Sedgwick Claims Management Services, Inc. - Tennesseetreasury.tn.gov/risk/LossControlReports/AccLoss-AllOther.pdf · Sedgwick Claims Management Services, Inc. ... Sedgwick Claims

Sedgwick Claims Management Services, Inc.

Accumulative Loss Analysis

Sedgwick Claims Management Services Inc.

CMS UNIT: 810

Requestor: Debra Banks

b851376.00001 (@ 23:04:19 12/31/2012)

Client: 1376 STATE OF TENNESSEE Account: *MULTIPLE ACCOUNTS* Unit: ALL Blanks: Include Blank Accts, Include Blank Units Plan: ALL Line: ALL Coverage: ALL Office: Office = ALL Home Office = ALL State: ALL Examiner: ALL Vendor: ALL ICD Group: ALL Include: CLAIM ONLY Claim Status: OPEN,CLOSED Major Classification: WC-ALL Subtypes: ALL Include Historical Pmnts: YES Incurred Range: ALL Incurred-Exclude Zero?: NO Paid To Dt Range: ALL Paid To Dt-Exclude Zero?: NO Date Option: LOSS Sort Option: Cause Code Claims: 07/01/2007-12/31/2012 As Of: 12/31/2012 Break Level: Client,Account Page Breaks: Client,Account Display Only Category Summary: NO Cause Category/Codes: ALL Result/Nature Category/Codes: ALL Target/Part Category/Codes: ALL

Sedgwick Claims Management Services

MULTI-SELECT COVER SHEET PREPARED: 12/31/2012

ACCUMULATIVE LOSS ANALYSIS

CMS UNIT: 810

SELECTED ITEMS

SELECTED CLIENTS

----------------

1376 STATE OF TENNESSEE

SELECTED ACCOUNTS (All accounts of any client not specified here are also considered)

-----------------

1376 41000000 DEPT. OF REVENUE - 34700 1376 41000002 HIGHER EDUCATION DEPARTMENT

1376 41000004 MISCELLANEOUS APPROPRIATIONS EXPIRE 1376 41000005 EMERGENCY & CONTINGENCY FUND EXPIRE

1376 41000006 STATE BUILDING COMMISSION EXPIRE 1376 41000065 TENNCARE

1376 41000066 TENNCARE SERVICES 1376 41000067 TENNCARE - LONG TERM CARE SERVICES

1376 41000068 PST-CONV DFD COM-DON'T USE AFTER 7-96 1376 41000069 TENNESSEE STATE VETERANS HOME

1376 41001120 COMMUNITY HEALTH AGENCIES 1376 41001122 EAST TN COMM HEALTH AGENCY

1376 41001123 FIRST TN REGION COMM HEALTH AGNCY 1376 41001124 MID CUMBERLAND REGION COMM HLTH AGNCY

1376 41001125 NORTHWEST REGION COMM HLTH AGNCY 1376 41001126 SOUTH CENTRAL REGION COMM HLTH AGNCY

1376 41001127 SOUTHEAST REGION COMM HLTH AGNCY 1376 41001128 SOUTHWEST REGION COMM HLTH AGNCY

1376 41001129 UPPER CUMBERLAND REGION COMM HLTH AGNCY 1376 41001130 KNOX COUNTY COMM HEALTH AGNCY

1376 41001131 SHELBY CO COMM HEALTH AGNCY 1376 41001132 DO NOT USE

1376 41002684 POST CONVICTION DEFENSE COUNCIL 1376 41002685 TENN REGULATORY BOARD

1376 41007547 DEPT. OF LEGISLATURE - 30100 1376 41007548 COURT SYSTEM - 30200

1376 41007549 ATTORNEY GENERAL 1376 41007550 DISTRICT ATTORNEYS GENERAL - 30400

1376 41007551 SECRATARY OF STATE - 30500 1376 41007553 DISTRICT OF PUPLIC DEFENDERS - 30600

1376 41007554 COMPTROLLER - 30700 1376 41007555 TREASURY - 30900

1376 41007556 PUB SERV COM-DON'T USE AFTER 7-96 1376 41007558 EXECUTIVE DEPARTMENT - 31500

1376 41007559 ALCOHOL & BEVERAGE COMMISSION (ABC) 1376 41007560 TN HOUSING DEVELOPMENT AUTHORITY (TDHA)

1376 41007561 ARTS COMMISSION 1376 41007562 BOARD OF PAROLES

1376 41007563 OBION FRKD DR AUTH-DON'T USE AFTER 7-96 1376 41007564 FINANCE & ADMINISTRATION - 31700

1376 41007565 PERSONNEL DEPARTMENT - 31900 1376 41007566 GENERAL SERVICES - 32100

1376 41007567 VETERAN'S AFFAIRS 1376 41007568 AGRICULTURE DEPT. - 32500

1376 41007569 DEPT. OF TOURISM DEVELOPEMENT - 32600 1376 41007572 ENVIRONMENT & CONSERVATION - 32700

1376 41007573 TN WILDLIFE RESOURCES AGENCY - 32800 1376 41007575 ECONOMIC/COMMUNITY DEVELOPEMENT - 3300

1376 41007576 EDUCATION DEPARTMENT - 33100 1376 41007578 EMPLOYMENT SECURITY

1376 41007579 COMMERCE AND INSURANCE DEPARTMENT 1376 41007580 FINANCIAL INSTITUTIONS

1376 41007581 LABOR AND WORK FORCE 1376 41007583 YTH DEV-DON'T USE AFTER 7-96

1376 41007584 MILITARY 1376 41007585 HEALTH DEPARTMENT - 34300

1376 41007586 DEPT. OF HUMAN SERVICES - 34500 1376 41007587 TENNESSEE BUREAU OF INVESTIGATION (TBI)

