Medical Only Sample Clauses

Medical Only. The parties agree to an award for payment of medical benefits that are reasonable, necessary, authorized and causally related to the compensable injury. Signature of Injured Worker Print Name Date (m/d/yyyy) Signature of Claim Administrator Print Name Date (m/d/yyyy) Print Name and Address of Claim Administrator Phone Number Print Name and Address of Injured Worker’s Attorney Phone Number 1. This form is to be completed whenever a claim has been accepted as compensable and the Injured Worker is entitled to an award. This Award Agreement provides the basis for the award of compensation and contains sufficient information to establish the essential elements of a compensable claim. Submit the completed form to the Virginia Workers’ Compensation Commission, 000 X. Xxxxxxxx St., Richmond, Virginia 23219. For subsequent periods of compensation benefits, this form should be used or a Varying Temporary Partial Award Agreement (VWC Form No. 4G) must be filed. 2. Definitions of Benefit Types: Calculation of Temporary Partial Rate: Average weekly wage before injury $ $ ̶ Current weekly wage $ All Amounts are Based on Weekly Figures = Difference in wages before injury and now * Compensation rate is subject to yearly maximum and minimum allowances. ** All wage information and compensation rate(s) reflected on the form(s) should be based on weekly figures. 3. For questions or assistance with completing this form, please contact Customer Assistance using the Commission’s toll-free number 877-664-2566.
Sample 1Sample 2
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Medical Only. Between age 50 and 65, or until the retiree becomes re-employed and is covered by a Health Plan, or becomes eligible for Medi-Cal, National Health, or other Government- sponsored programs.
Sample 1
Medical Only. The parties agree to an award for payment of medical benefits that are reasonable, necessary, authorized and causally related to the compensable injury. Signature of Injured Worker Print Name Date (m/d/yyyy) Signature on behalf of the Employer/Insurer Print Name Date (m/d/yyyy) Print Name and Address of Claim Administrator Phone Number Print Name and Address of Injured Worker’s Attorney Phone Number This form is required by the Virginia Workers’ Compensation Commission 1. This form is to be completed whenever a claim has been accepted as compensable and the Injured Worker is entitled to an award. This Award Agreement provides the basis for the award of compensation and contains sufficient information to establish the essential elements of a compensable claim. Submit the completed form to the Virginia Workers’ Compensation Commission, 0000 XXX Xxxxx, Xxxxxxxx, XX 00000. For subsequent periods of compensation benefits, this form should be used or a Varying Temporary Partial Award Agreement (VWC Form No. 4G) must be filed. 2. Definitions of Benefit Types: Calculation of Temporary Partial Rate: Average weekly wage before injury $ $ ̶ Current weekly wage $ All Amounts are Based on Weekly Figures = Difference in wages before injury and now x .66667 $ * Compensation rate is subject to yearly maximum and minimum allowances. ** All wage information and compensation rate(s) reflected on the form(s) should be based on weekly figures. 3. For questions or assistance with completing this form, please contact Customer Assistance using the Commission’s toll-free number 000-000-0000.
Sample 1
Medical Only. The parties agree to an award for payment of medical benefits that are reasonable, necessary, authorized and causally related to the compensable injury. Signature of Injured Worker Print Name Date (m/d/yyyy) Signature of Claim Administrator Print Name Date (m/d/yyyy) Print Name and Address of Claim Administrator Phone Number Print Name and Address of Injured Worker’s Attorney Phone Number 1. This form is to be completed whenever a claim has been accepted as compensable and the Injured Worker is entitled to an award. This Award Agreement provides the basis for the award of compensation and contains sufficient information to establish the essential elements of a compensable claim. Submit the completed form to the Virginia Workers’ Compensation Commission, 000 X. Xxxxxxxx St., Richmond, Virginia 23219. 2. Definitions of Benefit Types: Calculation of Temporary Partial Rate: Average weekly wage before injury $ $ ̶ Current weekly wage $ All Amounts are Based on Weekly Figures = Difference in wages before injury and now * Compensation rate is subject to yearly maximum and minimum allowances. ** All wage information and compensation rate(s) reflected on the form(s) should be based on weekly figures. 3. Have questions about the Virginia Workers’ Compensation Commission and no lawyer? Call the Ombuds Department at 000-000-0000, or email at xxxxxx@xxxxxxxx.xxxxxxxx.xxx. We cannot give legal advice, but all conversations will be kept confidential.
Sample 1

