Interest Calculation For Compensation Due
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Interest Calculation For Compensation Due Form. This is a Nevada form and can be use in Workers Comp.
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Tags: Interest Calculation For Compensation Due, D-27, Nevada Workers Comp,
INTEREST CALCULATION FOR COMPENSATION DUE
(Pursuant to NRS 616C.335)
INJURED EMPLOYEE:
EMPLOYER:
SOCIAL SECURITY NUMBER:
INSURER:
CLAIM NO.:
TPA:
(1)
TO BE USED FOR COMPENSATION AND REHABILITATION PAYMENTS ONLY
DATE PRECEDING PAYMENT DATE:
A
LESS FIRST PAYMENT DUE:
NO. DAYS OF EARNED INTEREST: A=
DATE PRECEDING PAYMENT DATE:
B
LESS LAST PAYMENT DUE:
NO. DAYS OF EARNED INTEREST: B=
C
DAILY COMPENSATION RATE:
C=
DAILY RATE OF INTEREST PER $1.00 @ 9% = .00024641
LEGEND: (+ = ADD) (- = SUBTRACT) (* = MULTIPLY) (/ = DIVIDE)
"A" TOTAL = A
* A+1
/2=
"B" TOTAL = B
* B-1
/2=
TOTAL INTEREST DUE
"A" TOTAL
(2)
- "B" TOTAL
*C
*.00024641 =
TO BE USED FOR LUMP SUM PAYMENTS, I.E.; PPD AWARDS,
REIMBURSEMENTS FOR MEDICAL TREATMENT, TRAVEL, PRESCRIPTIONS
FORMULA: (LUMP SUM AMOUNT) * (FACTOR .00024641)
*(NUMBER OF DAYS) = INTEREST DUE
EXAMPLE: $150 * .00024641 * 56 DAYS = $2.07
FIRST PAYMENT DUE DATE:
DATE PAYMENT MADE:
LUMP SUM:
* DAYS
PREPARED BY:
*.00024641
= INTEREST DUE
DATE:
D-27 (rev. 7/99)
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