Run date: 25-AUG-11 NCAComp Page: 1 CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS *** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 *** 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 ============ ============ ============ ============ ============ ============ W000101414 0.00 0.00 0.00 0.00 TRIP/SLIP & FALL 11,769.06 4,934.47 926.88 0.00 0.00 17,630.41 ANKLES 0.00 0.00 0.00 0.00 0.00 0.00 FRACTURE 12/15/95 I OP 11,769.06 4,934.47 926.88 17,630.41 W000101415 -0.40 -0.20 0.00 -0.60 STRUCK BY OBJECT 102.40 299.20 0.00 0.00 0.00 401.60 EYES 0.00 0.00 0.00 0.00 0.00 0.00 OTHER 01/30/96 I OP 102.00 299.00 0.00 401.00 W000101416 0.00 0.43 -0.10 0.33 OTHER 0.00 1,753.57 263.10 0.00 0.00 2,016.67 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 02/01/96 M OP 0.00 1,754.00 263.00 2,017.00 W000101417 0.00 -0.17 0.00 -0.17 TRIP/SLIP & FALL 0.00 37.17 0.00 0.00 0.00 37.17 MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 02/06/96 M OP 0.00 37.00 0.00 37.00 W000101418 0.00 -0.46 0.50 0.04 BENDING/STRETCHING/REACHING 0.00 1,252.46 313.50 0.00 0.00 1,565.96 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 02/21/96 M OP 0.00 1,252.00 314.00 1,566.00 W000101419 0.00 0.00 0.00 0.00 BENDING/STRETCHING/REACHING 0.00 0.00 95.00 0.00 0.00 95.00 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 02/22/96 M OP 0.00 0.00 95.00 95.00 W000101420 -0.31 0.19 -0.30 -0.42 AUTOMOBILE ACCIDENTS 6,229.31 11,110.81 11,143.30 0.00 0.00 28,483.42 BACK 0.00 0.00 0.00 0.00 0.00 0.00 SPRAINS/STRAINS 02/23/96 I OP 6,229.00 11,111.00 11,143.00 28,483.00
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Run date: 25-AUG-11 NCAComp Page: 1CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101414 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 11,769.06 4,934.47 926.88 0.00 0.00 17,630.41ANKLES 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 12/15/95 I OP 11,769.06 4,934.47 926.88 17,630.41
W000101415 -0.40 -0.20 0.00 -0.60STRUCK BY OBJECT 102.40 299.20 0.00 0.00 0.00 401.60EYES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 01/30/96 I OP 102.00 299.00 0.00 401.00
W000101416 0.00 0.43 -0.10 0.33OTHER 0.00 1,753.57 263.10 0.00 0.00 2,016.67BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/01/96 M OP 0.00 1,754.00 263.00 2,017.00
W000101417 0.00 -0.17 0.00 -0.17TRIP/SLIP & FALL 0.00 37.17 0.00 0.00 0.00 37.17MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/06/96 M OP 0.00 37.00 0.00 37.00
W000101418 0.00 -0.46 0.50 0.04BENDING/STRETCHING/REACHING 0.00 1,252.46 313.50 0.00 0.00 1,565.96BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/21/96 M OP 0.00 1,252.00 314.00 1,566.00
W000101419 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 95.00 0.00 0.00 95.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/22/96 M OP 0.00 0.00 95.00 95.00
W000101420 -0.31 0.19 -0.30 -0.42AUTOMOBILE ACCIDENTS 6,229.31 11,110.81 11,143.30 0.00 0.00 28,483.42BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 02/23/96 I OP 6,229.00 11,111.00 11,143.00 28,483.00
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Run date: 25-AUG-11 NCAComp Page: 2CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000047224 124,800.00 7,335.93 5,954.89 138,090.82
TRIP/SLIP & FALL 49,932.06 50,851.07 16,567.11 0.00 0.00 117,350.24NECK,SHOULDERS 59606622 0.00 735.50 0.00 0.00 0.00 735.50MULTIPLE INJURIES 03/06/96 6 OP 174,732.06 58,187.00 22,522.00 255,441.06
W000101422 0.00 0.18 0.00 0.18FALL FROM HEIGHT 0.00 308.82 0.00 0.00 0.00 308.82BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 03/09/96 M OP 0.00 309.00 0.00 309.00
W000101423 -0.05 -0.40 -0.44 -0.89BENDING/STRETCHING/REACHING 169.05 1,584.40 394.44 0.00 0.00 2,147.89BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 03/11/96 I OP 169.00 1,584.00 394.00 2,147.00
W000101424 0.00 -0.18 0.10 -0.08FALL FROM HEIGHT 0.00 64.18 3.90 0.00 0.00 68.08BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 03/18/96 M OP 0.00 64.00 4.00 68.00
