HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail …
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Run date: 06-FEB-12 NCAComp Page: 1 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 *** CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000 Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL ============ ============ ============ ============ ============ ============ HCP000011263 0.00 0.00 0.00 0.00 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 01/01/90 I CL 0.00 0.00 0.00 0.00 HCP004749 0.00 0.00 0.00 0.00 0.00 0.00 95.00 0.00 0.00 95.00 0.00 0.00 0.00 0.00 0.00 0.00 04/20/93 M CL 0.00 0.00 95.00 95.00 HCP000001 0.00 0.00 0.00 0.00 LIFTING 0.00 176.92 0.00 0.00 0.00 176.92 NECK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 05/11/93 M CL 0.00 176.92 0.00 176.92 HCP000002 0.00 0.00 0.00 0.00 LIFTING 326.55 108.02 0.00 0.00 0.00 434.57 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 05/17/93 I CL 326.55 108.02 0.00 434.57 HCP008384 0.00 0.00 0.00 0.00 0.00 0.00 95.00 0.00 0.00 95.00 0.00 0.00 0.00 0.00 0.00 0.00 05/18/93 M CL 0.00 0.00 95.00 95.00 HCP000033 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 46.02 77.87 0.00 0.00 123.89 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 06/25/93 I CL 0.00 46.02 77.87 123.89 HCP000008 0.00 0.00 0.00 0.00 REPETITIVE MOTION 0.00 0.00 820.00 0.00 0.00 820.00 WRIST RIGHT 09361508 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 07/04/93 I CL 0.00 0.00 820.00 820.00
Transcript of HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail …
untitledRun date: 06-FEB-12 NCAComp Page: 1 HCP - HEALTH CARE
PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period:
12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000011263 0.00 0.00 0.00 0.00
OTHER 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 01/01/90 I CL 0.00 0.00 0.00 0.00
HCP004749 0.00 0.00 0.00 0.00 0.00 0.00 95.00 0.00 0.00 95.00 0.00 0.00 0.00 0.00 0.00 0.00
04/20/93 M CL 0.00 0.00 95.00 95.00
HCP000001 0.00 0.00 0.00 0.00 LIFTING 0.00 176.92 0.00 0.00 0.00 176.92 NECK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 05/11/93 M CL 0.00 176.92 0.00 176.92
HCP000002 0.00 0.00 0.00 0.00 LIFTING 326.55 108.02 0.00 0.00 0.00 434.57 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 05/17/93 I CL 326.55 108.02 0.00 434.57
HCP008384 0.00 0.00 0.00 0.00 0.00 0.00 95.00 0.00 0.00 95.00 0.00 0.00 0.00 0.00 0.00 0.00
05/18/93 M CL 0.00 0.00 95.00 95.00
HCP000033 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 46.02 77.87 0.00 0.00 123.89 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 06/25/93 I CL 0.00 46.02 77.87 123.89
HCP000008 0.00 0.00 0.00 0.00 REPETITIVE MOTION 0.00 0.00 820.00 0.00 0.00 820.00 WRIST RIGHT 09361508 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 07/04/93 I CL 0.00 0.00 820.00 820.00
Run date: 06-FEB-12 NCAComp Page: 2 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000003 0.00 0.00 0.00 0.00
STRUCK AGAINST 0.00 133.59 150.00 0.00 0.00 283.59 WRIST LEFT 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 07/05/93 I CL 0.00 133.59 150.00 283.59
HCP000004 0.00 0.00 0.00 0.00 STRUCK BY OBJECT 0.00 0.00 0.00 0.00 0.00 0.00 LUNGS 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 07/06/93 M CL 0.00 0.00 0.00 0.00
HCP000554 0.00 0.00 0.00 0.00 LIFTING 0.00 222.84 0.00 0.00 0.00 222.84 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 07/09/93 M CL 0.00 222.84 0.00 222.84
HCP000005 0.00 0.00 0.00 0.00 LIFTING 648.52 747.61 6.40 0.00 0.00 1,402.53 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 07/13/93 I CL 648.52 747.61 6.40 1,402.53
HCP000006 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 373.60 4.97 0.00 0.00 378.57 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 07/19/93 M CL 0.00 373.60 4.97 378.57
HCP000011 0.00 0.00 0.00 0.00 LIFTING 227.50 332.09 0.00 0.00 0.00 559.59 HIP 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 07/21/93 I CL 227.50 332.09 0.00 559.59
HCP000563 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 140.38 3.82 0.00 0.00 144.20 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CUT/LACERATION/PUNTURE 07/26/93 M CL 0.00 140.38 3.82 144.20
Run date: 06-FEB-12 NCAComp Page: 3 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000034 0.00 0.00 0.00 0.00
REPETITIVE MOTION 0.00 0.00 0.00 0.00 0.00 0.00 ARM LEFT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 08/01/93 M CL 0.00 0.00 0.00 0.00
HCP000007 0.00 0.00 0.00 0.00 PUSHING/PULLING 0.00 3,546.05 0.00 0.00 0.00 3,546.05 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/02/93 I CL 0.00 3,546.05 0.00 3,546.05
HCP000009 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 HIP 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 08/02/93 M CL 0.00 0.00 0.00 0.00
HCP000013 0.00 0.00 0.00 0.00 STRUCK AGAINST 7,972.82 3,830.12 402.61 0.00 0.00 12,205.55 FINGERS 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 08/07/93 I CL 7,972.82 3,830.12 402.61 12,205.55
HCP000017 0.00 0.00 0.00 0.00 OTHER 469.14 409.01 11.44 0.00 0.00 889.59 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 INFECTION 08/11/93 I CL 469.14 409.01 11.44 889.59
HCP000016 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 1,350.00 441.01 100.00 0.00 0.00 1,891.01 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/12/93 I CL 1,350.00 441.01 100.00 1,891.01
HCP000556 0.00 0.00 0.00 0.00 LIFTING 0.00 221.35 5.72 0.00 0.00 227.07 ABDOMEN 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/16/93 M CL 0.00 221.35 5.72 227.07
Run date: 06-FEB-12 NCAComp Page: 4 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000143 0.00 0.00 0.00 0.00
LIFTING 51,101.00 7,575.28 5,853.40 0.00 0.00 64,529.68 BACK 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 08/17/93 I CL 51,101.00 7,575.28 5,853.40 64,529.68
HCP000031 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 260.42 19.39 0.00 0.00 279.81 ANKLES 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/20/93 M CL 0.00 260.42 19.39 279.81
HCP000012 0.00 0.00 0.00 0.00 TWISTING 15,228.11 11,830.46 2,510.07 0.00 0.00 29,568.64 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/23/93 I CL 15,228.11 11,830.46 2,510.07 29,568.64
HCP000010 0.00 0.00 0.00 0.00 FIRE 0.00 0.00 0.00 0.00 0.00 0.00 FINGERS 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 08/24/93 M CL 0.00 0.00 0.00 0.00
HCP000584 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 177.85 11.77 0.00 0.00 189.62 ANKLE LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/24/93 M CL 0.00 177.85 11.77 189.62
HCP000038 0.00 0.00 0.00 0.00 LIFTING 43,132.80 2,832.03 7,247.17 0.00 0.00 53,212.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/25/93 I CL 43,132.80 2,832.03 7,247.17 53,212.00
HCP000555 0.00 0.00 0.00 0.00 BITES/STINGS 0.00 81.92 4.87 0.00 0.00 86.79 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 SCRATCHES/ABRASIONS 08/30/93 M CL 0.00 81.92 4.87 86.79
