Dwc Form-46 Employee'S Request For Acceleration Of Impairment Income Benefits - Texas Department On Insurance Page 2

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Calculation of Accelerated Payments
Date Worksheet Completed: _________________
Interest Rate Used:
Impairment Income Benefits (IIBs) Period:
From_________________ To_________________
1.
Calculate weekly IIBs rate.
$________________
x
70%
=
$_____________
Average Weekly Wage
Weekly IIBs Rate
2.
Calculate weekly net pre-injury wage.
(
$_____________
$
x
85%
=
The weekly accelerated
Average Weekly Wage
Weekly Net Pre-injury Wage
payment cannot exceed
this amount.)
3.
Determine number of weeks remaining due in the IIBs period and discount.*
*Instructions to Authorized DWC staff: Using the “Present Value of Future Weekly Payments Discounted at a Given
Discount Rate” chart in effect at the time acceleration is requested, locate the number of weeks of remaining IIBs. The
number in the box to the right of the number of remaining weeks is the discounted value of those weeks.
Remaining number of weeks ____________ Discounted number/value of weeks ____________
4.
Calculate discounted IIBs amount due.
___________________
x
$_____________
=
$__________________
Number Discounted Weeks
IIBs Weekly Rate
Total Discounted Amount
5.
Calculate acceleration payment period.
$__________________
÷
$_____________________ =
________________________
Total Discounted Amount
Weekly Net Pre-injury Wage
Number Weeks Accelerated IIBs
(
or requested amount)
6.
Calculate number of weeks and weekly amount.
_______ Weeks @ $_________ and if necessary, Partial Week _______ @ $____________
DWC FORM-46 (Rev. 10/05) Page 2
DIVISION OF WORKERS’ COMPENSATION

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