Washington State Industrial Insurance Act

Time-Loss Calculation Estimate Including Tips & Bonuses (following Dept formula) (not including employer provided vehicle, cell phone, per diem, etc... [Cockle Benefits] unless you are aware of the amounts and add them in)

RCW 51 WAC 296

In the spaces below enter your relevant information and the speculated amount of your L&I Time-Loss payment will be calculated.

Use the keyboard "Tab" key to move from the boxes.

Use the "basis upon which compensation is computed" by the language of:
RCW 51.08.178 "Wages" -- Monthly wages as basis of compensation -- Computation thereof.

Hourly Rate "at the time of the injury" (RCW 51.08.178):

Average Number of Hours Worked Per Day for the 3 to 5 months prior to the accepted date of claim.
Calculate Straight and Overtime Hours together (WAC 296-14-530)
Add total hours and divide by number of days worked during this period. (Enter amount in box below):

Daily Wage before adding Tips & Bonuses:

Tips and/or Bonuses for the 12 months prior to the accepted date of claim
(Divided by the number of days worked the amount was paid):

Total Daily Wages Earned:

Enter Your Allowed Percantage for Dependents:

Estimated Daily Time-Loss Amount:

Use the keyboard "Tab" key to move from the boxes.

This is designed to determine time-loss for a worker earning an hourly rate of pay. Your personal amount may vary from the calculation due to factors of the "Cockle Benefits" (wages earned from employer, not reflected on check, such as a provided vehicle, cell phone, computer, per diem, etc...)

The estimate given is not to be taken as legal advice, it is only to estimate your potential time loss payments.

A -   Year to Date Gross Wages
B - / Year to Date Weeks Worked
C -   Wages Earned Per Week

C -   Wages Earned Per Week
D - / Days Worked Per Week
E -   Daily Wages

E -   Daily Wages
F - x Percentage Allowed
G -   Estimated Time-Loss