Run date: 06-FEB-12 NCAComp Page: 5 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000015 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 9,218.81 4,570.30 560.64 0.00 0.00 14,349.75 FINGERS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/04/93 I CL 9,218.81 4,570.30 560.64 14,349.75
HCP002162 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 213.94 0.00 0.00 0.00 213.94 ANKLE LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/06/93 M CL 0.00 213.94 0.00 213.94
HCP000024 0.00 0.00 0.00 0.00 LIFTING 26,595.09 8,493.33 3,958.68 0.00 0.00 39,047.10 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/15/93 I CL 26,595.09 8,493.33 3,958.68 39,047.10
HCP000051 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 175.59 0.00 0.00 0.00 175.59 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/18/93 M CL 0.00 175.59 0.00 175.59
HCP000018 0.00 0.00 0.00 0.00 BITES/STINGS 0.00 38.69 0.00 0.00 0.00 38.69 BACK 0.00 0.00 0.00 0.00 0.00 0.00 BITE/STING 09/19/93 M CL 0.00 38.69 0.00 38.69
HCP000035 5,107.44 0.00 619.09 5,726.53 LIFTING 0.00 3,871.98 5,182.83 62,418.33 3,314.59 9,054.81 BACK,NECK 59405363 0.00 0.00 0.00 0.00 456.86 0.00 SPRAINS/STRAINS 09/19/93 F OP 5,107.44 3,871.98 5,801.92 14,781.34 APPORTIONED @ 40% THIS FILE WITH 15-8 @ 100% 60% ON HCP000508
HCP000025 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 17,134.31 7,405.56 15,228.01 0.00 0.00 39,767.88 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/22/93 I CL 17,134.31 7,405.56 15,228.01 39,767.88
Run date: 06-FEB-12 NCAComp Page: 6 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000019 0.00 0.00 0.00 0.00
PUSHING/PULLING 25,000.00 3,704.71 5,730.08 60,000.00 0.00 34,434.79 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/24/93 I CL 25,000.00 3,704.71 5,730.08 34,434.79 15;8
HCP000078 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 625.36 79.79 0.00 0.00 0.00 705.15 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/28/93 I CL 625.36 79.79 0.00 705.15
HCP000114 0.00 0.00 0.00 0.00 STRUCK BY OBJECT 0.00 3,750.45 183.17 0.00 0.00 3,933.62 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 09/28/93 M CL 0.00 3,750.45 183.17 3,933.62
HCP000023 476,942.09 365,066.01 5,732.56 847,740.66 LIFTING 71,516.96 146,756.02 31,727.02 0.00 292,180.03 250,000.00 BACK,OTHER 5932 3455 0.00 0.00 0.00 0.00 2,431.56 0.00 SPRAINS/STRAINS 09/29/93 X OP 548,459.05 511,822.03 37,459.58 1,097,740.66 ANCR; BACK AND PSYCHIATRIC DISORDER PPD CCP @ $331.38 LESS $5/WK OLD ATTY FEE
HCP000058 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 608.00 1,119.30 162.97 0.00 0.00 1,890.27 ANKLE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/04/93 I CL 608.00 1,119.30 162.97 1,890.27
HCP000022 0.00 0.00 0.00 0.00 LIFTING 278.40 325.48 359.89 0.00 0.00 963.77 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/05/93 I CL 278.40 325.48 359.89 963.77
HCP000020 0.00 0.00 0.00 0.00 PUSHING/PULLING 0.00 0.00 0.00 0.00 0.00 0.00 WRIST RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/06/93 M CL 0.00 0.00 0.00 0.00
Run date: 06-FEB-12 NCAComp Page: 7 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000021 0.00 0.00 0.00 0.00
LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/07/93 M CL 0.00 0.00 0.00 0.00
HCP000032 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00 HAND LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SCRATCHES/ABRASIONS 10/08/93 M CL 0.00 0.00 0.00 0.00
HCP000026 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 13,247.49 16,983.43 2,241.74 0.00 0.00 32,472.66 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/12/93 I CL 13,247.49 16,983.43 2,241.74 32,472.66
HCP000028 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 29,146.10 3,135.51 6,585.40 10,000.00 0.00 38,867.01 KNEE RIGHT 29326915 0.00 0.00 0.00 0.00 0.00 0.00 TENDONITIS 10/12/93 I CL 29,146.10 3,135.51 6,585.40 38,867.01 SUBRORECD
HCP000068 0.00 0.00 0.00 0.00 LIFTING 1,336.52 20.59 0.00 0.00 0.00 1,357.11 GROIN 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 10/13/93 I CL 1,336.52 20.59 0.00 1,357.11
HCP000027 0.00 0.00 0.00 0.00 LIFTING 2,535.00 1,242.81 253.63 0.00 0.00 4,031.44 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/15/93 I CL 2,535.00 1,242.81 253.63 4,031.44
HCP000029 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 242.07 25.99 0.00 0.00 268.06 KNEE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 10/21/93 M CL 0.00 242.07 25.99 268.06
Run date: 06-FEB-12 NCAComp Page: 8 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP001041 0.00 0.00 0.00 0.00
AUTOMOBILE ACCIDENTS 0.00 1,472.89 237.23 0.00 0.00 1,710.12 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/21/93 M CL 0.00 1,472.89 237.23 1,710.12
HCP000030 0.00 0.00 0.00 0.00 FIRE 0.00 0.00 0.00 0.00 0.00 0.00 KNEE LEFT 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 10/22/93 M CL 0.00 0.00 0.00 0.00
HCP000054 0.00 0.00 0.00 0.00 LIFTING 2,713.60 1,537.95 424.27 0.00 0.00 4,675.82 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/22/93 I CL 2,713.60 1,537.95 424.27 4,675.82
HCP000036 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/23/93 M CL 0.00 0.00 0.00 0.00
HCP000059 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 48,992.68 34,337.16 7,622.40 43,448.62 0.00 90,952.24 BACK 59325075 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 10/25/93 I CL 48,992.68 34,337.16 7,622.40 90,952.24
HCP000039 0.00 0.00 0.00 0.00 LIFTING 51.20 1,361.07 96.05 0.00 0.00 1,508.32 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/27/93 I CL 51.20 1,361.07 96.05 1,508.32
HCP000106 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 3,383.12 1,475.09 212.14 0.00 0.00 5,070.35 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/29/93 I CL 3,383.12 1,475.09 212.14 5,070.35
Run date: 06-FEB-12 NCAComp Page: 9 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000519 0.00 0.00 0.00 0.00
OTHER 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 10/31/93 M CL 0.00 0.00 0.00 0.00
HCP002183 0.00 0.00 0.00 0.00 LIFTING 0.00 263.74 0.01 0.00 0.00 263.75 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/01/93 M CL 0.00 263.74 0.01 263.75
HCP000040 0.00 0.00 0.00 0.00 LIFTING 0.00 201.85 12.25 0.00 0.00 214.10 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/02/93 M CL 0.00 201.85 12.25 214.10
HCP000047 0.00 0.00 0.00 0.00 STRUCK AGAINST 5,300.00 2,039.94 379.38 0.00 0.00 7,719.32 SHOULDER RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/02/93 I CL 5,300.00 2,039.94 379.38 7,719.32
HCP000041 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 546.42 358.04 0.00 0.00 904.46 FOOT LEFT 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 11/03/93 I CL 0.00 546.42 358.04 904.46
HCP000062 0.00 0.00 0.00 0.00 LIFTING 0.00 1,079.81 50.68 0.00 0.00 1,130.49 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/04/93 I CL 0.00 1,079.81 50.68 1,130.49
HCP000073 0.00 0.00 0.00 0.00 LIFTING 14,612.41 9,243.17 4,479.71 0.00 0.00 28,335.29 BACK 29401157 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/04/93 I CL 14,612.41 9,243.17 4,479.71 28,335.29
Run date: 06-FEB-12 NCAComp Page: 10 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000048 0.00 0.00 0.00 0.00