1376 41007588 DEPT. OF SAFETY - 34900 1376 41007589 CHILDREN'S SERVICES PLAN - 35900

1376 41007592 CHILDREN AND YOUTH 1376 41007593 COMMISSION ON AGING

1376 41007594 HUMAN RIGHTS COMMISSION 1376 41007595 HEALTH FACILITIES COMMISSION

1376 41007596 TN CORRECTIONS INSTITUTE 1376 41007597 JUVENILE AND FAMILY COURT

1376 41007598 TACIR 1376 41007599 INSTITUTE FOR AFRICAN/CARIBBEAN AFFAIRS

1376 41007700 BBP - ENVIRONMENT & CONSERVATION - 32700 1376 41007701 BBP - DEPARTMENT OF CORRECTION - 32900

1376 41007702 BBP - BOARD OF REGENTS 1376 41007703 BBP - YOUTH DEVELOPEMENT DEPT - 34000

1376 41007704 EAST TN COMM HEALTH AGENCY 1376 41007705 FIRST TN REGION COMM HEALTH AGNCY

1376 41007706 MID CUMBERLAND REGION COMM HLTH AGNCY 1376 41007707 NORTHWEST REGION COMM HLTH AGNCY

1376 41007708 SOUTH CENTRAL REGION COMM HLTH AGNCY 1376 41007709 SOUTHEAST REGION COMM HLTH AGNCY

1376 41007710 SOUTHWEST REGION COMM HLTH AGNCY 1376 41007711 UPPER CUMBERLAND REGION COMM HLTH AGNCY

1376 41007712 KNOX COUNTY COMM HEALTH AGNCY 1376 41007713 SHELBY CO COMM HEALTH AGNCY

1376 41007714 BBP - CHILDREN'S SERVICES PLAN - 35900 1376 41007716 BBP - TRANSPORTATION DEPARTMENT - 40000

1376 41007717 BBP - MENTAL HEALTH/RETARDATION - 33900 1376 41007718 BBP - COMMUNITY HEALTH AGENCIES

1376 41107310 Highland Rim Regional Library 1376 41137601 TRICOR

1376 41137603 BOARD PROBATION & PAROLES - 32400 1376 41137604 LIBRARIES


MULTI-SELECT COVER SHEET PREPARED: 12/31/2012

ACCUMULATIVE LOSS ANALYSIS

CMS UNIT: 810

SELECTED ITEMS

1376 41137605 Nonlichucky Regional Library 1376 41137606 Shiloh Regional Library

1376 41137607 Clinch Regional Library 1376 41137608 Blue Grass Regional Library

1376 41137609 Caney Fork regional Library 1376 41137610 Highland Rim Regional Library

1376 41137611 Warioto Regional Library 1376 41137612 Forked Deer Regional Library

1376 41137613 Upper Cumberland Regional Library 1376 41137614 Reelfoot Regional Library