W000101425 0.00 -0.48 -0.30 -0.78FALL FROM HEIGHT 0.00 632.48 14.30 0.00 0.00 646.78BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 03/19/96 M OP 0.00 632.00 14.00 646.00
W000101426 0.00 -0.18 0.32 0.14STRUCK AGAINST 0.00 474.18 35.68 0.00 0.00 509.86ARMS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 04/21/96 M OP 0.00 474.00 36.00 510.00
W000101427 0.42 -0.49 0.02 -0.05STRUCK BY OBJECT 1,183.58 769.49 34.98 0.00 0.00 1,988.05BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 04/26/96 I OP 1,184.00 769.00 35.00 1,988.00
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Run date: 25-AUG-11 NCAComp Page: 3CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101428 0.37 0.42 0.00 0.79
TRIP/SLIP & FALL 281.63 542.58 0.00 0.00 0.00 824.21BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 05/04/96 I OP 282.00 543.00 0.00 825.00
W000101429 0.00 -0.11 0.11 0.00TRIP/SLIP & FALL 0.00 802.11 9.89 0.00 0.00 812.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 05/08/96 M OP 0.00 802.00 10.00 812.00
W000101430 0.08 0.49 0.10 0.67AUTOMOBILE ACCIDENTS 715.92 4,792.51 1,619.90 0.00 0.00 7,128.33MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 05/11/96 I OP 716.00 4,793.00 1,620.00 7,129.00
W000101431 0.00 -0.22 -0.07 -0.29TRIP/SLIP & FALL 0.00 481.22 106.07 0.00 0.00 587.29BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 05/11/96 M OP 0.00 481.00 106.00 587.00
W000101432 -0.45 -0.05 -0.17 -0.67FALL FROM HEIGHT 8,338.45 6,605.05 1,143.17 0.00 0.00 16,086.67KNEES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 05/13/96 I OP 8,338.00 6,605.00 1,143.00 16,086.00
W000101433 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 05/16/96 M OP 0.00 0.00 0.00 0.00
W000101434 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00KNEES 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 05/17/96 M OP 0.00 0.00 0.00 0.00
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Run date: 25-AUG-11 NCAComp Page: 4CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101435 0.00 -0.39 -0.20 -0.59
STRUCK BY OBJECT 0.00 144.39 5.20 0.00 0.00 149.59OTHER 0.00 0.00 0.00 0.00 0.00 0.00OTHER 05/18/96 M OP 0.00 144.00 5.00 149.00
W000101436 0.00 -0.05 0.20 0.15OTHER 0.00 275.05 7.80 0.00 0.00 282.85NOSE 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 05/18/96 M OP 0.00 275.00 8.00 283.00
W000101437 0.50 0.43 0.39 1.32STRUCK BY OBJECT 83.50 227.57 84.61 0.00 0.00 395.68OTHER 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 05/18/96 I OP 84.00 228.00 85.00 397.00
W000101438 0.00 -0.25 0.37 0.12OTHER 0.00 527.25 641.63 0.00 0.00 1,168.88MOUTH 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 05/26/96 M OP 0.00 527.00 642.00 1,169.00
W000101439 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 0.00 0.00 0.00 0.00 0.00ARMS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 06/03/96 M OP 0.00 0.00 0.00 0.00
W000101440 0.00 -0.43 0.08 -0.35STRUCK AGAINST 0.00 269.43 42.92 0.00 0.00 312.35HEAD 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/04/96 M OP 0.00 269.00 43.00 312.00
W000101441 0.00 -0.10 -0.14 -0.24FALL FROM HEIGHT 160.00 420.10 12.14 0.00 0.00 592.24KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/05/96 I OP 160.00 420.00 12.00 592.00
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Run date: 25-AUG-11 NCAComp Page: 5CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101442 0.00 0.00 0.00 0.00
OTHER 0.00 0.00 0.00 0.00 0.00 0.00ANKLES 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/05/96 M OP 0.00 0.00 0.00 0.00
W000101443 0.32 -0.25 -0.22 -0.15STRUCK BY OBJECT 65.68 398.25 28.22 0.00 0.00 492.15BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/05/96 I OP 66.00 398.00 28.00 492.00
W000101444 0.00 0.00 -0.31 -0.31OTHER 0.00 0.00 266.31 0.00 0.00 266.31MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/06/96 M OP 0.00 0.00 266.00 266.00
W000101445 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/07/96 M OP 0.00 0.00 0.00 0.00
