LOST WAGES AND EARNING CAPACITY CALCULATOR

CASE INFORMATION

Case Caption: [________________________________]

Plaintiff Name: [________________________________]

Date of Birth: [__/__/____]

Date of Injury: [__/__/____]

Case Number: [________________________________]

Prepared By: [________________________________]

Date Prepared: [__/__/____]

PART I: EMPLOYMENT INFORMATION AT TIME OF INJURY

A. Employment Status

Employment Type:
☐ Full-Time Employee (W-2)
☐ Part-Time Employee (W-2)
☐ Self-Employed/Independent Contractor (1099)
☐ Multiple Employers
☐ Seasonal/Temporary Worker
☐ Unemployed (Prior Work History)
☐ Student
☐ Homemaker

B. Employer Information

Primary Employer: [________________________________]

Address: [________________________________]

Supervisor/HR Contact: [________________________________]

Phone: [________________________________]

Position/Job Title: [________________________________]

Date of Hire: [__/__/____]

Employment Status: ☐ Active ☐ On Leave ☐ Terminated ☐ Other: [____]

C. Compensation Structure

Pay Type:
☐ Hourly ☐ Salary ☐ Commission ☐ Piece Rate ☐ Combination

Base Compensation:

Average Hours Worked Per Week: [____] hours

Standard Work Year: [____] weeks (typically 52)

PART II: PAST LOST WAGES CALCULATION

A. For Hourly Employees

Step 1: Calculate Hourly Rate

Base Hourly Rate: $[____]

Average Overtime Rate: $[____] (typically 1.5x or 2x base)

Average Weekly Overtime Hours: [____]

Step 2: Calculate Weekly Earnings

Step 3: Calculate Total Missed Time

Step 4: Calculate Lost Wages

Total Hours Missed: [____] x Blended Hourly Rate: $[____] = $[________________________________]

B. For Salaried Employees

Step 1: Determine Daily Rate

Annual Salary: $[____]

Work Days Per Year: [____] (typically 260)

Daily Rate: $[____] ÷ [____] = $[____] per day

Alternative: Hourly Rate
Annual Salary: $[____] ÷ 2080 hours = $[____] per hour

Step 2: Calculate Missed Work Days

Step 3: Calculate Lost Wages

Total Days Missed: [____] x Daily Rate: $[____] = $[________________________________]

C. For Self-Employed/Independent Contractors

Step 1: Establish Baseline Income

Use average of prior 3 years or most representative period:

Average Monthly Net Income: $[____]

Average Weekly Net Income: $[____]

Step 2: Calculate Lost Self-Employment Income

Step 3: Lost Business Opportunities/Contracts

PART III: FRINGE BENEFITS AND ADDITIONAL COMPENSATION

A. Lost Benefits During Absence

TOTAL LOST BENEFITS: $[________________________________]

B. Lost Bonuses and Incentive Pay

TOTAL LOST BONUSES/INCENTIVES: $[________________________________]

C. Lost Promotional Opportunities

Anticipated Promotion: [________________________________]

Expected Date: [__/__/____]

Evidence of Promotion Track:
☐ Performance Reviews
☐ Management Communications
☐ Company Policy/Practice
☐ Comparable Employee Progression
☐ Other: [____]

Salary Increase if Promoted: $[____] per year

Present Value of Lost Promotion: $[________________________________]

PART IV: TOTAL PAST LOST WAGES SUMMARY

PART V: FUTURE LOST EARNING CAPACITY

A. Plaintiff Demographics

Current Age: [____]

Date of Birth: [__/__/____]

Education Level:
☐ Less than High School
☐ High School Diploma/GED
☐ Some College
☐ Associate's Degree
☐ Bachelor's Degree
☐ Master's Degree
☐ Doctoral/Professional Degree (JD, MD, PhD)

Years of Experience in Field: [____]

Professional Licenses/Certifications: [________________________________]

B. Work Life Expectancy

Statistical Work Life Expectancy (Uninjured): [____] years

Source: Bureau of Labor Statistics / Worklife Tables

Expected Retirement Age (Uninjured): [____]

Post-Injury Work Capacity:
☐ Unable to Work (Total Disability)
☐ Able to Work Part-Time Only
☐ Able to Work with Restrictions
☐ Reduced Earning Capacity in Same Field
☐ Must Change Occupations

Reduced Work Life Expectancy (Injured): [____] years

C. Earning Capacity Analysis

Pre-Injury Annual Earning Capacity: $[________________________________]

Include base salary, average bonuses, benefits value, and expected raises

Post-Injury Annual Earning Capacity: $[________________________________]

Based on current abilities and vocational assessment

Annual Earnings Differential: $[________________________________]

D. Present Value Calculation

Methodology:
☐ Alaska Plan (Total Offset)
☐ Standard Discount to Present Value
☐ State-Mandated Approach: [________________________________]

Discount Rate Used: [____]%

Inflation/Growth Rate Assumed: [____]%

Net Discount Rate: [____]%

Work Life Expectancy (Years): [____]

TOTAL PRESENT VALUE OF FUTURE LOST EARNINGS: $[________________________________]

E. Lost Benefits - Future

TOTAL PRESENT VALUE OF FUTURE LOST BENEFITS: $[________________________________]

PART VI: HOUSEHOLD SERVICES VALUE

A. Services Plaintiff Can No Longer Perform

Replacement Cost Per Hour: $[____]

Weekly Lost Household Services Value: $[____]

Annual Lost Household Services Value: $[____]

Duration of Impairment: [____] years ☐ Permanent

TOTAL HOUSEHOLD SERVICES VALUE: $[________________________________]

PART VII: DOCUMENTATION CHECKLIST

Income Documentation:
☐ W-2 Forms (Past 3-5 years)
☐ Pay Stubs (12+ months)
☐ Tax Returns (Past 3-5 years)
☐ 1099 Forms (if self-employed)
☐ Schedule C/K-1 (if self-employed)
☐ Employer Verification Letter
☐ Employment Contract
☐ Union/CBA Documents

Absence Documentation:
☐ Medical Records (Work Restrictions)
☐ Doctor's Notes/Work Releases
☐ FMLA Paperwork
☐ Disability Claim Documents
☐ Employer Attendance Records

Expert Reports:
☐ Vocational Rehabilitation Assessment
☐ Economist Report
☐ Functional Capacity Evaluation
☐ Life Care Plan

PART VIII: TOTAL LOST WAGES AND EARNING CAPACITY SUMMARY

VERIFICATION

Prepared By: [________________________________]

Title: [________________________________]

Date: [__/__/____]

Reviewed By: [________________________________]

Date: [__/__/____]

Notes:

[________________________________]
[________________________________]
[________________________________]

SOURCES AND REFERENCES

• Bureau of Labor Statistics Worklife Tables
• U.S. Census Bureau Earnings Data
• IRS Tax Documentation Requirements
• State-specific damage calculation standards
• Vocational Rehabilitation Standards
• Economic Loss Assessment Methodologies

This calculator is for attorney use in estimating lost wages and earning capacity. All calculations should be verified with supporting documentation and expert economist opinions for trial or settlement purposes.