LIFTING 68,739.44 16,119.43 3,903.88 0.00 0.00 88,762.75 BACK 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 11/05/93 I CL 68,739.44 16,119.43 3,903.88 88,762.75
HCP000042 0.00 0.00 0.00 0.00 LIFTING 4,054.46 116.63 85.29 0.00 0.00 4,256.38 LEG LEFT 0.00 0.00 0.00 0.00 0.00 0.00 TENDONITIS 11/08/93 I CL 4,054.46 116.63 85.29 4,256.38
HCP000060 0.00 0.00 0.00 0.00 PUSHING/PULLING 1,041.97 2,894.62 156.77 0.00 0.00 4,093.36 GROIN 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 11/09/93 I CL 1,041.97 2,894.62 156.77 4,093.36
HCP000126 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 13,578.00 12,031.12 1,787.16 0.00 0.00 27,396.28 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/09/93 I CL 13,578.00 12,031.12 1,787.16 27,396.28
HCP000044 2,600.00 0.00 1,300.00 3,900.00 TWISTING 12,165.13 7,986.15 3,445.03 26,300.00 2,800.00 23,596.31 BACK 2932 6434 0.00 0.00 0.00 0.00 300.00 0.00 SPRAINS/STRAINS 11/10/93 F OP 14,765.13 7,986.15 4,745.03 27,496.31 50% APPORTIONMENT - 15.8 @ 100% CLASS PPD NOD 6/11/01 - CCP @ $100 50% APPORT
HCP000046 0.00 0.00 0.00 0.00 FIRE 3,845.30 88.01 75.00 0.00 0.00 4,008.31 FACIAL 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 11/10/93 I CL 3,845.30 88.01 75.00 4,008.31
HCP000050 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 8,640.00 2,327.75 96.87 0.00 0.00 11,064.62 KNEE RIGHT 59327343 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/10/93 I CL 8,640.00 2,327.75 96.87 11,064.62
25A
Run date: 06-FEB-12 NCAComp Page: 11 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000055 0.00 0.00 0.00 0.00
LIFTING 46,238.69 8,237.70 2,009.64 0.00 0.00 56,486.03 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/11/93 I CL 46,238.69 8,237.70 2,009.64 56,486.03
HCP000079 0.00 0.00 0.00 0.00 LIFTING 328.68 404.76 223.01 0.00 0.00 956.45 HAND LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/12/93 I CL 328.68 404.76 223.01 956.45
HCP000109 0.00 0.00 0.00 0.00 OTHER 0.00 5,921.16 2,413.42 0.00 0.00 8,334.58 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/12/93 I CL 0.00 5,921.16 2,413.42 8,334.58
HCP002164 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 240.45 5.78 0.00 0.00 246.23 ANKLE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/15/93 M CL 0.00 240.45 5.78 246.23
HCP000056 0.00 0.00 0.00 0.00 LIFTING 27,021.69 5,744.77 5,130.82 3,638.19 0.00 37,897.28 WRISTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/17/93 I CL 27,021.69 5,744.77 5,130.82 37,897.28
HCP000045 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 25,131.91 44,772.00 6,477.36 25,000.00 0.00 76,381.27 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/18/93 I CL 25,131.91 44,772.00 6,477.36 76,381.27
HCP000080 0.00 0.00 0.00 0.00 OTHER 0.00 0.00 75.00 0.00 0.00 75.00 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 DERMATITIS 11/20/93 I CL 0.00 0.00 75.00 75.00
Run date: 06-FEB-12 NCAComp Page: 12 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000191 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 0.00 8,634.38 2,363.33 0.00 0.00 10,997.71 HEAD 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 11/20/93 I CL 0.00 8,634.38 2,363.33 10,997.71
HCP000057 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 177.95 0.00 0.00 0.00 177.95 HANDS 0.00 0.00 0.00 0.00 0.00 0.00 CUT/LACERATION/PUNTURE 11/22/93 M CL 0.00 177.95 0.00 177.95
HCP000049 0.00 0.00 0.00 0.00 LIFTING 0.00 188.26 9.31 0.00 0.00 197.57 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/23/93 M CL 0.00 188.26 9.31 197.57
HCP000072 0.00 0.00 0.00 0.00 LIFTING 0.00 347.05 1.44 0.00 0.00 348.49 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/23/93 M CL 0.00 347.05 1.44 348.49
HCP000117 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 258.61 40.70 0.00 0.00 299.31 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 11/23/93 M CL 0.00 258.61 40.70 299.31
HCP000061 0.00 0.00 0.00 0.00 STRUCK AGAINST 30.00 210.27 5.78 0.00 0.00 246.05 HEAD 0.00 0.00 0.00 0.00 0.00 0.00 CONCUSSION 11/26/93 I CL 30.00 210.27 5.78 246.05
HCP000052 0.00 0.00 0.00 0.00 LIFTING 132.00 220.75 18.66 0.00 0.00 371.41 ARM LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/30/93 I CL 132.00 220.75 18.66 371.41
Run date: 06-FEB-12 NCAComp Page: 13 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000085 0.00 0.00 0.00 0.00
LIFTING 127.09 191.59 29.85 0.00 0.00 348.53 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/30/93 I CL 127.09 191.59 29.85 348.53
HCP000067 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/01/93 M CL 0.00 0.00 0.00 0.00
HCP000053 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 0.00 0.00 125.00 0.00 0.00 125.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/03/93 I CL 0.00 0.00 125.00 125.00
HCP000174 0.00 0.00 0.00 0.00 BITES/STINGS 5,688.37 2,185.98 2,561.42 0.00 0.00 10,435.77 FOOT LEFT 0.00 0.00 0.00 0.00 0.00 0.00 BITE/STING 12/06/93 I CL 5,688.37 2,185.98 2,561.42 10,435.77
HCP000161 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 1,555.33 972.45 57.69 0.00 0.00 2,585.47 WRIST RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 12/08/93 I CL 1,555.33 972.45 57.69 2,585.47
HCP000064 0.00 0.00 0.00 0.00 LIFTING 426.69 307.10 0.33 0.00 0.00 734.12 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/09/93 I CL 426.69 307.10 0.33 734.12
HCP000101 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 1,787.38 1,443.93 676.90 0.00 0.00 3,908.21 ANKLE LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/12/93 I CL 1,787.38 1,443.93 676.90 3,908.21
Run date: 06-FEB-12 NCAComp Page: 14 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP002135 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 12/12/93 M CL 0.00 0.00 0.00 0.00
HCP000063 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 75.00 0.00 0.00 75.00 ANKLE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/13/93 I CL 0.00 0.00 75.00 75.00
HCP000065 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 76.34 37.88 0.00 0.00 114.22 HIP 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 12/13/93 M CL 0.00 76.34 37.88 114.22
HCP000120 0.00 0.00 0.00 0.00 LIFTING 0.00 245.48 0.00 0.00 0.00 245.48 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/13/93 M CL 0.00 245.48 0.00 245.48
HCP001224 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 75.00 0.00 0.00 75.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/16/93 I CL 0.00 0.00 75.00 75.00
HCP000076 0.00 0.00 0.00 0.00 LIFTING 0.00 301.08 20.72 0.00 0.00 321.80 WRIST RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/18/93 I CL 0.00 301.08 20.72 321.80
HCP000082 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 274.90 0.00 0.00 0.00 274.90 ARM RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 12/20/93 M CL 0.00 274.90 0.00 274.90
Run date: 06-FEB-12 NCAComp Page: 15 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000066 0.00 0.00 0.00 0.00
AUTOMOBILE ACCIDENTS 491.89 183.66 80.24 0.00 0.00 755.79 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 12/21/93 I CL 491.89 183.66 80.24 755.79