W000101446 0.00 0.30 0.37 0.67TRIP/SLIP & FALL 0.00 1,112.70 4.63 0.00 0.00 1,117.33FACIAL 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 06/08/96 M OP 0.00 1,113.00 5.00 1,118.00
W000101447 0.10 0.49 -0.40 0.19AUTOMOBILE ACCIDENTS 15,679.90 16,781.51 5,504.40 0.00 0.00 37,965.81NECK 0.00 0.00 0.00 0.00 0.00 0.00INFLAM, JOINT/TENDON/MUSC 06/10/96 I OP 15,680.00 16,782.00 5,504.00 37,966.00
W000101448 0.00 0.22 -0.06 0.16STRUCK BY OBJECT 0.00 220.78 21.06 0.00 0.00 241.84KNEES 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/11/96 M OP 0.00 221.00 21.00 242.00
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Run date: 25-AUG-11 NCAComp Page: 6CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101449 0.00 0.00 0.00 0.00
OTHER 0.00 0.00 0.00 0.00 0.00 0.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/12/96 M OP 0.00 0.00 0.00 0.00
W000101450 0.24 0.46 -0.37 0.33AUTOMOBILE ACCIDENTS 45,942.76 24,615.54 4,346.37 0.00 0.00 74,904.67MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/12/96 I OP 45,943.00 24,616.00 4,346.00 74,905.00
W000101451 0.00 -0.20 -0.09 -0.29AUTOMOBILE ACCIDENTS 4,640.00 1,169.20 72.09 0.00 0.00 5,881.29MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 06/12/96 I OP 4,640.00 1,169.00 72.00 5,881.00
W000101452 0.40 -0.24 0.27 0.43AUTOMOBILE ACCIDENTS 2,279.60 8,636.24 1,573.73 0.00 0.00 12,489.57MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/12/96 I OP 2,280.00 8,636.00 1,574.00 12,490.00
W000101453 0.00 0.00 0.00 0.00OTHER 0.00 0.00 0.00 0.00 0.00 0.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/12/96 M OP 0.00 0.00 0.00 0.00
W000101454 0.00 0.08 0.01 0.09FALL FROM HEIGHT 0.00 94.92 25.99 0.00 0.00 120.91MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/12/96 M OP 0.00 95.00 26.00 121.00
W000101455 0.00 0.00 0.00 0.00OTHER 0.00 0.00 0.00 0.00 0.00 0.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/12/96 M OP 0.00 0.00 0.00 0.00
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Run date: 25-AUG-11 NCAComp Page: 7CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101456 0.39 0.00 0.05 0.44
AUTOMOBILE ACCIDENTS 16,827.61 23,871.00 7,386.95 0.00 0.00 48,085.56MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 06/12/96 I OP 16,828.00 23,871.00 7,387.00 48,086.00
W000101457 0.00 0.00 0.00 0.00OTHER 0.00 0.00 0.00 0.00 0.00 0.00FINGERS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/16/96 M OP 0.00 0.00 0.00 0.00
W000101458 0.00 -0.36 0.00 -0.36STRUCK BY OBJECT 0.00 87.36 0.00 0.00 0.00 87.36CHEST 0.00 0.00 0.00 0.00 0.00 0.00OTHER 06/17/96 M OP 0.00 87.00 0.00 87.00
W000101459 0.10 -0.33 0.08 -0.15TRIP/SLIP & FALL 688.90 1,783.33 849.92 0.00 0.00 3,322.15BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/22/96 I OP 689.00 1,783.00 850.00 3,322.00
W000101460 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/24/96 M OP 0.00 0.00 0.00 0.00
W000101461 0.00 -0.33 0.00 -0.33TRIP/SLIP & FALL 0.00 81.33 0.00 0.00 0.00 81.33ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/25/96 M OP 0.00 81.00 0.00 81.00
W000101462 0.00 -0.31 0.30 -0.01OTHER 0.00 136.31 11.70 0.00 0.00 148.01MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/25/96 M OP 0.00 136.00 12.00 148.00
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Run date: 25-AUG-11 NCAComp Page: 8CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101463 0.00 -0.29 0.20 -0.09
BENDING/STRETCHING/REACHING 0.00 24.29 7.80 0.00 0.00 32.09MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/28/96 M OP 0.00 24.00 8.00 32.00
W000101464 -0.02 0.00 0.00 -0.02TRIP/SLIP & FALL 900.02 0.00 530.00 0.00 0.00 1,430.02ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 06/30/96 I OP 900.00 0.00 530.00 1,430.00
W000101465 0.40 -0.05 0.29 0.64BENDING/STRETCHING/REACHING 142,988.60 17,480.05 6,120.71 0.00 0.00 166,589.36KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/03/96 I OP 142,989.00 17,480.00 6,121.00 166,590.00