1376 41137615 Ft. Loudon Regional Library


CLIENT 1376 STATE OF TENNESSEE ACCUMULATIVE LOSS ANALYSIS REPORT PREPARED: 12/31/2012

ACCOUNT 41000000 DEPT. OF REVENUE - 34700 LOSS 07/01/2007 - 12/31/2012 AS OF 12/31/2012 PAGE: 1

TOTAL PAID CMS UNIT: 810

07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS

CAUSE OF LOSS CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS TOTAL PAID

1300 Caught In, Under or Between, NOC 1 383.31 0 0.00 0 0.00 0 0.00 0 0.00 1 383.31

1900 Cut, Punctured, Scraped, NOC 0 0.00 1 511.93 0 0.00 0 0.00 0 0.00 1 511.93

1901 Bitten 1 323.61 0 0.00 0 0.00 0 0.00 0 0.00 1 323.61

1902 Needle Stick 0 0.00 1 0.00 0 0.00 0 0.00 0 0.00 1 0.00

2500 Fall/Slip From a Different Level 1 299.15 0 0.00 0 0.00 1 2,293.50 0 0.00 2 2,592.65

2700 Fall/Slip From Liquid/Grease Spills 0 0.00 0 0.00 0 0.00 2 284.71 0 0.00 2 284.71

2900 Fall On the Same Level 1 0.00 4 655.28 3 1,869.40 5 6,816.80 1 1,111.62 14 10,453.10

3000 Slipped, Did Not Fall 0 0.00 0 0.00 0 0.00 1 226.84 0 0.00 1 226.84

3100 Fall, Slip or Trip, NOC 10 63,211.51 5 80,492.66 2 5,488.03 5 1,746.02 1 0.00 23 150,938.22

3101 Trip 1 0.00 1 0.00 0 0.00 0 0.00 1 0.00 3 0.00

3200 Fall/Slip on Ice or Snow 0 0.00 1 5,311.67 0 0.00 1 0.00 0 0.00 2 5,311.67

3300 Fall/Slip On Stairs 1 398.40 2 522.45 0 0.00 1 4,291.29 0 0.00 4 5,212.14

4500 Collision with Another Vehicle 0 0.00 1 1,122.84 1 233.31 0 0.00 1 2,412.49 3 3,768.64

5000 Motor Vehicle, NOC 2 134,967.71 1 0.00 0 0.00 0 0.00 0 0.00 3 134,967.71

5001 Public Transportation Accident 0 0.00 0 0.00 0 0.00 0 0.00 1 825.12 1 825.12

5300 Twisting 2 25,533.64 0 0.00 0 0.00 0 0.00 0 0.00 2 25,533.64

5600 Lifting 0 0.00 1 90.36 0 0.00 1 6,364.94 1 18,226.90 3 24,682.20

5700 Pushing or Pulling 0 0.00 0 0.00 0 0.00 0 0.00 1 18,449.66 1 18,449.66

5800 Reaching 0 0.00 0 0.00 0 0.00 1 45,866.49 0 0.00 1 45,866.49

6000 Strain or Injury By, NOC 1 587.27 0 0.00 1 0.00 1 0.00 0 0.00 3 587.27

6001 Bodily Reaction 0 0.00 1 25.60 0 0.00 0 0.00 0 0.00 1 25.60

6003 Overexertion 0 0.00 0 0.00 0 0.00 1 0.00 0 0.00 1 0.00

6004 Running and Training 0 0.00 2 2,951.93 0 0.00 0 0.00 0 0.00 2 2,951.93

6800 Stationary Object 0 0.00 0 0.00 1 461.43 0 0.00 1 8,675.08 2 9,136.51

7000 Striking Against/Stepping On, NOC 0 0.00 1 110,079.44 2 657.73 0 0.00 0 0.00 3 110,737.17

7400 Fellow Worker, Patient 0 0.00 1 0.00 0 0.00 0 0.00 0 0.00 1 0.00

7500 Falling or Flying Object 1 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 0.00

7700 Motor Vehicle 0 0.00 0 0.00 1 6.85 0 0.00 0 0.00 1 6.85

8000 Object Handled By Others 0 0.00 1 0.00 0 0.00 0 0.00 0 0.00 1 0.00

8100 Struck or Injured By, NOC 0 0.00 0 0.00 0 0.00 0 0.00 1 781.97 1 781.97

8200 Absorption, Ingestion, or Inhalatio 1 0.00 3 20.55 9 6.85 0 0.00 0 0.00 13 27.40

8500 Animal or Insect 0 0.00 1 90.18 1 205.05 0 0.00 0 0.00 2 295.23

8901 Altercation 1 1,963.84 1 170.28 0 0.00 0 0.00 0 0.00 2 2,134.12

9700 Repetitive Motion (reported aft. 7/ 2 52,077.23 1 20,448.48 2 10,675.82 2 9,098.93 2 732.44 9 93,032.90

9800 Cumulative (All Other) 0 0.00 0 0.00 0 0.00 1 7.55 0 0.00 1 7.55

9804 Repetitive Motion (reported bef. 7/ 0 0.00 0 0.00 0 0.00 1 5,689.16 0 0.00 1 5,689.16

9806 Continuous Trauma 1 6.50 0 0.00 0 0.00 0 0.00 0 0.00 1 6.50

9900 Other Miscellaneous, NOC 0 0.00 0 0.00 1 7.25 0 0.00 0 0.00 1 7.25

TOTALS 27 279,752.17 30 222,493.65 24 19,611.72 24 82,686.23 11 51,215.28 116 655,759.05





07/01/2012 - 06/30/2013 TOTALS


2900 Fall On the Same Level 1 0.00 1 0.00

3101 Trip 1 7.90 1 7.90

5300 Twisting 1 1,161.17 1 1,161.17

7800 Moving Parts of Machine 1 0.00 1 0.00

TOTALS 4 1,169.07 4 1,169.07




TOTAL INCURRED CMS UNIT: 810

07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS

CAUSE OF LOSS CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS TOTAL INCURRED

