| |
Quick Reference Guide |
| 1 |
Average Weekly Wage Worksheet |
| 2 |
Calculating Lump Sum Discounts |
| 3A |
$10,000 Lump Sum 4% Discount Whole Person (Use "PPD Lump Sum" tab) |
| 3B |
$10,000 Lump Sum 4% Discount Scheduled Impairment (Use "PPD Lump Sum" tab) |
| 4 |
Maximum Benefit Rates | Quick Reference Guide |
| 5 |
Age Factor Chart |
| 7 |
Calculating TPD Benefits |
| 9 |
Basic Claims Process |
| 10 |
Evaluation of Previous Spinal ROM Impairment |
| 11 |
Impairment Rating Tips |
| 12 |
Mileage Reimbursement | Quick Reference Guide |
| 13 |
Scheduled Impairment Chart |
| 14 |
Apportionment Calculation Worksheet |
| 15A |
Non-medical Discharge Form Letter |
| 15B |
Non-medical Discharge Form Letter (Spanish) |