Related to Medical Only

  • Medical Plan ‌ Eligible employees and dependants shall be covered by the British Columbia Medical Services Plan or carrier approved by the British Columbia Medical Services Commission. The Employer shall pay one hundred percent (100%) of the premium. An eligible employee who wishes to have coverage for other than dependants may do so provided the Medical Plan is agreeable and the extra premium is paid by the employee through payroll deduction. Membership shall be a condition of employment for eligible employees who shall be enrolled for coverage following the completion of three (3) months’ employment or upon the initial date of employment for those employees with portable service as outlined in Article 14.12.

  • Medical There shall be an open enrollment period for medical coverage in each year of this Agreement. An employee may elect no medical coverage during any open enrollment period. An employee who has elected no medical coverage may elect medical coverage during an open enrollment period. No pre-existing condition limitations will apply.

  • Wellness i. To support the statewide goal for a healthy and productive workforce, employees are encouraged to participate in a Well-Being Assessment survey. Employees will be granted work time and may use a state computer to complete the survey. ii. The Coalition of Unions agrees to partner with the Employer to educate their members on the wellness program and encourage participation. Eligible, enrolled subscribers who register for the Smart Health Program and complete the Well-Being Assessment will be eligible to receive a twenty-five dollar ($25) gift certificate. In addition, eligible, enrolled subscribers shall have the option to earn an annual one hundred twenty-five dollars ($125.00) or more wellness incentive in the form of reduction in deductible or deposit into the Health Savings Account upon successful completion of required Smart Health Program activities. During the term of this Agreement, the Steering Committee created by Executive Order 13-06 shall make recommendations to the PEBB regarding changes to the wellness incentive or the elements of the Smart Health Program.

  • Medical Care Leave An Employee who is unable to make the necessary arrangements for maintenance of personal health care outside of scheduled work time, shall be granted time off with pay. Such time off shall not exceed sixteen (16) working hours per calendar year. Hours in excess of sixteen (16) hours per calendar year shall be deducted from the Employee's sick leave accumulation.

  • Medical Care The Parents must comply with the School Welfare Officer's recommendations which may include a reasonable decision to release the Pupil home or to his / her education guardian when s/he is unwell.

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • Medical Plans The Employer will maintain the current health (including vision) and dental insurance programs and practices. For Calendar Years 2022 — 2023, the Employer shall contribute 80% of the premium charge for PPO plans, 85% of premium for the EPO plan, 85% of premium for the IHM plan, 80% for the prescription drug plan and 50% for the dental plan.

  • Medical Benefits The Company shall reimburse the Employee for the cost of the Employee's group health, vision and dental plan coverage in effect until the end of the Termination Period. The Employee may use this payment, as well as any other payment made under this Section 6, for such continuation coverage or for any other purpose. To the extent the Employee pays the cost of such coverage, and the cost of such coverage is not deductible as a medical expense by the Employee, the Company shall "gross-up" the amount of such reimbursement for all taxes payable by the Employee on the amount of such reimbursement and the amount of such gross-up.

  • Prescription Claims against the Issuer or any Guarantor for the payment of principal or Additional Amounts, if any, on the Notes will be prescribed ten years after the applicable due date for payment thereof. Claims against the Issuer or any Guarantor for the payment of interest on the Notes will be prescribed five years after the applicable due date for payment of interest.

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

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