1300 Caught In, Under or Between, NOC 1 383.31 0 0.00 0 0.00 0 0.00 0 0.00 1 383.31

1900 Cut, Punctured, Scraped, NOC 0 0.00 1 511.93 0 0.00 0 0.00 0 0.00 1 511.93

1901 Bitten 1 323.61 0 0.00 0 0.00 0 0.00 0 0.00 1 323.61

1902 Needle Stick 0 0.00 1 0.00 0 0.00 0 0.00 0 0.00 1 0.00

2500 Fall/Slip From a Different Level 1 299.15 0 0.00 0 0.00 1 2,293.50 0 0.00 2 2,592.65

2700 Fall/Slip From Liquid/Grease Spills 0 0.00 0 0.00 0 0.00 2 284.71 0 0.00 2 284.71

2900 Fall On the Same Level 1 0.00 4 655.28 3 1,869.40 5 6,816.80 1 26,650.56 14 35,992.04

3000 Slipped, Did Not Fall 0 0.00 0 0.00 0 0.00 1 226.84 0 0.00 1 226.84

3100 Fall, Slip or Trip, NOC 10 108,977.74 5 80,492.66 2 5,488.03 5 9,964.49 1 0.00 23 204,922.92

3101 Trip 1 0.00 1 0.00 0 0.00 0 0.00 1 0.00 3 0.00

3200 Fall/Slip on Ice or Snow 0 0.00 1 5,311.67 0 0.00 1 0.00 0 0.00 2 5,311.67

3300 Fall/Slip On Stairs 1 398.40 2 522.45 0 0.00 1 4,291.29 0 0.00 4 5,212.14

4500 Collision with Another Vehicle 0 0.00 1 1,122.84 1 233.31 0 0.00 1 2,412.49 3 3,768.64

5000 Motor Vehicle, NOC 2 134,967.71 1 0.00 0 0.00 0 0.00 0 0.00 3 134,967.71

5001 Public Transportation Accident 0 0.00 0 0.00 0 0.00 0 0.00 1 825.12 1 825.12

5300 Twisting 2 25,533.64 0 0.00 0 0.00 0 0.00 0 0.00 2 25,533.64

5600 Lifting 0 0.00 1 90.36 0 0.00 1 7,298.93 1 37,469.60 3 44,858.89

5700 Pushing or Pulling 0 0.00 0 0.00 0 0.00 0 0.00 1 30,012.48 1 30,012.48

5800 Reaching 0 0.00 0 0.00 0 0.00 1 45,866.49 0 0.00 1 45,866.49

6000 Strain or Injury By, NOC 1 587.27 0 0.00 1 0.00 1 0.00 0 0.00 3 587.27

6001 Bodily Reaction 0 0.00 1 25.60 0 0.00 0 0.00 0 0.00 1 25.60

6003 Overexertion 0 0.00 0 0.00 0 0.00 1 0.00 0 0.00 1 0.00

6004 Running and Training 0 0.00 2 2,951.93 0 0.00 0 0.00 0 0.00 2 2,951.93

6800 Stationary Object 0 0.00 0 0.00 1 461.43 0 0.00 1 10,713.63 2 11,175.06

7000 Striking Against/Stepping On, NOC 0 0.00 1 121,999.83 2 657.73 0 0.00 0 0.00 3 122,657.56

7400 Fellow Worker, Patient 0 0.00 1 0.00 0 0.00 0 0.00 0 0.00 1 0.00


7700 Motor Vehicle 0 0.00 0 0.00 1 6.85 0 0.00 0 0.00 1 6.85

8000 Object Handled By Others 0 0.00 1 0.00 0 0.00 0 0.00 0 0.00 1 0.00

8100 Struck or Injured By, NOC 0 0.00 0 0.00 0 0.00 0 0.00 1 781.97 1 781.97

8200 Absorption, Ingestion, or Inhalatio 1 0.00 3 20.55 9 6.85 0 0.00 0 0.00 13 27.40

8500 Animal or Insect 0 0.00 1 90.18 1 205.05 0 0.00 0 0.00 2 295.23

8901 Altercation 1 1,963.84 1 170.28 0 0.00 0 0.00 0 0.00 2 2,134.12

9700 Repetitive Motion (reported aft. 7/ 2 61,914.87 1 20,448.48 2 21,804.73 2 9,098.93 2 732.44 9 113,999.45

9800 Cumulative (All Other) 0 0.00 0 0.00 0 0.00 1 7.55 0 0.00 1 7.55

9804 Repetitive Motion (reported bef. 7/ 0 0.00 0 0.00 0 0.00 1 5,689.16 0 0.00 1 5,689.16

9806 Continuous Trauma 1 6.50 0 0.00 0 0.00 0 0.00 0 0.00 1 6.50

9900 Other Miscellaneous, NOC 0 0.00 0 0.00 1 7,171.90 0 0.00 0 0.00 1 7,171.90

TOTALS 27 335,356.04 30 234,414.04 24 37,905.28 24 91,838.69 11 109,598.29 116 809,112.34





07/01/2012 - 06/30/2013 TOTALS


2900 Fall On the Same Level 1 0.00 1 0.00

3101 Trip 1 5,000.00 1 5,000.00

5300 Twisting 1 3,927.67 1 3,927.67

7800 Moving Parts of Machine 1 0.00 1 0.00

TOTALS 4 8,927.67 4 8,927.67





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS

NATURE OR RESULT CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS TOTAL PAID

