Notice Of Change In Compensation Rate (For Injuries After) {28}

FORM 28 - NOTICE OF CHANGE IN COMPENSATION RATE (for INJURIES AFTER JULY 1, 1986). This form issued by the Vermont Department of Labor’s Workers’ Compensation Division, is used to officially document an annual adjustment in a worker’s compensation rate for injuries occurring after July 1, 1986. This form is relevant for various types of compensation agreements, including temporary total, temporary partial, permanent total, permanent partial, and fatal injury cases. It calculates the new weekly compensation rate effective July 1 of each year, based on a 6% increase from the prior year’s rate, while ensuring the new rate does not exceed the state-mandated maximum or fall below the minimum. The form also includes an additional amount for dependents under age 21—$20 per dependent—which is added to the base rate. The insurance company or self-insured employer must complete and submit this form to the Department of Labor, and once approved, provide a copy to the injured worker. www.FormsWorkflow.com