HCP000151 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/21/93 M CL 0.00 0.00 0.00 0.00
HCP000100 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 440.26 1,296.26 179.47 0.00 0.00 1,915.99 ARM RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 12/22/93 I CL 440.26 1,296.26 179.47 1,915.99
HCP000069 0.00 0.00 0.00 0.00 LIFTING 1,387.36 557.53 3.43 0.00 0.00 1,948.32 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/26/93 I CL 1,387.36 557.53 3.43 1,948.32
HCP000119 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 383.29 14.31 0.00 0.00 397.60 SHOULDER RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/27/93 M CL 0.00 383.29 14.31 397.60
HCP000110 0.00 0.00 0.00 0.00 TWISTING 467.09 428.98 75.00 0.00 0.00 971.07 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/28/93 I CL 467.09 428.98 75.00 971.07
HCP000111 0.00 0.00 0.00 0.00 LIFTING 4,104.00 2,801.00 139.55 0.00 0.00 7,044.55 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/29/93 I CL 4,104.00 2,801.00 139.55 7,044.55
Run date: 06-FEB-12 NCAComp Page: 16 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000652 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 1,545.58 0.00 325.00 0.00 0.00 1,870.58 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/30/93 I CL 1,545.58 0.00 325.00 1,870.58
HCP002163 0.00 0.00 0.00 0.00 LIFTING 0.00 194.27 25.12 0.00 0.00 219.39 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CARPAL TUNNEL 12/30/93 M CL 0.00 194.27 25.12 219.39
HCP000086 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 2,153.40 2,122.27 562.90 0.00 0.00 4,838.57 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/31/93 I CL 2,153.40 2,122.27 562.90 4,838.57
HCP000070 16,900.00 0.00 1,247.50 18,147.50 TRIP/SLIP & FALL 61,376.54 21,055.99 8,183.37 301,357.28 13,127.14 90,615.90 KNEE LEFT,BACK 09404689 0.00 0.00 0.00 0.00 2,077.14 0.00 TENDONITIS 01/03/94 F OP 78,276.54 21,055.99 9,430.87 108,763.40 ANCR: LEFT KNEE CONSEQUENTIAL BACK CLASSIFIED PPD 6/17/98
HCP000077 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 657.93 272.30 0.00 0.00 0.00 930.23 LEG LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/03/94 I CL 657.93 272.30 0.00 930.23
HCP000083 0.00 0.00 0.00 0.00 LIFTING 34,974.63 2,284.28 2,623.11 0.00 0.00 39,882.02 NECK 69402487 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/04/94 I CL 34,974.63 2,284.28 2,623.11 39,882.02
HCP000071 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/05/94 M CL 0.00 0.00 0.00 0.00
Run date: 06-FEB-12 NCAComp Page: 17 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000074 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL -21,954.94 22,746.76 10,608.08 68,623.41 0.00 11,399.90 ANKLE RIGHT 09404807 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 01/05/94 I CL -21,954.94 22,746.76 10,608.08 11,399.90 146 SUBROGATION 125
HCP000096 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 5,226.42 12,759.58 980.58 2,125.72 0.00 18,966.58 BACK 99400616 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/07/94 I CL 5,226.42 12,759.58 980.58 18,966.58 15;8
HCP000923 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 170.00 0.00 0.00 170.00 ANKLE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/11/94 I CL 0.00 0.00 170.00 170.00
HCP000092 0.00 0.00 0.00 0.00 PUSHING/PULLING 0.00 92.50 0.00 0.00 0.00 92.50 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/12/94 M CL 0.00 92.50 0.00 92.50
HCP000098 0.00 0.00 0.00 0.00 TWISTING 221.34 482.62 71.65 0.00 0.00 775.61 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/12/94 I CL 221.34 482.62 71.65 775.61
HCP000095 0.00 0.00 0.00 0.00 PSYCHOLOGICAL STRESS 743.69 302.71 0.00 0.00 0.00 1,046.40 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/13/94 I CL 743.69 302.71 0.00 1,046.40
HCP000125 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 6,894.15 19,052.45 6,633.43 0.00 0.00 32,580.03 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/13/94 I CL 6,894.15 19,052.45 6,633.43 32,580.03
Run date: 06-FEB-12 NCAComp Page: 18 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000097 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 946.53 877.94 8.68 0.00 0.00 1,833.15 CHEST 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 01/15/94 I CL 946.53 877.94 8.68 1,833.15
HCP000118 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 150.00 0.00 0.00 150.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 01/15/94 I CL 0.00 0.00 150.00 150.00
HCP000088 0.00 0.00 0.00 0.00 LIFTING 0.00 3,187.87 75.14 0.00 0.00 3,263.01 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/16/94 M CL 0.00 3,187.87 75.14 3,263.01
HCP000081 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 274.82 947.61 50.46 0.00 0.00 1,272.89 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 01/17/94 I CL 274.82 947.61 50.46 1,272.89
HCP000084 0.00 0.00 0.00 0.00 PUSHING/PULLING 0.00 0.00 0.00 0.00 0.00 0.00 FACIAL 0.00 0.00 0.00 0.00 0.00 0.00 SCRATCHES/ABRASIONS 01/17/94 M CL 0.00 0.00 0.00 0.00
HCP000087 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 2,791.37 668.26 683.01 0.00 3,459.63 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/17/94 M CL 0.00 2,791.37 668.26 3,459.63
HCP000089 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/17/94 M CL 0.00 0.00 0.00 0.00
Run date: 06-FEB-12 NCAComp Page: 19 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000131 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 0.00 137.44 15.49 0.00 0.00 152.93 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/17/94 M CL 0.00 137.44 15.49 152.93
HCP002160 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/17/94 M CL 0.00 0.00 0.00 0.00
HCP000102 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/18/94 M CL 0.00 0.00 0.00 0.00
HCP000093 0.00 0.00 0.00 0.00 LIFTING 0.00 136.59 0.00 0.00 0.00 136.59 WRIST RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/19/94 M CL 0.00 136.59 0.00 136.59
HCP000149 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 4,401.00 730.63 290.00 0.00 0.00 5,421.63 NECK 00803404 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 01/19/94 I CL 4,401.00 730.63 290.00 5,421.63
HCP000137 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 889.31 9,484.19 1,566.29 0.00 0.00 11,939.79 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/21/94 I CL 889.31 9,484.19 1,566.29 11,939.79
HCP000091 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 79.98 0.12 0.00 0.00 80.10 FINGERS 0.00 0.00 0.00 0.00 0.00 0.00 CUT/LACERATION/PUNTURE 01/24/94 M CL 0.00 79.98 0.12 80.10
Run date: 06-FEB-12 NCAComp Page: 20 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000103 0.00 0.00 0.00 0.00
LIFTING 0.00 467.88 6.40 0.00 0.00 474.28 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/24/94 M CL 0.00 467.88 6.40 474.28
HCP000115 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/24/94 M CL 0.00 0.00 0.00 0.00
HCP000116 0.00 0.00 0.00 0.00 PSYCHOLOGICAL STRESS 0.00 0.00 0.00 0.00 0.00 0.00 CHEST 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/24/94 M CL 0.00 0.00 0.00 0.00
