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Maryland Statement of Wage Information (average Weekly Wage) 14 Weeks

State:
Maryland
Control #:
MD-SKU-1576
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PDF
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Statement of Wage Information (average Weekly Wage) 14 Weeks

The Maryland Statement of Wage Information (average Weekly Wage) 14 Weeks is a document used by the Maryland Department of Labor, Licensing, and Regulation (DLR) to calculate an individual’s average weekly wage for purposes of determining eligibility for workers’ compensation benefits. This document is used to calculate the average of an employee’s wages for th14-weekek period prior to the employee’s injury. The types of information requested on the Maryland Statement of Wage Information (average Weekly Wage) 14 Weeks include the employee’s name, address, social security number, and any wages earned during the relevant 14-week period. The wages are broken down into the number of hours worked, rate of pay, and total wages earned for each week and for the 14-week period. The document can also be used to calculate the employee’s overtime pay and holiday pay if applicable.

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FAQ

The Employer's First Report of Occupational Injury or Illness form is to be completed by an employer or its workers' compensation insurance carrier to notify the Workers' Compensation Commission of occupational injuries or illnesses that result in incapacity for one day or more.

In 2022, Maryland workers averaged a per capita personal income of $70,730 a year, higher than the national average of $65,280 a year. In 2021, Maryland workers were paid about $1,375 per week, while the national average salary was approximately $1,220 per week.

The Employer's First Report of Injury (FROI) IAIABC 1A-1 (WCC # SF-1) is filed by the employer or their workers' compensation insurance carrier. The injured worker will file the Employee Claim Form C-1. A First Report of Injury (FROI) must be filed by the employer/insurer with the Workers' Compensation Commission.

If you don't report your injury within 30 days, you could lose your right to receive workers' compensation benefits.

Filing a Claim Injured employees first must tell their employer about the injury either orally or in writing within 10 days of the injury. If the employee dies because of the injury, the family must notify the employer of the injury within 30 days.

The Employer's First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimant's employment and circumstances surrounding the injury or illness are also requested.

Form IA-1 Employer's First Report of Injury or Occupational Disease (FROI). As soon as you have been notified of a work-related injury, please fill out this form and submit it to EMPLOYERS. This form must be completed within 10 days from notice of a work-related injury. Fatalities must be reported within 24 hours.

The Employee must file Employee Claim Form C-1 and a physician's report, if available. You can complete the form online or request a print form from the Workers' Compensation Commission. For most accidental injuries not ending in death, employees have 60 days to file a claim.

More info

Enter the number of hours per week for the employer's full-time (or part-time) employees. When the employee is paid weekly, complete each row for the most recent 14 weeks where wages were paid.If paid alternate weeks please. Reproduce as needed. The purpose of the form is to provide the employee's wage information to the carrier for calculating the employee's Average Weekly. PART-TIME WAGE STATEMENT (Hired for less than 20 hours per week). Calculating Average Weekly Wage. Average Weekly Wage will be based on the greater of: Hourly. Rate. Calculating Average Weekly Wage. Average Weekly Wage will be based on the greater of: Hourly. Rate.

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Maryland Statement of Wage Information (average Weekly Wage) 14 Weeks