| Name |
|
|
|
| HPE date/Date of Death |
|
|
|
| Date of Injury |
|
|
|
| Compensation Rate |
|
|
|
| Paid thru date |
|
|
|
| Actual Benefits Pd-to-Date |
|
|
|
| |
| Calculated Pd to Date |
$0.00 |
|
Underpayment
Due Now |
| Provider's Balance of Liab |
$0.00 |
|
$0.00 |
| Provider's Balance /wks |
0 |
|
|
| |
| PRESENT VALUES |
|
|
|
| Provider's Remaining Liab |
|
|
|
|
|
PV t weeks |
|
| Balance in Weeks |
0 |
-441.5501 |
| |
|
|
| |
|
|