HCP000150 0.00 0.00 0.00 0.00 LIFTING 0.00 289.26 0.00 0.00 0.00 289.26 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/24/94 M CL 0.00 289.26 0.00 289.26
HCP000094 132,216.00 2,575.19 416.95 135,208.14 LIFTING 135,310.34 24,419.83 14,246.34 0.00 0.00 173,976.51 BACK 29406368 560.00 0.00 0.00 0.00 0.00 560.00 SPRAINS/STRAINS 01/25/94 P OP 267,526.34 26,995.02 14,663.29 309,184.65
NO ATTY ON RECORD SIR-$250K
HCP000099 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 3,979.15 4,329.84 2,278.70
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000011263 0.00 0.00 0.00 0.00
OTHER 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 01/01/90 I CL 0.00 0.00 0.00 0.00
HCP004749 0.00 0.00 0.00 0.00 0.00 0.00 95.00 0.00 0.00 95.00 0.00 0.00 0.00 0.00 0.00 0.00
04/20/93 M CL 0.00 0.00 95.00 95.00
HCP000001 0.00 0.00 0.00 0.00 LIFTING 0.00 176.92 0.00 0.00 0.00 176.92 NECK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 05/11/93 M CL 0.00 176.92 0.00 176.92
HCP000002 0.00 0.00 0.00 0.00 LIFTING 326.55 108.02 0.00 0.00 0.00 434.57 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 05/17/93 I CL 326.55 108.02 0.00 434.57
HCP008384 0.00 0.00 0.00 0.00 0.00 0.00 95.00 0.00 0.00 95.00 0.00 0.00 0.00 0.00 0.00 0.00
05/18/93 M CL 0.00 0.00 95.00 95.00
HCP000033 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 46.02 77.87 0.00 0.00 123.89 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 06/25/93 I CL 0.00 46.02 77.87 123.89
HCP000008 0.00 0.00 0.00 0.00 REPETITIVE MOTION 0.00 0.00 820.00 0.00 0.00 820.00 WRIST RIGHT 09361508 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 07/04/93 I CL 0.00 0.00 820.00 820.00
Run date: 06-FEB-12 NCAComp Page: 2 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000003 0.00 0.00 0.00 0.00
STRUCK AGAINST 0.00 133.59 150.00 0.00 0.00 283.59 WRIST LEFT 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 07/05/93 I CL 0.00 133.59 150.00 283.59
HCP000004 0.00 0.00 0.00 0.00 STRUCK BY OBJECT 0.00 0.00 0.00 0.00 0.00 0.00 LUNGS 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 07/06/93 M CL 0.00 0.00 0.00 0.00
HCP000554 0.00 0.00 0.00 0.00 LIFTING 0.00 222.84 0.00 0.00 0.00 222.84 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 07/09/93 M CL 0.00 222.84 0.00 222.84
HCP000005 0.00 0.00 0.00 0.00 LIFTING 648.52 747.61 6.40 0.00 0.00 1,402.53 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 07/13/93 I CL 648.52 747.61 6.40 1,402.53
HCP000006 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 373.60 4.97 0.00 0.00 378.57 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 07/19/93 M CL 0.00 373.60 4.97 378.57
HCP000011 0.00 0.00 0.00 0.00 LIFTING 227.50 332.09 0.00 0.00 0.00 559.59 HIP 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 07/21/93 I CL 227.50 332.09 0.00 559.59
HCP000563 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 140.38 3.82 0.00 0.00 144.20 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CUT/LACERATION/PUNTURE 07/26/93 M CL 0.00 140.38 3.82 144.20
Run date: 06-FEB-12 NCAComp Page: 3 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000034 0.00 0.00 0.00 0.00
REPETITIVE MOTION 0.00 0.00 0.00 0.00 0.00 0.00 ARM LEFT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 08/01/93 M CL 0.00 0.00 0.00 0.00
HCP000007 0.00 0.00 0.00 0.00 PUSHING/PULLING 0.00 3,546.05 0.00 0.00 0.00 3,546.05 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/02/93 I CL 0.00 3,546.05 0.00 3,546.05
HCP000009 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 HIP 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 08/02/93 M CL 0.00 0.00 0.00 0.00
HCP000013 0.00 0.00 0.00 0.00 STRUCK AGAINST 7,972.82 3,830.12 402.61 0.00 0.00 12,205.55 FINGERS 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 08/07/93 I CL 7,972.82 3,830.12 402.61 12,205.55
HCP000017 0.00 0.00 0.00 0.00 OTHER 469.14 409.01 11.44 0.00 0.00 889.59 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 INFECTION 08/11/93 I CL 469.14 409.01 11.44 889.59
HCP000016 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 1,350.00 441.01 100.00 0.00 0.00 1,891.01 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/12/93 I CL 1,350.00 441.01 100.00 1,891.01
HCP000556 0.00 0.00 0.00 0.00 LIFTING 0.00 221.35 5.72 0.00 0.00 227.07 ABDOMEN 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/16/93 M CL 0.00 221.35 5.72 227.07
Run date: 06-FEB-12 NCAComp Page: 4 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000143 0.00 0.00 0.00 0.00
LIFTING 51,101.00 7,575.28 5,853.40 0.00 0.00 64,529.68 BACK 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 08/17/93 I CL 51,101.00 7,575.28 5,853.40 64,529.68
HCP000031 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 260.42 19.39 0.00 0.00 279.81 ANKLES 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/20/93 M CL 0.00 260.42 19.39 279.81
HCP000012 0.00 0.00 0.00 0.00 TWISTING 15,228.11 11,830.46 2,510.07 0.00 0.00 29,568.64 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/23/93 I CL 15,228.11 11,830.46 2,510.07 29,568.64
HCP000010 0.00 0.00 0.00 0.00 FIRE 0.00 0.00 0.00 0.00 0.00 0.00 FINGERS 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 08/24/93 M CL 0.00 0.00 0.00 0.00
HCP000584 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 177.85 11.77 0.00 0.00 189.62 ANKLE LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/24/93 M CL 0.00 177.85 11.77 189.62
HCP000038 0.00 0.00 0.00 0.00 LIFTING 43,132.80 2,832.03 7,247.17 0.00 0.00 53,212.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 08/25/93 I CL 43,132.80 2,832.03 7,247.17 53,212.00
HCP000555 0.00 0.00 0.00 0.00 BITES/STINGS 0.00 81.92 4.87 0.00 0.00 86.79 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 SCRATCHES/ABRASIONS 08/30/93 M CL 0.00 81.92 4.87 86.79
Run date: 06-FEB-12 NCAComp Page: 5 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000015 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 9,218.81 4,570.30 560.64 0.00 0.00 14,349.75 FINGERS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/04/93 I CL 9,218.81 4,570.30 560.64 14,349.75
HCP002162 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 213.94 0.00 0.00 0.00 213.94 ANKLE LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/06/93 M CL 0.00 213.94 0.00 213.94
HCP000024 0.00 0.00 0.00 0.00 LIFTING 26,595.09 8,493.33 3,958.68 0.00 0.00 39,047.10 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/15/93 I CL 26,595.09 8,493.33 3,958.68 39,047.10
HCP000051 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 175.59 0.00 0.00 0.00 175.59 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/18/93 M CL 0.00 175.59 0.00 175.59
HCP000018 0.00 0.00 0.00 0.00 BITES/STINGS 0.00 38.69 0.00 0.00 0.00 38.69 BACK 0.00 0.00 0.00 0.00 0.00 0.00 BITE/STING 09/19/93 M CL 0.00 38.69 0.00 38.69
HCP000035 5,107.44 0.00 619.09 5,726.53 LIFTING 0.00 3,871.98 5,182.83 62,418.33 3,314.59 9,054.81 BACK,NECK 59405363 0.00 0.00 0.00 0.00 456.86 0.00 SPRAINS/STRAINS 09/19/93 F OP 5,107.44 3,871.98 5,801.92 14,781.34 APPORTIONED @ 40% THIS FILE WITH 15-8 @ 100% 60% ON HCP000508
