /> 21 8 8 <br /> <br /> OPEN---CLSD NO PAY OF TTD <br /> 0 i 4 2 <br />DISTRIBUTION OF RESERVES -> <br /> <br />MEDICAL INDEMNITY EXPENSE RESERVE COST <br />2367.39 245.55 761.92 <br />4791.41 0.00 1450.00 6241.41 9616.27 <br /> <br /> <br />