1681_DEC_response attachment
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ABCDEF
1
Policy YearPolicy DescriptionIncidentStatus DescriptionInjury DescriptionPaid
2
2007Employers Liability4/23/2007Repudiated ClosedLegs Bruising/Swelling0.00
3
2007Employers Liability10/29/2007Repudiated ClosedTeeth Chipped/broken0.00
4
2007Employers Liability9/27/2007Under InvestigationBack Strains/Sprains104,267.35
5
2007Employers Liability1/25/2008Repudiated ClosedLegs Bruising/Swelling0.00
6
2008Employers Liability5/14/2008SettledArms Broken Bones0.00
7
2008Employers Liability12/1/2008ReopenedCombination Bruising/Swelling2,950.91
8
2008Employers Liability11/5/2008Repudiated ClosedBack Strains/Sprains0.00
9
2008Employers Liability9/19/2008Repudiated ClosedWrist Broken/fractured0.00
10
2008Employers Liability12/2/2008Withdrawn - Not PursuedBack Strains/Sprains0.00
11
2009Employers Liability11/17/2009Repudiated ClosedWrist Broken/fractured0.00
12
2009Employers Liability4/17/2009SettledLegs Strains/Sprains0.00
13
2009Employers Liability6/24/2009Repudiated ClosedBack Strains/Sprains0.00
14
2009Employers Liability10/5/2009SettledBack Strains/Sprains0.00
15
2009Employers Liability8/3/2009Under InvestigationBroken Bones7,359.38
16
2009Employers Liability6/8/2009Repudiated ClosedFoot Injury0.00
17
2009Employers Liability11/13/2009Under NegotiationHead Other:2,118.80
18
2009Employers Liability9/30/2009Repudiated ClosedHead Other:0.00
19
2009Employers Liability10/9/2009Under InvestigationFoot Injury520.20
20
2010Employers Liability5/26/2010SettledLegs Strains/Sprains0.00
21
2010Employers Liability9/2/2010Repudiated ClosedCombination Strains/Sprains0.00
22
2010Employers Liability3/16/2010SettledBack Strains/Sprains0.00
23
2010Employers Liability3/29/2011Under InvestigationLegs Strains/Sprains1,988.40
24
2010Employers Liability3/10/2010Under NegotiationHand Injury520.20
25
2010Employers Liability3/1/2010Under InvestigationBack Strains/Sprains1,794.00
26
2010Employers Liability1/17/2011Under InvestigationBack Bruising/Swelling571.20
27
2011Employers Liability3/29/2012Under InvestigationBack Strains/Sprains0.00
28
2011Employers Liability8/17/2011Repudiated ClosedLegs Cuts/Scars0.00
29
2011Employers Liability1/6/2012Repudiated ClosedCombination Bruising/Swelling0.00
30
2011Employers Liability6/23/2011Under InvestigationCombination Strains/Sprains754.80
31
2011Employers Liability4/29/2011Repudiated ClosedCombination Bruising/Swelling0.00
32
2011Employers Liability10/18/2011ReopenedAnkle Broken/fractured879.00
33
2011Employers Liability10/19/2011Repudiated ClosedBruising/Swelling0.00
34
2011Employers Liability1/5/2012Under NegotiationCombination Bruising/Swelling316.20
35
2011Employers Liability5/13/2011Repudiated OpenBack632.40
36
2011Employers Liability9/28/2011Under NegotiationBruising/Swelling479.40
37
2011Employers Liability1/24/2012Under NegotiationHead Other:540.60
38
2012Employers Liability4/5/2012Under InvestigationCombination Strains/Sprains0.00
39
2012Employers Liability2/5/2013Under InvestigationBruising/Swelling0.00
40
2012Employers Liability1/31/2013Under InvestigationHead Bruising/Swelling0.00
41
2012Employers Liability1/23/2013Under InvestigationBack Strains/Sprains0.00
42
2012Employers Liability12/12/2012Under InvestigationHand Injury0.00
43
2012Employers Liability7/17/2012Under InvestigationLegs Broken Bones0.00
44
45
2007Public Liability4/24/2007Repudiated ClosedNone0.00
46
2007Public Liability7/13/2007Repudiated ClosedHead Cuts/Scars0.00
47
2007Public Liability6/7/2007Repudiated ClosedAnkle Broken/fractured0.00
48
2007Public Liability6/25/2007SettledArms Broken Bones0.00