HCP000025 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 17,134.31 7,405.56 15,228.01 0.00 0.00 39,767.88 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/22/93 I CL 17,134.31 7,405.56 15,228.01 39,767.88
Run date: 06-FEB-12 NCAComp Page: 6 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000019 0.00 0.00 0.00 0.00
PUSHING/PULLING 25,000.00 3,704.71 5,730.08 60,000.00 0.00 34,434.79 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/24/93 I CL 25,000.00 3,704.71 5,730.08 34,434.79 15;8
HCP000078 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 625.36 79.79 0.00 0.00 0.00 705.15 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 09/28/93 I CL 625.36 79.79 0.00 705.15
HCP000114 0.00 0.00 0.00 0.00 STRUCK BY OBJECT 0.00 3,750.45 183.17 0.00 0.00 3,933.62 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 09/28/93 M CL 0.00 3,750.45 183.17 3,933.62
HCP000023 476,942.09 365,066.01 5,732.56 847,740.66 LIFTING 71,516.96 146,756.02 31,727.02 0.00 292,180.03 250,000.00 BACK,OTHER 5932 3455 0.00 0.00 0.00 0.00 2,431.56 0.00 SPRAINS/STRAINS 09/29/93 X OP 548,459.05 511,822.03 37,459.58 1,097,740.66 ANCR; BACK AND PSYCHIATRIC DISORDER PPD CCP @ $331.38 LESS $5/WK OLD ATTY FEE
HCP000058 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 608.00 1,119.30 162.97 0.00 0.00 1,890.27 ANKLE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/04/93 I CL 608.00 1,119.30 162.97 1,890.27
HCP000022 0.00 0.00 0.00 0.00 LIFTING 278.40 325.48 359.89 0.00 0.00 963.77 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/05/93 I CL 278.40 325.48 359.89 963.77
HCP000020 0.00 0.00 0.00 0.00 PUSHING/PULLING 0.00 0.00 0.00 0.00 0.00 0.00 WRIST RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/06/93 M CL 0.00 0.00 0.00 0.00
Run date: 06-FEB-12 NCAComp Page: 7 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000021 0.00 0.00 0.00 0.00
LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/07/93 M CL 0.00 0.00 0.00 0.00
HCP000032 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00 HAND LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SCRATCHES/ABRASIONS 10/08/93 M CL 0.00 0.00 0.00 0.00
HCP000026 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 13,247.49 16,983.43 2,241.74 0.00 0.00 32,472.66 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/12/93 I CL 13,247.49 16,983.43 2,241.74 32,472.66
HCP000028 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 29,146.10 3,135.51 6,585.40 10,000.00 0.00 38,867.01 KNEE RIGHT 29326915 0.00 0.00 0.00 0.00 0.00 0.00 TENDONITIS 10/12/93 I CL 29,146.10 3,135.51 6,585.40 38,867.01 SUBRORECD
HCP000068 0.00 0.00 0.00 0.00 LIFTING 1,336.52 20.59 0.00 0.00 0.00 1,357.11 GROIN 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 10/13/93 I CL 1,336.52 20.59 0.00 1,357.11
HCP000027 0.00 0.00 0.00 0.00 LIFTING 2,535.00 1,242.81 253.63 0.00 0.00 4,031.44 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/15/93 I CL 2,535.00 1,242.81 253.63 4,031.44
HCP000029 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 242.07 25.99 0.00 0.00 268.06 KNEE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 10/21/93 M CL 0.00 242.07 25.99 268.06
Run date: 06-FEB-12 NCAComp Page: 8 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP001041 0.00 0.00 0.00 0.00
AUTOMOBILE ACCIDENTS 0.00 1,472.89 237.23 0.00 0.00 1,710.12 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/21/93 M CL 0.00 1,472.89 237.23 1,710.12
HCP000030 0.00 0.00 0.00 0.00 FIRE 0.00 0.00 0.00 0.00 0.00 0.00 KNEE LEFT 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 10/22/93 M CL 0.00 0.00 0.00 0.00
HCP000054 0.00 0.00 0.00 0.00 LIFTING 2,713.60 1,537.95 424.27 0.00 0.00 4,675.82 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/22/93 I CL 2,713.60 1,537.95 424.27 4,675.82
HCP000036 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/23/93 M CL 0.00 0.00 0.00 0.00
HCP000059 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 48,992.68 34,337.16 7,622.40 43,448.62 0.00 90,952.24 BACK 59325075 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 10/25/93 I CL 48,992.68 34,337.16 7,622.40 90,952.24
HCP000039 0.00 0.00 0.00 0.00 LIFTING 51.20 1,361.07 96.05 0.00 0.00 1,508.32 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/27/93 I CL 51.20 1,361.07 96.05 1,508.32
HCP000106 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 3,383.12 1,475.09 212.14 0.00 0.00 5,070.35 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 10/29/93 I CL 3,383.12 1,475.09 212.14 5,070.35
Run date: 06-FEB-12 NCAComp Page: 9 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000519 0.00 0.00 0.00 0.00
OTHER 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 10/31/93 M CL 0.00 0.00 0.00 0.00
HCP002183 0.00 0.00 0.00 0.00 LIFTING 0.00 263.74 0.01 0.00 0.00 263.75 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/01/93 M CL 0.00 263.74 0.01 263.75
HCP000040 0.00 0.00 0.00 0.00 LIFTING 0.00 201.85 12.25 0.00 0.00 214.10 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/02/93 M CL 0.00 201.85 12.25 214.10
HCP000047 0.00 0.00 0.00 0.00 STRUCK AGAINST 5,300.00 2,039.94 379.38 0.00 0.00 7,719.32 SHOULDER RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/02/93 I CL 5,300.00 2,039.94 379.38 7,719.32
HCP000041 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 546.42 358.04 0.00 0.00 904.46 FOOT LEFT 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 11/03/93 I CL 0.00 546.42 358.04 904.46
HCP000062 0.00 0.00 0.00 0.00 LIFTING 0.00 1,079.81 50.68 0.00 0.00 1,130.49 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/04/93 I CL 0.00 1,079.81 50.68 1,130.49
HCP000073 0.00 0.00 0.00 0.00 LIFTING 14,612.41 9,243.17 4,479.71 0.00 0.00 28,335.29 BACK 29401157 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/04/93 I CL 14,612.41 9,243.17 4,479.71 28,335.29
Run date: 06-FEB-12 NCAComp Page: 10 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000048 0.00 0.00 0.00 0.00
LIFTING 68,739.44 16,119.43 3,903.88 0.00 0.00 88,762.75 BACK 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 11/05/93 I CL 68,739.44 16,119.43 3,903.88 88,762.75
HCP000042 0.00 0.00 0.00 0.00 LIFTING 4,054.46 116.63 85.29 0.00 0.00 4,256.38 LEG LEFT 0.00 0.00 0.00 0.00 0.00 0.00 TENDONITIS 11/08/93 I CL 4,054.46 116.63 85.29 4,256.38
HCP000060 0.00 0.00 0.00 0.00 PUSHING/PULLING 1,041.97 2,894.62 156.77 0.00 0.00 4,093.36 GROIN 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 11/09/93 I CL 1,041.97 2,894.62 156.77 4,093.36
HCP000126 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 13,578.00 12,031.12 1,787.16 0.00 0.00 27,396.28 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/09/93 I CL 13,578.00 12,031.12 1,787.16 27,396.28
HCP000044 2,600.00 0.00 1,300.00 3,900.00 TWISTING 12,165.13 7,986.15 3,445.03 26,300.00 2,800.00 23,596.31 BACK 2932 6434 0.00 0.00 0.00 0.00 300.00 0.00 SPRAINS/STRAINS 11/10/93 F OP 14,765.13 7,986.15 4,745.03 27,496.31 50% APPORTIONMENT - 15.8 @ 100% CLASS PPD NOD 6/11/01 - CCP @ $100 50% APPORT
HCP000046 0.00 0.00 0.00 0.00 FIRE 3,845.30 88.01 75.00 0.00 0.00 4,008.31 FACIAL 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 11/10/93 I CL 3,845.30 88.01 75.00 4,008.31
