WC Calculator
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Case Name:
Case Number:
Date of Death  
Total Dependents  

Partial Dependents  

Date Total & Partial 
Dependents or Estate 
Benefits Ends      
Date Minors Continuation  
Benefits Ends          
Actual Burial Expenses   
Burial Expenses Allowed 
Estimated % Invrease in SAWW 
Weekly Earnings 
Date of birth of youngest child 
Annual Support for all partial 
Dependents          
Total Dependents 
Partial Dependents 
Minor's Continuation 
Estate 
Total