W000101466 0.00 0.00 0.00 0.00CAUGHT IN UNDER BETWEEN 0.00 0.00 0.00 0.00 0.00 0.00FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 07/04/96 M OP 0.00 0.00 0.00 0.00
W000101467 0.00 -0.36 0.00 -0.36BENDING/STRETCHING/REACHING 0.00 85.36 0.00 0.00 0.00 85.36BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/08/96 M OP 0.00 85.00 0.00 85.00
W000101468 0.10 -0.36 -0.02 -0.28TRIP/SLIP & FALL 1,839.90 2,648.36 43.02 0.00 0.00 4,531.28BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/08/96 I OP 1,840.00 2,648.00 43.00 4,531.00
W000101469 0.00 -0.02 -0.14 -0.16TRIP/SLIP & FALL 0.00 141.02 12.14 0.00 0.00 153.16ELBOW 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 07/11/96 M OP 0.00 141.00 12.00 153.00
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Run date: 25-AUG-11 NCAComp Page: 9CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101470 0.00 0.22 0.00 0.22
OTHER 0.00 314.78 13.00 0.00 0.00 327.78SHOULDERS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 07/11/96 M OP 0.00 315.00 13.00 328.00
W000101471 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 0.00 0.00 0.00 0.00 0.00EYES 0.00 0.00 0.00 0.00 0.00 0.00INFLAM, JOINT/TENDON/MUSC 07/12/96 M OP 0.00 0.00 0.00 0.00
W000101472 0.00 0.50 -0.22 0.28STRUCK AGAINST 0.00 142.50 2.22 0.00 0.00 144.72HEAD 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 07/13/96 M OP 0.00 143.00 2.00 145.00
W000101473 0.00 0.13 0.35 0.48BENDING/STRETCHING/REACHING 0.00 8,791.87 573.65 0.00 0.00 9,365.52BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/16/96 M OP 0.00 8,792.00 574.00 9,366.00
W000101474 0.35 0.16 0.24 0.75TRIP/SLIP & FALL 8,775.65 959.84 774.76 0.00 0.00 10,510.25HANDS 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 07/18/96 I OP 8,776.00 960.00 775.00 10,511.00
W000101475 0.00 0.00 0.00 0.00AUTOMOBILE ACCIDENTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 0.00 0.00 0.00 0.00 0.00 0.00OTHER 07/19/96 M OP 0.00 0.00 0.00 0.00
W000101476 0.00 -0.01 0.00 -0.01STRUCK AGAINST 0.00 646.01 26.00 0.00 0.00 672.01THUMBS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 07/25/96 M OP 0.00 646.00 26.00 672.00
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Run date: 25-AUG-11 NCAComp Page: 10CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101477 0.00 0.42 0.15 0.57
BENDING/STRETCHING/REACHING 0.00 2,164.58 645.85 0.00 0.00 2,810.43KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/25/96 M OP 0.00 2,165.00 646.00 2,811.00
W000101478 0.00 -0.07 0.15 0.08BENDING/STRETCHING/REACHING 0.00 10,729.07 1,902.85 0.00 0.00 12,631.92BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/25/96 M OP 0.00 10,729.00 1,903.00 12,632.00
W000101479 0.00 -0.40 0.19 -0.21OTHER 0.00 280.40 13.81 0.00 0.00 294.21FACIAL 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 07/26/96 M OP 0.00 280.00 14.00 294.00
W000101480 0.35 0.23 0.37 0.95AUTOMOBILE ACCIDENTS 33,341.65 3,732.77 4,114.63 0.00 0.00 41,189.05BACK 0.00 0.00 0.00 0.00 0.00 0.00INFLAM, JOINT/TENDON/MUSC 07/29/96 I OP 33,342.00 3,733.00 4,115.00 41,190.00
W000101481 0.00 0.17 0.29 0.46BENDING/STRETCHING/REACHING 0.00 1,326.83 41.71 0.00 0.00 1,368.54BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/30/96 M OP 0.00 1,327.00 42.00 1,369.00
W000101482 0.00 0.00 0.10 0.10OTHER 0.00 761.00 3.90 0.00 0.00 764.90MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 07/31/96 M OP 0.00 761.00 4.00 765.00
W000101483 -0.44 -0.24 0.03 -0.65FALL FROM HEIGHT 9,189.44 11,930.24 2,687.97 0.00 0.00 23,807.65ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 07/31/96 I OP 9,189.00 11,930.00 2,688.00 23,807.00
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Run date: 25-AUG-11 NCAComp Page: 11CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101484 0.03 0.15 0.45 0.63
CAUGHT IN UNDER BETWEEN 15,599.97 5,045.85 384.55 0.00 0.00 21,030.37HANDS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 08/01/96 I OP 15,600.00 5,046.00 385.00 21,031.00
