Award Computations - Scheduled Injury

Date of Accident: (MM/DD/YY)		Docket Number:
(a) AWW:		[AWW x .__ = benefit rate [BR] [can't exceed max ]
(b) Benefit Rate:
(c) TTD Weeks:
(d) % of Disability:		[NOTE: For Amputations, add a healing period allowance of 10% and not over 15 weeks to the weeks on the schedule.]
(e) Member of Body:
(f) Healing period allowance:

1.	Benefit Rate = line 1a x 1b		[can't exceed max]
a.		AWW	[line a]
b.		x .__		__
2.	Total TTD due = TTD weeks x benefit rate.
a.		TTD weeks	[line c]
b.		x BR	[line 1]
3.	To determine weeks payable:		[get off schedule list]
4.	Less TTD weeks paid		[line c]
5.	Equals # of payable weeks for calculations
6.	x % of disability		[line d]
7.	Equals # of compensable weeks due claimant
8.	x Benefit Rate		[line 1]
9.	Equals Total PPD due to claimant
10.	Plus Total TTD due to claimant		[line 2]
11.	Equals TOTAL AWARD		[can't exceed max]