Personal Injury Compensation Form and Death Compensation Form Sample Clauses

Personal Injury Compensation Form and Death Compensation Form. The Spe- cial Master shall develop a Personal In- jury Compensation Form, which may be a portion of a complete claim form, that each injured claimant must sub- mit. The Special Master shall also de- velop a Death Compensation Form, which may be a portion of a complete claim form, that each Personal Rep- resentative must submit. These forms shall require the claimant to provide certain information that the Special Master deems necessary to determining the amount of any award, including in- formation concerning income, collat- eral sources, benefits, settlements and attorneys’ fees relating to civil actions described in section 405(c)(3)(C)(iii) of the Act, and other financial informa- tion, and shall require the claimant to state the factual basis for the amount of compensation sought. It shall also allow the claimant to submit certain other information that may be rel- evant, but not necessary, to the deter- mination of the amount of any award. (1) The Special Master may ask claimants to submit certain tax re- turns or tax transcripts for returns that the Special Master deems appro- priate for determination of an award. The Special Master may also require waivers, consents, or authorizations from claimants to obtain directly from third parties medical information, em- ployment information, or other infor- mation that the Special Master deems relevant to determining the amount of any award. (2) Claimants may attach to the ‘Per- xxxxx Injury Compensation Form’’ or ‘‘Death Compensation Form’’ any addi- tional statements, documents or anal- yses by physicians, experts, advisors, or any other person or entity that the claimant believes may be relevant to a determination of compensation.
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Related to Personal Injury Compensation Form and Death Compensation Form

  • Salary Benefits and Bonus Compensation 3.1 BASE SALARY. Effective July 1, 2000, as payment for the services to be rendered by the Employee as provided in Section 1 and subject to the terms and conditions of Section 2, the Employer agrees to pay to the Employee a "Base Salary" at the rate of $180,000 per annum, payable in equal bi-weekly installments. The Base Salary for each calendar year (or proration thereof) beginning January 1, 2001 shall be determined by the Board of Directors of Avocent Corporation upon a recommendation of the Compensation Committee of Avocent Corporation (the "Compensation Committee"), which shall authorize an increase in the Employee's Base Salary in an amount which, at a minimum, shall be equal to the cumulative cost-of-living increment on the Base Salary as reported in the "Consumer Price Index, Huntsville, Alabama, All Items," published by the U.S. Department of Labor (using July 1, 2000, as the base date for computation prorated for any partial year). The Employee's Base Salary shall be reviewed annually by the Board of Directors and the Compensation Committee of Avocent Corporation.

  • Compensation/Benefit Programs During the Term of Employment, the Executive shall be entitled to participate in all medical, dental, hospitalization, accidental death and dismemberment, disability, travel and life insurance plans, and any and all other plans as are presently and hereinafter offered by the Company to its executive personnel, including savings, pension, profit-sharing and deferred compensation plans, subject to the general eligibility and participation provisions set forth in such plans.

  • Disability Benefits Technology Errors and Omissions Not less than $1,000,000 each claim Not less than $2,000,000 in aggregate At the time of the first transaction with an Authorized User and updated in accordance with Contract Crime Insurance Not less than $50,000 Commercial General Liability Not less than $5,000,000 each occurrence Updated in accordance with Contract General Aggregate $2,000,000 Products – Completed Operations Aggregate $2,000,000 Personal and Advertising Injury $1,000,000 Business Automobile Liability Insurance Not less than $5,000,000 each occurrence

  • Death Benefits Upon the Executive’s death during the Contract Period, the Executive’s estate shall not be entitled to any further benefits under this Agreement.

  • Employment and Compensation The following terms and conditions will govern the Executive’s employment with the Company throughout the Term.

  • Other Compensation or Benefits You acknowledge that, except as expressly provided in this Agreement, you will not receive any additional compensation, severance or benefits after the Separation Date.

  • Disability Benefit If the Executive terminates employment due to Disability prior to Normal Retirement Age, the Company shall pay to the Executive the benefit described in this Section 2.3 in lieu of any other benefit under this Agreement.

  • Compensation Benefits Etc During the Employment Period, the Manager shall be compensated as follows: (a) The Manager shall (i) receive an annual cash base salary, payable not less frequently than semi-monthly, which is not less than the annualized cash base salary payable to Manager as of the Effective Date; (ii) be entitled to at least as favorable annual incentive award opportunity under the Company's annual incentive compensation plan as he did in the calendar year immediately prior to the year in which the Change of Control Event occurs; and (iii) be eligible to participate in all of the Company's long-term incentive compensation plans and programs on terms that are at least as favorable to the Manager as provided to the Manager in the four calendar years prior to the Effective Date. (b) The Manager shall be entitled to receive fringe benefits, employee benefits, and perquisites (including, but not limited to, vacation, medical, disability, dental, and life insurance benefits) which are at least as favorable to those made generally available as of the Effective Date to all of the Company's salaried managers as a group. In addition, the Manager shall be eligible to participate in the Company's Supplemental Retirement Income Program ("SRIP"). (c) Notwithstanding any other provision of this Agreement (whether in this Section 4, in Section 6, or elsewhere), (i) the Board of Directors may authorize an increase in the amount, duration, and nature of and/or the acceleration of any compensation or benefits payable under this Agreement, as well as waive or reduce the requirements for entitlement thereto and (ii) the Company may deduct from amounts otherwise payable to the Manager such amounts as it reasonably believes it is required to withhold for the payment of federal, state, and local taxes.

  • Survivor Benefits 1. A surviving dependent of a retiree who was eligible to receive a Retiree Medical Grant, as stated above in A through C, and who qualifies for a monthly allowance shall be eligible for fifty (50) percent of the Grant authorized for the retiree. 2. A surviving eligible retiree who qualifies for a monthly retirement allowance who was married to a retiree who was also eligible for a Grant shall receive the survivor benefit described in D.1., above, or his or her own Grant, whichever is greater. Such retiree shall not be eligible for both Grants.

  • Compensation Benefits In accordance with Section 142 of the State Finance Law, this contract shall be void and of no force and effect unless the Contractor shall provide and maintain coverage during the life of this contract for the benefit of such employees as are required to be covered by the provisions of the Workers' Compensation Law.

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