W000101485 0.00 -0.49 0.48 -0.01TRIP/SLIP & FALL 0.00 330.49 20.52 0.00 0.00 351.01HEAD 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 08/04/96 M OP 0.00 330.00 21.00 351.00
W000101486 0.00 -0.07 0.00 -0.07FALL FROM HEIGHT 0.00 59.07 0.00 0.00 0.00 59.07BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/05/96 M OP 0.00 59.00 0.00 59.00
W000101487 0.00 0.01 0.24 0.25AUTOMOBILE ACCIDENTS 1,280.00 761.99 45.76 0.00 0.00 2,087.75NECK 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 08/09/96 I OP 1,280.00 762.00 46.00 2,088.00
W000101488 0.30 -0.49 -0.10 -0.29BENDING/STRETCHING/REACHING 791.70 5,968.49 628.10 0.00 0.00 7,388.29BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/12/96 I OP 792.00 5,968.00 628.00 7,388.00
W000101489 0.39 -0.10 0.00 0.29OTHER 135.61 448.10 13.00 0.00 0.00 596.71BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/13/96 I OP 136.00 448.00 13.00 597.00
W000101490 0.30 0.28 0.39 0.97AUTOMOBILE ACCIDENTS 109.70 376.72 9.61 0.00 0.00 496.03BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/13/96 I OP 110.00 377.00 10.00 497.00
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Run date: 25-AUG-11 NCAComp Page: 12CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101491 0.13 0.23 0.20 0.56
STRUCK BY OBJECT 63.87 208.77 7.80 0.00 0.00 280.44ARMS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 08/14/96 I OP 64.00 209.00 8.00 281.00
W000101492 0.00 -0.38 0.00 -0.38STRUCK AGAINST 0.00 242.38 0.00 0.00 0.00 242.38EYES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 08/16/96 M OP 0.00 242.00 0.00 242.00
W000101493 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/19/96 M OP 0.00 0.00 0.00 0.00
W000101494 0.00 0.09 -0.07 0.02STRUCK AGAINST 0.00 954.91 994.07 0.00 0.00 1,948.98MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 08/21/96 M OP 0.00 955.00 994.00 1,949.00
W000101495 0.00 0.30 0.39 0.69STRUCK AGAINST 0.00 70.70 10.61 0.00 0.00 81.31HEAD 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 08/22/96 M OP 0.00 71.00 11.00 82.00
W000101496 -0.32 0.39 0.36 0.43BENDING/STRETCHING/REACHING 293.32 840.61 9.64 0.00 0.00 1,143.57BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/25/96 I OP 293.00 841.00 10.00 1,144.00
W000101497 0.00 -0.29 0.00 -0.29BENDING/STRETCHING/REACHING 0.00 219.29 0.00 0.00 0.00 219.29BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/26/96 M OP 0.00 219.00 0.00 219.00
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Run date: 25-AUG-11 NCAComp Page: 13CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101498 0.00 -0.40 0.22 -0.18
STRUCK AGAINST 0.00 114.40 12.78 0.00 0.00 127.18ARMS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 08/29/96 M OP 0.00 114.00 13.00 127.00
W000101499 -0.39 -0.01 -0.12 -0.52BENDING/STRETCHING/REACHING 729.39 918.01 22.12 0.00 0.00 1,669.52KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 08/30/96 I OP 729.00 918.00 22.00 1,669.00
W000101500 0.12 -0.41 -0.33 -0.62BENDING/STRETCHING/REACHING 13,221.88 7,597.41 1,460.33 0.00 0.00 22,279.62MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CARPAL TUNNEL 09/01/96 I OP 13,222.00 7,597.00 1,460.00 22,279.00
W000101501 0.00 -0.14 0.10 -0.04TEMPERATURE EXTREMES 0.00 373.14 16.90 0.00 0.00 390.04HANDS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 09/01/96 M OP 0.00 373.00 17.00 390.00
W000101502 0.42 0.24 0.34 1.00BENDING/STRETCHING/REACHING 1,242.58 3,170.76 131.66 0.00 0.00 4,545.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/03/96 I OP 1,243.00 3,171.00 132.00 4,546.00
W000101503 0.00 0.00 0.00 0.00FALL FROM HEIGHT 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/03/96 M OP 0.00 0.00 0.00 0.00
W000101504 0.00 0.26 0.35 0.61CAUGHT IN UNDER BETWEEN 0.00 291.74 37.65 0.00 0.00 329.39FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/03/96 M OP 0.00 292.00 38.00 330.00
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Run date: 25-AUG-11 NCAComp Page: 14CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101505 -0.28 0.42 -0.06 0.08
