PART E WAGE-LOSS WORKSHEET #2

 

Part E Wage-Loss Worksheet - # 2

Employee’s Name: 

     

File #:

     

Claims Examiner’s Name:

     

District Office:

     

Adjust Wages for Each Year of Claimed Wage-Loss

1.

Calendar year in which wage-loss commenced.

          

2.

Calendar year in which wage-loss is claimed.

          

3.

Total amount of wages earned in the claimed year of wage-loss.

     

4.

Using CPI Inflation Calculator

 

      a.    Dollar amount from line 3.

 

      b.   Year from line 2.

 

      c.   Year from line 1.

 

      d.   Press “Calculate” button.  This is the Adjust Earnings for this year of wage-loss.

 

a.      

b.      

c.      

d.