Applicant Name
Case Number
Rating
Date of Calculation
(mm/dd/yyyy)
Date of Birth
(mm/dd/yyyy)
Date of Injury
(mm/dd/yyyy)
P&S Date (mm/dd/yyyy)
Weekly Earnings
Maximum
Interest Rate
SAWW
Gender
Male
Female
Payment Increase starts
January 1 after P&S
January 1 after LP
January 1 2004
January 1 After DOI
January 1 after DOI
January 1 after P&S
Life Table
Regulation 10169
US Life Table 2000
Latest US Life Table
Attorney Fee%
Or Amount
Attorney Fee
Value
on PD amount due or paid at DOC
on present value of remainder of PD
on present value of life pension
Total
Calculate where number of employees greater than 50
Job Offer Date
Payment Split-up of Present Value:
Actual payment may vary. This is only an estimate of the payments in the future based on a SAWW increase predicted in the amount of 4.7%.
Actual payments should be re-calculated each year.
Payment Date
Weekly Amount
Interest Discount
Probability
Payment Amount
CANNOT CALCULATE
Insuffient PD remaining to deduct attorney fee on PD.
Some or all attorney fee on PD will have to be deducted from present value of life pension or past due PD.