0100 No Physical Injury 1 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 0.00

0700 Concussion (Brain, Cerebral) 0 0.00 0 0.00 1 461.43 0 0.00 0 0.00 1 461.43

1000 Contusion (Bruise, Skin Surface) 10 2,522.94 3 888.34 1 0.00 4 716.67 1 8,675.08 19 12,803.03

1600 Dislocation 1 25,533.64 0 0.00 0 0.00 0 0.00 0 0.00 1 25,533.64

1601 Herniated Disc 2 189,403.78 1 77,699.11 0 0.00 0 0.00 0 0.00 3 267,102.89

2800 Fracture 2 3,512.81 2 737.64 3 5,501.73 1 4,291.29 1 0.00 9 14,043.47

3700 Inflammation 0 0.00 0 0.00 0 0.00 1 461.79 0 0.00 1 461.79

3702 Bursitis 0 0.00 0 0.00 0 0.00 1 7.55 0 0.00 1 7.55

3703 Tenosynovitis 0 0.00 1 20,448.48 0 0.00 0 0.00 0 0.00 1 20,448.48

4000 Laceration 0 0.00 2 1,039.25 2 1,741.77 1 0.00 1 781.97 6 3,562.99

4300 Puncture 1 323.61 1 0.00 1 205.05 0 0.00 0 0.00 3 528.66

4900 Sprain 1 0.00 1 0.00 0 0.00 1 2,721.40 1 0.00 4 2,721.40

4902 Rotator Cuff 1 33,160.80 0 0.00 0 0.00 1 45,866.49 1 1,111.62 3 80,138.91

5200 Strain 3 6,066.51 5 111,869.14 3 1,466.85 8 18,268.92 4 39,914.17 23 177,585.59

5900 All Other Injuries, NOC 0 0.00 1 2,233.87 8 0.00 0 0.00 0 0.00 9 2,233.87

5908 Chipped / Broken Tooth 1 299.15 0 0.00 0 0.00 0 0.00 0 0.00 1 299.15

5999 Unclassified, Insufficient Data 0 0.00 0 0.00 1 7.25 0 0.00 0 0.00 1 7.25

6502 Inhalation 0 0.00 4 46.15 1 6.85 0 0.00 0 0.00 5 53.00

7700 Mental Stress 1 6.50 0 0.00 0 0.00 0 0.00 0 0.00 1 6.50

7800 Carpal Tunnel Syndrome 1 18,916.43 0 0.00 1 9,442.28 1 5,689.16 1 7.90 4 34,055.77

9000 Multiple Physical Injuries Only 2 6.00 9 7,531.67 2 778.51 5 4,662.96 1 724.54 19 13,703.68

TOTALS 27 279,752.17 30 222,493.65 24 19,611.72 24 82,686.23 11 51,215.28 116 655,759.05





07/01/2012 - 06/30/2013 TOTALS


1000 Contusion (Bruise, Skin Surface) 1 7.90 1 7.90

5200 Strain 2 1,161.17 2 1,161.17

9000 Multiple Physical Injuries Only 1 0.00 1 0.00

TOTALS 4 1,169.07 4 1,169.07





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS

NATURE OR RESULT CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS TOTAL INCURRED

0100 No Physical Injury 1 0.00 0 0.00 0 0.00 0 0.00 0 0.00 1 0.00

0700 Concussion (Brain, Cerebral) 0 0.00 0 0.00 1 461.43 0 0.00 0 0.00 1 461.43

1000 Contusion (Bruise, Skin Surface) 10 2,522.94 3 888.34 1 0.00 4 716.67 1 10,713.63 19 14,841.58

1600 Dislocation 1 25,533.64 0 0.00 0 0.00 0 0.00 0 0.00 1 25,533.64

1601 Herniated Disc 2 235,170.01 1 77,699.11 0 0.00 0 0.00 0 0.00 3 312,869.12

2800 Fracture 2 3,512.81 2 737.64 3 5,501.73 1 4,291.29 1 0.00 9 14,043.47

3700 Inflammation 0 0.00 0 0.00 0 0.00 1 461.79 0 0.00 1 461.79

3702 Bursitis 0 0.00 0 0.00 0 0.00 1 7.55 0 0.00 1 7.55

3703 Tenosynovitis 0 0.00 1 20,448.48 0 0.00 0 0.00 0 0.00 1 20,448.48

4000 Laceration 0 0.00 2 1,039.25 2 1,741.77 1 0.00 1 781.97 6 3,562.99

4300 Puncture 1 323.61 1 0.00 1 205.05 0 0.00 0 0.00 3 528.66

4900 Sprain 1 0.00 1 0.00 0 0.00 1 2,721.40 1 0.00 4 2,721.40

4902 Rotator Cuff 1 33,160.80 0 0.00 0 0.00 1 45,866.49 1 26,650.56 3 105,677.85

5200 Strain 3 6,066.51 5 123,789.53 3 1,466.85 8 19,202.91 4 70,719.69 23 221,245.49

5900 All Other Injuries, NOC 0 0.00 1 2,233.87 8 0.00 0 0.00 0 0.00 9 2,233.87

5908 Chipped / Broken Tooth 1 299.15 0 0.00 0 0.00 0 0.00 0 0.00 1 299.15

5999 Unclassified, Insufficient Data 0 0.00 0 0.00 1 7,171.90 0 0.00 0 0.00 1 7,171.90

6502 Inhalation 0 0.00 4 46.15 1 6.85 0 0.00 0 0.00 5 53.00

7700 Mental Stress 1 6.50 0 0.00 0 0.00 0 0.00 0 0.00 1 6.50

7800 Carpal Tunnel Syndrome 1 28,754.07 0 0.00 1 20,571.19 1 5,689.16 1 7.90 4 55,022.32

9000 Multiple Physical Injuries Only 2 6.00 9 7,531.67 2 778.51 5 12,881.43 1 724.54 19 21,922.15

TOTALS 27 335,356.04 30 234,414.04 24 37,905.28 24 91,838.69 11 109,598.29 116 809,112.34





07/01/2012 - 06/30/2013 TOTALS


1000 Contusion (Bruise, Skin Surface) 1 5,000.00 1 5,000.00

5200 Strain 2 3,927.67 2 3,927.67

9000 Multiple Physical Injuries Only 1 0.00 1 0.00

TOTALS 4 8,927.67 4 8,927.67





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS

PART OR TARGET CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS PAID CLAIMS TOTAL PAID