BENDING/STRETCHING/REACHING 63,966.28 31,487.58 7,671.06 0.00 0.00 103,124.92BACK 0.00 0.00 0.00 0.00 0.00 0.00HERNIA/RUPTURE 09/04/96 I OP 63,966.00 31,488.00 7,671.00 103,125.00
W000101506 0.00 -0.26 0.07 -0.19STRUCK AGAINST 0.00 57.26 29.93 0.00 0.00 87.19FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 09/10/96 I OP 0.00 57.00 30.00 87.00
W000101507 0.00 0.35 0.10 0.45STRUCK BY OBJECT 0.00 118.65 3.90 0.00 0.00 122.55MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 09/11/96 M OP 0.00 119.00 4.00 123.00
W000101508 0.00 -0.27 0.00 -0.27BENDING/STRETCHING/REACHING 0.00 103.27 145.00 0.00 0.00 248.27OTHER 0.00 0.00 0.00 0.00 0.00 0.00OTHER 09/11/96 M OP 0.00 103.00 145.00 248.00
W000101509 0.11 -0.44 -0.22 -0.55FALL FROM HEIGHT 7,611.89 8,804.44 2,063.22 0.00 0.00 18,479.55MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00INFLAM, JOINT/TENDON/MUSC 09/11/96 I OP 7,612.00 8,804.00 2,063.00 18,479.00
W000101510 0.00 0.48 0.00 0.48STRUCK AGAINST 0.00 98.52 0.00 0.00 0.00 98.52MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/15/96 M OP 0.00 99.00 0.00 99.00
W000101511 0.00 -0.19 0.04 -0.15TRIP/SLIP & FALL 0.00 268.19 2.96 0.00 0.00 271.15MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/15/96 M OP 0.00 268.00 3.00 271.00
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Run date: 25-AUG-11 NCAComp Page: 15CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101512 0.00 -0.19 0.00 -0.19
STRUCK BY OBJECT 0.00 91.19 0.00 0.00 0.00 91.19FEET 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/15/96 M OP 0.00 91.00 0.00 91.00
W000101513 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 93.00 0.00 0.00 93.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/16/96 M OP 0.00 0.00 93.00 93.00
W000101514 0.00 0.00 -0.44 -0.44STRUCK AGAINST 0.00 1,132.00 412.44 0.00 0.00 1,544.44MOUTH 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/17/96 M OP 0.00 1,132.00 412.00 1,544.00
W000101515 0.00 0.15 0.50 0.65BENDING/STRETCHING/REACHING 0.00 175.85 70.50 0.00 0.00 246.35BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/18/96 M OP 0.00 176.00 71.00 247.00
W000101516 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 09/20/96 M OP 0.00 0.00 0.00 0.00
W000101517 0.00 0.21 0.10 0.31STRUCK AGAINST 0.00 31.79 3.90 0.00 0.00 35.69FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 09/21/96 M OP 0.00 32.00 4.00 36.00
W000101518 0.21 0.19 -0.17 0.23AUTOMOBILE ACCIDENTS 17,679.79 15,487.81 2,823.17 0.00 0.00 35,990.77MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/25/96 I OP 17,680.00 15,488.00 2,823.00 35,991.00
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Run date: 25-AUG-11 NCAComp Page: 16CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101519 0.00 -0.36 0.00 -0.36
STRUCK AGAINST 0.00 189.36 0.00 0.00 0.00 189.36FEET 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 09/27/96 M OP 0.00 189.00 0.00 189.00
W000101520 0.29 -0.32 0.30 0.27FALL FROM HEIGHT 1,109.71 1,495.32 182.70 0.00 0.00 2,787.73MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 10/02/96 I OP 1,110.00 1,495.00 183.00 2,788.00
W000101521 0.00 0.47 -0.43 0.04STRUCK AGAINST 64.00 319.53 35.43 0.00 0.00 418.96FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 10/02/96 I OP 64.00 320.00 35.00 419.00
W000101522 0.00 0.00 -0.40 -0.40TRIP/SLIP & FALL 0.00 0.00 81.40 0.00 0.00 81.40ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/02/96 M OP 0.00 0.00 81.00 81.00
W000101523 -0.33 0.05 -0.29 -0.57OTHER 21.33 385.95 7.29 0.00 0.00 414.57NOSE 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 10/03/96 I OP 21.00 386.00 7.00 414.00
W000101524 0.33 -0.03 -0.05 0.25OTHER 1,660.67 857.03 147.05 0.00 0.00 2,664.75NOSE 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 10/04/96 I OP 1,661.00 857.00 147.00 2,665.00
W000101525 0.00 -0.05 0.00 -0.05OTHER 0.00 344.05 13.00 0.00 0.00 357.05OTHER 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 10/04/96 M OP 0.00 344.00 13.00 357.00