49
2007Public Liability9/12/2007Withdrawn - Not PursuedTeeth Chipped/broken0.00
50
2007Public Liability7/20/2007Repudiated ClosedNone0.00
51
2007Public Liability12/7/2007Repudiated ClosedAnkle Broken/fractured0.00
52
2007Public Liability1/23/2008Repudiated ClosedOther:0.00
53
2007Public Liability3/11/2008SettledHand Injury0.00
54
2007Public Liability1/17/2008SettledWrist Broken/fractured0.00
55
2008Public Liability5/6/2008Withdrawn - Not PursuedWrist Broken/fractured0.00
56
2008Public Liability6/27/2008Repudiated ClosedNone0.00
57
2008Public Liability7/1/2008Repudiated ClosedHand Injury0.00
58
2008Public Liability6/23/2008Repudiated ClosedHead Bruising/Swelling0.00
59
2008Public Liability5/30/2008Withdrawn - Not PursuedHead Other:0.00
60
2008Public Liability4/3/2008Repudiated ClosedArms Broken Bones0.00
61
2008Public Liability9/15/2008Repudiated ClosedHead Cuts/Scars0.00
62
2008Public Liability9/17/2008Repudiated ClosedBroken Bones0.00
63
2008Public Liability7/17/2008Repudiated ClosedNone0.00
64
2008Public Liability7/3/2008Repudiated ClosedHead Cuts/Scars0.00
65
2008Public Liability12/17/2008Repudiated ClosedNone0.00
66
2008Public Liability10/21/2008Repudiated ClosedHead Cuts/Scars0.00
67
2008Public Liability4/6/2008Repudiated ClosedCombination Bruising/Swelling0.00
68
2008Public Liability8/13/2008Repudiated ClosedNone0.00
69
2008Public Liability7/17/2008Repudiated ClosedBruising/Swelling0.00
70
2008Public Liability1/6/2009Repudiated ClosedBruising/Swelling0.00
71
2008Public Liability5/5/2008Repudiated ClosedHead Bruising/Swelling0.00
72
2008Public Liability7/14/2008Under InvestigationBroken Bones17,519.60
73
2009Public Liability6/9/2009Repudiated ClosedWrist Broken/fractured0.00
74
2009Public Liability6/7/2009Repudiated ClosedBroken Bones0.00
75
2009Public Liability11/26/2009SettledNone0.00
76
2009Public Liability8/18/2009Under InvestigationPsychological50.53
77
2009Public Liability6/25/2009Repudiated ClosedNone0.00
78
2009Public Liability7/22/2009Under NegotiationHand Injury470.00
79
2009Public Liability12/17/2009Repudiated ClosedBack Strains/Sprains0.00
80
2009Public Liability7/13/2009Under NegotiationHead Cuts/Scars0.00
81
2010Officials Indemnity9/16/2010Under InvestigationOther:223.20
82
2010Public Liability1/17/2011Under NegotiationOther:0.00
83
2010Public Liability1/28/2010ReopenedFoot Injury6,652.58
84
2010Public Liability1/26/2010Withdrawn - Not PursuedBruising/Swelling0.00
85
2010Public Liability7/1/2010Repudiated ClosedAnkle Broken/fractured0.00
86
2010Public Liability5/21/2010Withdrawn - Not PursuedCombination Bruising/Swelling0.00
87
2010Public Liability3/17/2011Repudiated ClosedBroken Bones0.00
88
2010Public Liability3/10/2011Repudiated OpenTeeth Chipped/broken4,944.60
89
2010Public Liability2/8/2011Repudiated ClosedBack Bruising/Swelling0.00
90
2010Public Liability11/25/2010ReopenedHead Cuts/Scars909.60
91
2010Public Liability2/10/2010Repudiated ClosedOther:0.00
92
2010Public Liability9/17/2010SettledWrist Broken/fractured0.00
93
2010Public Liability3/31/2011Repudiated ClosedWrist Broken/fractured0.00
94
2010Public Liability10/4/2010ReopenedHead Other:256.80
95
2010Public Liability9/23/2010Under InvestigationLegs Cuts/Scars0.00
96
2011Officials Indemnity2/15/2012Under InvestigationPsychological51.60
97
2011Public Liability5/27/2011Under InvestigationBroken Bones2,843.20
98
2011Public Liability5/25/2011ReopenedLegs Other:695.40
99
2011Public Liability5/19/2011Repudiated ClosedBack Strains/Sprains0.00
100
2011Public Liability11/17/2011Withdrawn - Not PursuedBruising/Swelling0.00
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