1001 Head NEC 1 0.00 1 718.06 0 0.00 0 0.00 1 8,675.08 3 9,393.14

1100 Skull 0 0.00 0 0.00 3 475.13 0 0.00 0 0.00 3 475.13

1101 Scalp 0 0.00 0 0.00 0 0.00 1 0.00 0 0.00 1 0.00

1300 Ear(s) 0 0.00 0 0.00 1 205.05 0 0.00 0 0.00 1 205.05

1500 Nose 0 0.00 0 0.00 0 0.00 0 0.00 1 0.00 1 0.00

1600 Teeth 1 299.15 0 0.00 0 0.00 0 0.00 0 0.00 1 299.15

2102 Cervical 2 189,403.78 0 0.00 0 0.00 2 11,392.43 0 0.00 4 200,796.21

2500 Soft Tissue-Neck 0 0.00 0 0.00 0 0.00 0 0.00 1 825.12 1 825.12

3000 Multiple Upper Extremities 0 0.00 0 0.00 0 0.00 1 0.00 1 724.54 2 724.54

3302 Arm, Multiple 0 0.00 1 170.28 0 0.00 0 0.00 0 0.00 1 170.28

3400 Wrist 3 3,318.93 1 20,448.48 0 0.00 0 0.00 0 0.00 4 23,767.41

3500 Hand 1 323.61 1 511.93 1 650.88 1 2,721.40 1 7.90 5 4,215.72

3600 Finger(s) 0 0.00 1 0.00 0 0.00 0 0.00 1 781.97 2 781.97

3700 Thumb 0 0.00 0 0.00 1 1,233.54 0 0.00 0 0.00 1 1,233.54

3800 Shoulder(s) 3 59,281.71 0 0.00 0 0.00 3 52,238.98 2 3,524.11 8 115,044.80

3900 Wrist(s) and Hand(s) 0 0.00 0 0.00 1 9,442.28 1 5,689.16 0 0.00 2 15,131.44

4101 Back (All Other) 0 0.00 1 90.36 0 0.00 0 0.00 0 0.00 1 90.36

4200 Low Back Area (Incl. Lumbar & Lumbo 0 0.00 1 0.00 1 0.00 1 0.00 2 36,676.56 5 36,676.56

4400 Chest (Incl. Ribs, Sternum & Soft T 0 0.00 0 0.00 0 0.00 1 0.00 0 0.00 1 0.00

5000 Multiple Lower Extremities 1 0.00 1 885.52 1 778.51 0 0.00 0 0.00 3 1,664.03

5300 Knee 2 0.00 3 2,761.19 0 0.00 5 3,117.53 1 0.00 11 5,878.72

5400 Lower Leg 0 0.00 0 0.00 2 5,488.03 0 0.00 0 0.00 2 5,488.03

5500 Ankle 2 5,673.12 1 731.14 0 0.00 2 4,753.08 0 0.00 5 11,157.34

5600 Foot 1 383.31 2 6.50 0 0.00 0 0.00 0 0.00 3 389.81

6300 Lumbar and/or Sacral Vertebrae 0 0.00 1 77,699.11 0 0.00 0 0.00 0 0.00 1 77,699.11

6500 Insufficient Info to Identify; Uncl 0 0.00 0 0.00 1 7.25 0 0.00 0 0.00 1 7.25

9000 Multiple Body Parts 8 21,062.06 11 118,424.93 3 1,324.20 6 2,773.65 0 0.00 28 143,584.84

9001 Stress 1 6.50 0 0.00 0 0.00 0 0.00 0 0.00 1 6.50

9100 Body Systems & Multiple Body System 0 0.00 0 0.00 8 0.00 0 0.00 0 0.00 8 0.00

9106 Respiratory System 1 0.00 4 46.15 1 6.85 0 0.00 0 0.00 6 53.00

TOTALS 27 279,752.17 30 222,493.65 24 19,611.72 24 82,686.23 11 51,215.28 116 655,759.05





07/01/2012 - 06/30/2013 TOTALS


5000 Multiple Lower Extremities 1 0.00 1 0.00

5300 Knee 1 7.90 1 7.90

5500 Ankle 1 1,161.17 1 1,161.17

9000 Multiple Body Parts 1 0.00 1 0.00

TOTALS 4 1,169.07 4 1,169.07





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS

PART OR TARGET CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS INCURRED CLAIMS TOTAL INCURRED

1001 Head NEC 1 0.00 1 718.06 0 0.00 0 0.00 1 10,713.63 3 11,431.69

1100 Skull 0 0.00 0 0.00 3 475.13 0 0.00 0 0.00 3 475.13

1101 Scalp 0 0.00 0 0.00 0 0.00 1 0.00 0 0.00 1 0.00

1300 Ear(s) 0 0.00 0 0.00 1 205.05 0 0.00 0 0.00 1 205.05

1500 Nose 0 0.00 0 0.00 0 0.00 0 0.00 1 0.00 1 0.00

1600 Teeth 1 299.15 0 0.00 0 0.00 0 0.00 0 0.00 1 299.15