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Run date: 25-AUG-11 NCAComp Page: 17CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101526 0.00 -0.36 -0.23 -0.59
BENDING/STRETCHING/REACHING 0.00 62.36 5.23 0.00 0.00 67.59BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/07/96 M OP 0.00 62.00 5.00 67.00
W000101527 0.00 -0.45 0.45 0.00STRUCK AGAINST 0.00 450.45 7.55 0.00 0.00 458.00SHOULDERS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 10/08/96 M OP 0.00 450.00 8.00 458.00
W000101528 0.00 -0.44 -0.20 -0.64TRIP/SLIP & FALL 0.00 521.44 44.20 0.00 0.00 565.64MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/10/96 M OP 0.00 521.00 44.00 565.00
W000101529 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/16/96 M OP 0.00 0.00 0.00 0.00
W000101530 -0.16 0.02 0.00 -0.14BENDING/STRETCHING/REACHING 52.16 218.98 0.00 0.00 0.00 271.14KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/16/96 I OP 52.00 219.00 0.00 271.00
W000101531 0.00 0.00 0.31 0.31FALL FROM HEIGHT 0.00 0.00 6.69 0.00 0.00 6.69MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/17/96 M OP 0.00 0.00 7.00 7.00
W000101532 0.00 -0.12 -0.20 -0.32OTHER 0.00 645.12 31.20 0.00 0.00 676.32THUMBS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/19/96 M OP 0.00 645.00 31.00 676.00
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Run date: 25-AUG-11 NCAComp Page: 18CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101533 0.00 0.37 0.50 0.87
OTHER 0.00 107.63 6.50 0.00 0.00 114.13MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 10/19/96 M OP 0.00 108.00 7.00 115.00
W000101534 0.00 -0.40 0.14 -0.26BENDING/STRETCHING/REACHING 0.00 285.40 9.86 0.00 0.00 295.26BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/21/96 M OP 0.00 285.00 10.00 295.00
W000101535 0.00 0.00 0.00 0.00BENDING/STRETCHING/REACHING 0.00 0.00 0.00 0.00 0.00 0.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/21/96 M OP 0.00 0.00 0.00 0.00
W000101536 0.13 -0.43 0.37 0.07BENDING/STRETCHING/REACHING 321.87 452.43 80.63 0.00 0.00 854.93BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/25/96 I OP 322.00 452.00 81.00 855.00
W000101537 0.00 0.33 0.00 0.33TRIP/SLIP & FALL 0.00 203.67 0.00 0.00 0.00 203.67ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/26/96 M OP 0.00 204.00 0.00 204.00
W000101538 -0.48 -0.04 0.00 -0.52FALL FROM HEIGHT 631.48 104.04 0.00 0.00 0.00 735.52BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 10/28/96 I OP 631.00 104.00 0.00 735.00
W000101539 0.22 -0.02 0.17 0.37TRIP/SLIP & FALL 18,641.78 19,529.02 6,143.83 0.00 0.00 44,314.63FEET 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 10/31/96 I OP 18,642.00 19,529.00 6,144.00 44,315.00
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Run date: 25-AUG-11 NCAComp Page: 19CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101540 0.00 0.00 0.00 0.00
STRUCK BY OBJECT 0.00 40.00 0.00 0.00 0.00 40.00ELBOW 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/01/96 M OP 0.00 40.00 0.00 40.00
W000101541 0.00 -0.30 0.40 0.10STRUCK AGAINST 0.00 798.30 160.60 0.00 0.00 958.90FINGERS 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 11/05/96 M OP 0.00 798.00 161.00 959.00
W000101542 0.00 -0.31 0.47 0.16OTHER 36,534.00 9,307.31 4,755.53 0.00 0.00 50,596.84MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/07/96 I OP 36,534.00 9,307.00 4,756.00 50,597.00
W000101543 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00KNEES 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 11/07/96 M OP 0.00 0.00 0.00 0.00
W000101544 0.44 -0.03 0.33 0.74REPETITIVE MOTION 5,380.56 8,576.03 271.67 0.00 0.00 14,228.26KNEES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/11/96 I OP 5,381.00 8,576.00 272.00 14,229.00
W000101545 0.00 0.00 0.00 0.00TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00KNEES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/13/96 M OP 0.00 0.00 0.00 0.00
