Statement Of Earnings Of Injured Employee {20}

WCC Form 20 - STATEMENT OF EARNINGS OF INJURED EMPLOYEE. This form is used to calculate a claimant's average weekly wage and compensation rate for a workers' compensation claim. It requires information about the claimant's total wages, the number of weeks worked, and the compensation rate based on the average weekly wage. The form helps determine the compensation amount the claimant should receive. The employer's representative must complete and send this form to the claimant and resolve any disagreements about the compensation rate if they arise. www.FormsWorkflow.com