2102 Cervical 2 235,170.01 0 0.00 0 0.00 2 11,392.43 0 0.00 4 246,562.44

2500 Soft Tissue-Neck 0 0.00 0 0.00 0 0.00 0 0.00 1 825.12 1 825.12

3000 Multiple Upper Extremities 0 0.00 0 0.00 0 0.00 1 0.00 1 724.54 2 724.54

3302 Arm, Multiple 0 0.00 1 170.28 0 0.00 0 0.00 0 0.00 1 170.28

3400 Wrist 3 3,318.93 1 20,448.48 0 0.00 0 0.00 0 0.00 4 23,767.41

3500 Hand 1 323.61 1 511.93 1 650.88 1 2,721.40 1 7.90 5 4,215.72

3600 Finger(s) 0 0.00 1 0.00 0 0.00 0 0.00 1 781.97 2 781.97

3700 Thumb 0 0.00 0 0.00 1 1,233.54 0 0.00 0 0.00 1 1,233.54

3800 Shoulder(s) 3 59,281.71 0 0.00 0 0.00 3 53,172.97 2 29,063.05 8 141,517.73

3900 Wrist(s) and Hand(s) 0 0.00 0 0.00 1 20,571.19 1 5,689.16 0 0.00 2 26,260.35

4101 Back (All Other) 0 0.00 1 90.36 0 0.00 0 0.00 0 0.00 1 90.36

4200 Low Back Area (Incl. Lumbar & Lumbo 0 0.00 1 0.00 1 0.00 1 0.00 2 67,482.08 5 67,482.08

4400 Chest (Incl. Ribs, Sternum & Soft T 0 0.00 0 0.00 0 0.00 1 0.00 0 0.00 1 0.00

5000 Multiple Lower Extremities 1 0.00 1 885.52 1 778.51 0 0.00 0 0.00 3 1,664.03

5300 Knee 2 0.00 3 2,761.19 0 0.00 5 3,117.53 1 0.00 11 5,878.72

5400 Lower Leg 0 0.00 0 0.00 2 5,488.03 0 0.00 0 0.00 2 5,488.03

5500 Ankle 2 5,673.12 1 731.14 0 0.00 2 4,753.08 0 0.00 5 11,157.34

5600 Foot 1 383.31 2 6.50 0 0.00 0 0.00 0 0.00 3 389.81

6300 Lumbar and/or Sacral Vertebrae 0 0.00 1 77,699.11 0 0.00 0 0.00 0 0.00 1 77,699.11

6500 Insufficient Info to Identify; Uncl 0 0.00 0 0.00 1 7,171.90 0 0.00 0 0.00 1 7,171.90

9000 Multiple Body Parts 8 30,899.70 11 130,345.32 3 1,324.20 6 10,992.12 0 0.00 28 173,561.34

9001 Stress 1 6.50 0 0.00 0 0.00 0 0.00 0 0.00 1 6.50

9100 Body Systems & Multiple Body System 0 0.00 0 0.00 8 0.00 0 0.00 0 0.00 8 0.00

9106 Respiratory System 1 0.00 4 46.15 1 6.85 0 0.00 0 0.00 6 53.00

TOTALS 27 335,356.04 30 234,414.04 24 37,905.28 24 91,838.69 11 109,598.29 116 809,112.34





07/01/2012 - 06/30/2013 TOTALS


5000 Multiple Lower Extremities 1 0.00 1 0.00

5300 Knee 1 5,000.00 1 5,000.00

5500 Ankle 1 3,927.67 1 3,927.67

9000 Multiple Body Parts 1 0.00 1 0.00

TOTALS 4 8,927.67 4 8,927.67



ACCOUNT 41000002 HIGHER EDUCATION DEPARTMENT LOSS 07/01/2007 - 12/31/2012 AS OF 12/31/2012 PAGE: 13


07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS


2500 Fall/Slip From a Different Level 0 0.00 0 0.00 1 30,611.93 0 0.00 0 0.00 1 30,611.93

2900 Fall On the Same Level 0 0.00 0 0.00 1 0.00 0 0.00 0 0.00 1 0.00

3100 Fall, Slip or Trip, NOC 2 1,004.01 0 0.00 0 0.00 0 0.00 0 0.00 2 1,004.01

3200 Fall/Slip on Ice or Snow 1 875.85 0 0.00 0 0.00 1 4,223.59 0 0.00 2 5,099.44


TOTALS 3 1,879.86 0 0.00 3 30,726.19 1 4,223.59 0 0.00 7 36,829.64





07/01/2012 - 06/30/2013 TOTALS


9700 Repetitive Motion (reported aft. 7/ 1 7.90 1 7.90

TOTALS 1 7.90 1 7.90





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS


2500 Fall/Slip From a Different Level 0 0.00 0 0.00 1 30,611.93 0 0.00 0 0.00 1 30,611.93