HCP000050 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 8,640.00 2,327.75 96.87 0.00 0.00 11,064.62 KNEE RIGHT 59327343 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/10/93 I CL 8,640.00 2,327.75 96.87 11,064.62
25A
Run date: 06-FEB-12 NCAComp Page: 11 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000055 0.00 0.00 0.00 0.00
LIFTING 46,238.69 8,237.70 2,009.64 0.00 0.00 56,486.03 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/11/93 I CL 46,238.69 8,237.70 2,009.64 56,486.03
HCP000079 0.00 0.00 0.00 0.00 LIFTING 328.68 404.76 223.01 0.00 0.00 956.45 HAND LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/12/93 I CL 328.68 404.76 223.01 956.45
HCP000109 0.00 0.00 0.00 0.00 OTHER 0.00 5,921.16 2,413.42 0.00 0.00 8,334.58 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/12/93 I CL 0.00 5,921.16 2,413.42 8,334.58
HCP002164 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 240.45 5.78 0.00 0.00 246.23 ANKLE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/15/93 M CL 0.00 240.45 5.78 246.23
HCP000056 0.00 0.00 0.00 0.00 LIFTING 27,021.69 5,744.77 5,130.82 3,638.19 0.00 37,897.28 WRISTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/17/93 I CL 27,021.69 5,744.77 5,130.82 37,897.28
HCP000045 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 25,131.91 44,772.00 6,477.36 25,000.00 0.00 76,381.27 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/18/93 I CL 25,131.91 44,772.00 6,477.36 76,381.27
HCP000080 0.00 0.00 0.00 0.00 OTHER 0.00 0.00 75.00 0.00 0.00 75.00 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 DERMATITIS 11/20/93 I CL 0.00 0.00 75.00 75.00
Run date: 06-FEB-12 NCAComp Page: 12 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000191 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 0.00 8,634.38 2,363.33 0.00 0.00 10,997.71 HEAD 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 11/20/93 I CL 0.00 8,634.38 2,363.33 10,997.71
HCP000057 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 177.95 0.00 0.00 0.00 177.95 HANDS 0.00 0.00 0.00 0.00 0.00 0.00 CUT/LACERATION/PUNTURE 11/22/93 M CL 0.00 177.95 0.00 177.95
HCP000049 0.00 0.00 0.00 0.00 LIFTING 0.00 188.26 9.31 0.00 0.00 197.57 OTHER 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/23/93 M CL 0.00 188.26 9.31 197.57
HCP000072 0.00 0.00 0.00 0.00 LIFTING 0.00 347.05 1.44 0.00 0.00 348.49 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/23/93 M CL 0.00 347.05 1.44 348.49
HCP000117 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 258.61 40.70 0.00 0.00 299.31 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 11/23/93 M CL 0.00 258.61 40.70 299.31
HCP000061 0.00 0.00 0.00 0.00 STRUCK AGAINST 30.00 210.27 5.78 0.00 0.00 246.05 HEAD 0.00 0.00 0.00 0.00 0.00 0.00 CONCUSSION 11/26/93 I CL 30.00 210.27 5.78 246.05
HCP000052 0.00 0.00 0.00 0.00 LIFTING 132.00 220.75 18.66 0.00 0.00 371.41 ARM LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/30/93 I CL 132.00 220.75 18.66 371.41
Run date: 06-FEB-12 NCAComp Page: 13 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000085 0.00 0.00 0.00 0.00
LIFTING 127.09 191.59 29.85 0.00 0.00 348.53 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 11/30/93 I CL 127.09 191.59 29.85 348.53
HCP000067 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 SHOULDER LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/01/93 M CL 0.00 0.00 0.00 0.00
HCP000053 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 0.00 0.00 125.00 0.00 0.00 125.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/03/93 I CL 0.00 0.00 125.00 125.00
HCP000174 0.00 0.00 0.00 0.00 BITES/STINGS 5,688.37 2,185.98 2,561.42 0.00 0.00 10,435.77 FOOT LEFT 0.00 0.00 0.00 0.00 0.00 0.00 BITE/STING 12/06/93 I CL 5,688.37 2,185.98 2,561.42 10,435.77
HCP000161 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 1,555.33 972.45 57.69 0.00 0.00 2,585.47 WRIST RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 12/08/93 I CL 1,555.33 972.45 57.69 2,585.47
HCP000064 0.00 0.00 0.00 0.00 LIFTING 426.69 307.10 0.33 0.00 0.00 734.12 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/09/93 I CL 426.69 307.10 0.33 734.12
HCP000101 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 1,787.38 1,443.93 676.90 0.00 0.00 3,908.21 ANKLE LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/12/93 I CL 1,787.38 1,443.93 676.90 3,908.21
Run date: 06-FEB-12 NCAComp Page: 14 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP002135 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 12/12/93 M CL 0.00 0.00 0.00 0.00
HCP000063 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 75.00 0.00 0.00 75.00 ANKLE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/13/93 I CL 0.00 0.00 75.00 75.00
HCP000065 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 76.34 37.88 0.00 0.00 114.22 HIP 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 12/13/93 M CL 0.00 76.34 37.88 114.22
HCP000120 0.00 0.00 0.00 0.00 LIFTING 0.00 245.48 0.00 0.00 0.00 245.48 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/13/93 M CL 0.00 245.48 0.00 245.48
HCP001224 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 75.00 0.00 0.00 75.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/16/93 I CL 0.00 0.00 75.00 75.00
HCP000076 0.00 0.00 0.00 0.00 LIFTING 0.00 301.08 20.72 0.00 0.00 321.80 WRIST RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/18/93 I CL 0.00 301.08 20.72 321.80
HCP000082 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 274.90 0.00 0.00 0.00 274.90 ARM RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 12/20/93 M CL 0.00 274.90 0.00 274.90
Run date: 06-FEB-12 NCAComp Page: 15 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000066 0.00 0.00 0.00 0.00
AUTOMOBILE ACCIDENTS 491.89 183.66 80.24 0.00 0.00 755.79 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 12/21/93 I CL 491.89 183.66 80.24 755.79
HCP000151 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/21/93 M CL 0.00 0.00 0.00 0.00
HCP000100 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 440.26 1,296.26 179.47 0.00 0.00 1,915.99 ARM RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 12/22/93 I CL 440.26 1,296.26 179.47 1,915.99
HCP000069 0.00 0.00 0.00 0.00 LIFTING 1,387.36 557.53 3.43 0.00 0.00 1,948.32 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/26/93 I CL 1,387.36 557.53 3.43 1,948.32
HCP000119 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 383.29 14.31 0.00 0.00 397.60 SHOULDER RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/27/93 M CL 0.00 383.29 14.31 397.60
HCP000110 0.00 0.00 0.00 0.00 TWISTING 467.09 428.98 75.00 0.00 0.00 971.07 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/28/93 I CL 467.09 428.98 75.00 971.07
HCP000111 0.00 0.00 0.00 0.00 LIFTING 4,104.00 2,801.00 139.55 0.00 0.00 7,044.55 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/29/93 I CL 4,104.00 2,801.00 139.55 7,044.55
Run date: 06-FEB-12 NCAComp Page: 16 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000652 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 1,545.58 0.00 325.00 0.00 0.00 1,870.58 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/30/93 I CL 1,545.58 0.00 325.00 1,870.58
