Full-Time Employee - Alternating Work Schedule

WEEK 1: WORKS 36 HOURS
WEEK 2: WORKS 48 HOURS

$10.00 X 36 = $360.00

$10.00 X 40 = $400.00

$15.00 X 8 = $120.00

TOTAL: $880.00 DIVIDED BY 2 = $440.00

GROSS: $16,961.70 DIVIDED BY 42 = $403.85

WAGE: $440.00

Section 1) HOURLY WAGE

a) Hourly rate at time of injury: Need to know if the employee is paid by the following:
Standard (include shift differential if the employee was earning it when injured) or
Piece rate or Tips

b) Hours per week
Multiply by the usual scheduled hours and hours at time and a half

Section 2) GROSS WAGE

a) The gross taxable wages earned in the 52 week period prior to the week of the injury (exclude tips)

b) Divide by the number of weeks worked in the 52 week period prior to the
week of injury.

Section 5) WEEKLY WAGE and TTD RATE COMPUTATION

a) Weekly Wage (Greater of #1 or #2 above)

b) Multiply by .66667 Equals Weekly TTD Rate

Enter Insurance Claim Rep. Name and Phone Number

For help with temporary total or partial disability, contact Bureau of Claims Management