2900 Fall On the Same Level 0 0.00 0 0.00 1 0.00 0 0.00 0 0.00 1 0.00

3100 Fall, Slip or Trip, NOC 2 1,004.01 0 0.00 0 0.00 0 0.00 0 0.00 2 1,004.01

3200 Fall/Slip on Ice or Snow 1 875.85 0 0.00 0 0.00 1 4,223.59 0 0.00 2 5,099.44


TOTALS 3 1,879.86 0 0.00 3 30,726.19 1 4,223.59 0 0.00 7 36,829.64





07/01/2012 - 06/30/2013 TOTALS


9700 Repetitive Motion (reported aft. 7/ 1 32,796.08 1 32,796.08

TOTALS 1 32,796.08 1 32,796.08





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS


1000 Contusion (Bruise, Skin Surface) 0 0.00 0 0.00 1 0.00 0 0.00 0 0.00 1 0.00

4000 Laceration 0 0.00 0 0.00 1 30,611.93 0 0.00 0 0.00 1 30,611.93

4900 Sprain 1 875.85 0 0.00 0 0.00 0 0.00 0 0.00 1 875.85

5200 Strain 1 0.00 0 0.00 1 114.26 1 4,223.59 0 0.00 3 4,337.85

9000 Multiple Physical Injuries Only 1 1,004.01 0 0.00 0 0.00 0 0.00 0 0.00 1 1,004.01

TOTALS 3 1,879.86 0 0.00 3 30,726.19 1 4,223.59 0 0.00 7 36,829.64





07/01/2012 - 06/30/2013 TOTALS


7800 Carpal Tunnel Syndrome 1 7.90 1 7.90

TOTALS 1 7.90 1 7.90





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS


1000 Contusion (Bruise, Skin Surface) 0 0.00 0 0.00 1 0.00 0 0.00 0 0.00 1 0.00

4000 Laceration 0 0.00 0 0.00 1 30,611.93 0 0.00 0 0.00 1 30,611.93

4900 Sprain 1 875.85 0 0.00 0 0.00 0 0.00 0 0.00 1 875.85

5200 Strain 1 0.00 0 0.00 1 114.26 1 4,223.59 0 0.00 3 4,337.85

9000 Multiple Physical Injuries Only 1 1,004.01 0 0.00 0 0.00 0 0.00 0 0.00 1 1,004.01

TOTALS 3 1,879.86 0 0.00 3 30,726.19 1 4,223.59 0 0.00 7 36,829.64





07/01/2012 - 06/30/2013 TOTALS


7800 Carpal Tunnel Syndrome 1 32,796.08 1 32,796.08

TOTALS 1 32,796.08 1 32,796.08





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS


1101 Scalp 0 0.00 0 0.00 1 30,611.93 0 0.00 0 0.00 1 30,611.93

1300 Ear(s) 0 0.00 0 0.00 1 114.26 0 0.00 0 0.00 1 114.26

5300 Knee 0 0.00 0 0.00 1 0.00 1 4,223.59 0 0.00 2 4,223.59

5500 Ankle 1 875.85 0 0.00 0 0.00 0 0.00 0 0.00 1 875.85

9000 Multiple Body Parts 2 1,004.01 0 0.00 0 0.00 0 0.00 0 0.00 2 1,004.01

TOTALS 3 1,879.86 0 0.00 3 30,726.19 1 4,223.59 0 0.00 7 36,829.64





07/01/2012 - 06/30/2013 TOTALS


3900 Wrist(s) and Hand(s) 1 7.90 1 7.90

TOTALS 1 7.90 1 7.90





07/01/2007 - 06/30/2008 07/01/2008 - 06/30/2009 07/01/2009 - 06/30/2010 07/01/2010 - 06/30/2011 07/01/2011 - 06/30/2012 TOTALS


1101 Scalp 0 0.00 0 0.00 1 30,611.93 0 0.00 0 0.00 1 30,611.93

1300 Ear(s) 0 0.00 0 0.00 1 114.26 0 0.00 0 0.00 1 114.26

5300 Knee 0 0.00 0 0.00 1 0.00 1 4,223.59 0 0.00 2 4,223.59

5500 Ankle 1 875.85 0 0.00 0 0.00 0 0.00 0 0.00 1 875.85

9000 Multiple Body Parts 2 1,004.01 0 0.00 0 0.00 0 0.00 0 0.00 2 1,004.01

TOTALS 3 1,879.86 0 0.00 3 30,726.19 1 4,223.59 0 0.00 7 36,829.64





07/01/2012 - 06/30/2013 TOTALS

PART OR TARGET CLAIMS INCU

Documents

Sedgwick Claims Management Services, Inc. - Tennesseetreasury.tn.gov/risk/LossControlReports/AccLoss-AllOther.pdf · Sedgwick Claims Management Services, Inc. ... Sedgwick Claims