W000101546 0.28 -0.08 0.10 0.30FALL FROM HEIGHT 4,477.72 4,239.08 379.90 0.00 0.00 9,096.70BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/14/96 I OP 4,478.00 4,239.00 380.00 9,097.00
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Run date: 25-AUG-11 NCAComp Page: 20CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101547 0.00 -0.24 -0.33 -0.57
STRUCK BY OBJECT 0.00 138.24 6.33 0.00 0.00 144.57EYES 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/15/96 M OP 0.00 138.00 6.00 144.00
W000101548 0.00 0.36 0.35 0.71STRUCK BY OBJECT 0.00 766.64 88.65 0.00 0.00 855.29HANDS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/15/96 M OP 0.00 767.00 89.00 856.00
W000101549 0.00 0.17 0.30 0.47STRUCK AGAINST 0.00 2,338.83 174.70 0.00 0.00 2,513.53HANDS 0.00 0.00 0.00 0.00 0.00 0.00FRACTURE 11/19/96 M OP 0.00 2,339.00 175.00 2,514.00
W000101550 0.00 0.00 0.00 0.00STRUCK BY OBJECT 0.00 80.00 0.00 0.00 0.00 80.00ARMS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 11/21/96 M OP 0.00 80.00 0.00 80.00
W000101551 0.00 -0.20 0.20 0.00STRUCK BY OBJECT 0.00 184.20 7.80 0.00 0.00 192.00BACK 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/21/96 M OP 0.00 184.00 8.00 192.00
W000101552 0.26 -0.48 -0.20 -0.42TRIP/SLIP & FALL 17.74 67.48 5.20 0.00 0.00 90.42SHOULDERS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 11/27/96 I OP 18.00 67.00 5.00 90.00
W000101553 -0.18 -0.33 -0.45 -0.96BENDING/STRETCHING/REACHING 212.18 455.33 97.45 0.00 0.00 764.96SHOULDERS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/04/96 I OP 212.00 455.00 97.00 764.00
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Run date: 25-AUG-11 NCAComp Page: 21CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101554 0.00 0.00 0.00 0.00
TRIP/SLIP & FALL 0.00 0.00 0.00 0.00 0.00 0.00ABDOMEN 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 12/05/96 M OP 0.00 0.00 0.00 0.00
W000101555 0.00 -0.27 0.40 0.13BENDING/STRETCHING/REACHING 2,400.00 6,016.27 559.60 0.00 0.00 8,975.87MULTIPLE BODY PARTS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 12/06/96 I OP 2,400.00 6,016.00 560.00 8,976.00
W000101556 -0.30 0.36 0.45 0.51STRUCK AGAINST 937.30 465.64 109.55 0.00 0.00 1,512.49FINGERS 0.00 0.00 0.00 0.00 0.00 0.00OTHER 12/09/96 I OP 937.00 466.00 110.00 1,513.00
W000101557 0.00 -0.41 -0.20 -0.61TRIP/SLIP & FALL 0.00 154.41 5.20 0.00 0.00 159.61FINGERS 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/10/96 M OP 0.00 154.00 5.00 159.00
W000101558 0.00 -0.19 -0.40 -0.59OTHER 0.00 2,489.19 77.40 0.00 0.00 2,566.59NOSE 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/10/96 M OP 0.00 2,489.00 77.00 2,566.00
W000101559 0.13 -0.40 -0.20 -0.47STRUCK AGAINST 608.87 172.40 290.20 0.00 0.00 1,071.47ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/11/96 I OP 609.00 172.00 290.00 1,071.00
W000101560 0.00 0.00 0.00 0.00STRUCK AGAINST 0.00 0.00 0.00 0.00 0.00 0.00HEAD 0.00 0.00 0.00 0.00 0.00 0.00CONTUSION 12/11/96 M OP 0.00 0.00 0.00 0.00
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Run date: 25-AUG-11 NCAComp Page: 22CRISP-COMMUNITY RESIDENCE INSURANCE SAVINGS*** Detail Loss Report for Current Period: 08/01/2011 - 08/25/2011 ***
CLAIMS LISTED: ALL CASESWITH ACCIDENTS 01/01/1900 - 12/31/4000
Claimant Name Claim # CAUSE SS# LOCATION Claim Status Type WCB# TYPE ALL Acc Date StatusClaim Description COMP MEDICAL EXPENSE REIM/ToDate REIM/ToBe TOTAL
============ ============ ============ ============ ============ ============W000101561 -0.25 -0.19 0.20 -0.24
FALL FROM HEIGHT 3,891.25 1,159.19 432.80 0.00 0.00 5,483.24ANKLES 0.00 0.00 0.00 0.00 0.00 0.00SPRAINS/STRAINS 12/12/96 I OP 3,891.00 1,159.00 433.00 5,483.00
W000101562 0.00 0.10 0.17 0.27STRUCK AGAINST 0.00 185.90 10.83 0.00 0.00 196.73FINGERS 0.00 0.00 0.00 0.00 0.00 0.00CUT/LACERATION/PUNTURE 12/13/96 M OP 0.00 186.00 11.00 197.00
W000101563 0.00 -0.30 0.40 0.10TEMPERATURE EXTREMES 0.00 274.30 15.60 0.00 0.0
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