HCP002163 0.00 0.00 0.00 0.00 LIFTING 0.00 194.27 25.12 0.00 0.00 219.39 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 CARPAL TUNNEL 12/30/93 M CL 0.00 194.27 25.12 219.39
HCP000086 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 2,153.40 2,122.27 562.90 0.00 0.00 4,838.57 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 12/31/93 I CL 2,153.40 2,122.27 562.90 4,838.57
HCP000070 16,900.00 0.00 1,247.50 18,147.50 TRIP/SLIP & FALL 61,376.54 21,055.99 8,183.37 301,357.28 13,127.14 90,615.90 KNEE LEFT,BACK 09404689 0.00 0.00 0.00 0.00 2,077.14 0.00 TENDONITIS 01/03/94 F OP 78,276.54 21,055.99 9,430.87 108,763.40 ANCR: LEFT KNEE CONSEQUENTIAL BACK CLASSIFIED PPD 6/17/98
HCP000077 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 657.93 272.30 0.00 0.00 0.00 930.23 LEG LEFT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/03/94 I CL 657.93 272.30 0.00 930.23
HCP000083 0.00 0.00 0.00 0.00 LIFTING 34,974.63 2,284.28 2,623.11 0.00 0.00 39,882.02 NECK 69402487 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/04/94 I CL 34,974.63 2,284.28 2,623.11 39,882.02
HCP000071 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/05/94 M CL 0.00 0.00 0.00 0.00
Run date: 06-FEB-12 NCAComp Page: 17 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000074 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL -21,954.94 22,746.76 10,608.08 68,623.41 0.00 11,399.90 ANKLE RIGHT 09404807 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 01/05/94 I CL -21,954.94 22,746.76 10,608.08 11,399.90 146 SUBROGATION 125
HCP000096 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 5,226.42 12,759.58 980.58 2,125.72 0.00 18,966.58 BACK 99400616 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/07/94 I CL 5,226.42 12,759.58 980.58 18,966.58 15;8
HCP000923 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 170.00 0.00 0.00 170.00 ANKLE RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/11/94 I CL 0.00 0.00 170.00 170.00
HCP000092 0.00 0.00 0.00 0.00 PUSHING/PULLING 0.00 92.50 0.00 0.00 0.00 92.50 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/12/94 M CL 0.00 92.50 0.00 92.50
HCP000098 0.00 0.00 0.00 0.00 TWISTING 221.34 482.62 71.65 0.00 0.00 775.61 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/12/94 I CL 221.34 482.62 71.65 775.61
HCP000095 0.00 0.00 0.00 0.00 PSYCHOLOGICAL STRESS 743.69 302.71 0.00 0.00 0.00 1,046.40 HAND RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/13/94 I CL 743.69 302.71 0.00 1,046.40
HCP000125 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 6,894.15 19,052.45 6,633.43 0.00 0.00 32,580.03 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/13/94 I CL 6,894.15 19,052.45 6,633.43 32,580.03
Run date: 06-FEB-12 NCAComp Page: 18 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000097 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 946.53 877.94 8.68 0.00 0.00 1,833.15 CHEST 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 01/15/94 I CL 946.53 877.94 8.68 1,833.15
HCP000118 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 150.00 0.00 0.00 150.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 CONTUSION 01/15/94 I CL 0.00 0.00 150.00 150.00
HCP000088 0.00 0.00 0.00 0.00 LIFTING 0.00 3,187.87 75.14 0.00 0.00 3,263.01 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/16/94 M CL 0.00 3,187.87 75.14 3,263.01
HCP000081 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 274.82 947.61 50.46 0.00 0.00 1,272.89 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 01/17/94 I CL 274.82 947.61 50.46 1,272.89
HCP000084 0.00 0.00 0.00 0.00 PUSHING/PULLING 0.00 0.00 0.00 0.00 0.00 0.00 FACIAL 0.00 0.00 0.00 0.00 0.00 0.00 SCRATCHES/ABRASIONS 01/17/94 M CL 0.00 0.00 0.00 0.00
HCP000087 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 2,791.37 668.26 683.01 0.00 3,459.63 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/17/94 M CL 0.00 2,791.37 668.26 3,459.63
HCP000089 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/17/94 M CL 0.00 0.00 0.00 0.00
Run date: 06-FEB-12 NCAComp Page: 19 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000131 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 0.00 137.44 15.49 0.00 0.00 152.93 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/17/94 M CL 0.00 137.44 15.49 152.93
HCP002160 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/17/94 M CL 0.00 0.00 0.00 0.00
HCP000102 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/18/94 M CL 0.00 0.00 0.00 0.00
HCP000093 0.00 0.00 0.00 0.00 LIFTING 0.00 136.59 0.00 0.00 0.00 136.59 WRIST RIGHT 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/19/94 M CL 0.00 136.59 0.00 136.59
HCP000149 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 4,401.00 730.63 290.00 0.00 0.00 5,421.63 NECK 00803404 0.00 0.00 0.00 0.00 0.00 0.00 HERNIA/RUPTURE 01/19/94 I CL 4,401.00 730.63 290.00 5,421.63
HCP000137 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 889.31 9,484.19 1,566.29 0.00 0.00 11,939.79 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/21/94 I CL 889.31 9,484.19 1,566.29 11,939.79
HCP000091 0.00 0.00 0.00 0.00 STRUCK AGAINST 0.00 79.98 0.12 0.00 0.00 80.10 FINGERS 0.00 0.00 0.00 0.00 0.00 0.00 CUT/LACERATION/PUNTURE 01/24/94 M CL 0.00 79.98 0.12 80.10
Run date: 06-FEB-12 NCAComp Page: 20 HCP - HEALTH CARE PROVIDERS SELF-INSURANCE *** Detail Loss Report for Current Period: 12/01/2011 - 12/31/2011 ***
CLAIMS LISTED: ALL CASES WITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # <------------------------ R E S E R V E S ---------------------------------> CAUSE SS# <------------------------ NET PAID TO DATE ---------------------------------> LOCATION Claim Status Type WCB# <--------------------- NET PAID CURRENT PERIOD -----------------------------> TYPE ALL Acc Date Status<------------------------- TOTAL INCURRED ---------------------------------> Claim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============ HCP000103 0.00 0.00 0.00 0.00
LIFTING 0.00 467.88 6.40 0.00 0.00 474.28 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/24/94 M CL 0.00 467.88 6.40 474.28
HCP000115 0.00 0.00 0.00 0.00 LIFTING 0.00 0.00 0.00 0.00 0.00 0.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/24/94 M CL 0.00 0.00 0.00 0.00
HCP000116 0.00 0.00 0.00 0.00 PSYCHOLOGICAL STRESS 0.00 0.00 0.00 0.00 0.00 0.00 CHEST 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/24/94 M CL 0.00 0.00 0.00 0.00
HCP000150 0.00 0.00 0.00 0.00 LIFTING 0.00 289.26 0.00 0.00 0.00 289.26 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 01/24/94 M CL 0.00 289.26 0.00 289.26
HCP000094 132,216.00 2,575.19 416.95 135,208.14 LIFTING 135,310.34 24,419.83 14,246.34 0.00 0.00 173,976.51 BACK 29406368 560.00 0.00 0.00 0.00 0.00 560.00 SPRAINS/STRAINS 01/25/94 P OP 267,526.34 26,995.02 14,663.29 309,184.65
NO ATTY ON RECORD SIR-$250K
HCP000099 0.00 0.00 0.00 0.00 AUTOMOBILE ACCIDENTS 3,979.15 4,329.84 2,278.70
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