Colorado > Workers Comp
Temporary Partial Disability (TPD) Benefit Worksheet DK7 - Colorado
| Temporary Partial Disability (TPD) Benefit Worksheet Form. This is a Colorado form and can be used in Workers Comp . |
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TEMPORARY PARTIAL DISABILITY (TPD) BENEFIT WORKSHEET TPD Period: (A) (B) Dates from __________to__________ = _________Weeks* Wages should have earned: ____ Weeks (from above) x ____ AWW ................................................. _____________ Wages actually earned: ____ Hours worked during TPD period x ____ Hourly Rate or Gross Wages earned during TPD period .......................................... _____________ Wage Loss: (A) - (B) ................................................................................. _____________ Total TPD Benefits Due: Wage loss (C) x 66-2/3% .......................................................................... _____________ (C) (D) To Check if Greater than the Statutory Maximum TTD Rate: (E) _______Weeks* x _______ Statutory Maximum ....................................... _____________ (F) Lesser Amount of (D) or (E) Is Due ............................................................. _____________ When the TPD period has ended, the TPD benefit rate per week for reporting on an admission is calculated by taking: Total TPD (D) divided by the number of Weeks during the entire period of TPD = Rate Per v Week * Calculations should be computed on a one-week or partial week basis in increments of 1/7 weeks. DK 7 Rev. 3/01 2002 © American LegalNet, Inc.
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