- Are any benefits awarded herein? No
- Was the injury or occupational disease compensable under Chapter 287? Yes
- Was there an accident or incident of occupational disease under the Law? Yes
- Date of accident or onset of occupational disease: March 11, 2005
- State location where accident occurred or occupational disease was contracted: St. Louis, Mo.
- Was above employee in employ of above employer at time of alleged accident or occupational disease? Yes
- Did employer receive proper notice? Yes
- Did accident or occupational disease arise out of and in the course of the employment? Yes
- Was claim for compensation filed within time required by Law? Yes
- Was employer insured by above insurer? Yes
- Describe work employee was doing and how accident occurred or occupational disease contracted:
While working, Claimant's jacket became caught in a machine injuring his right shoulder. 12. Did accident or occupational disease cause death? No Date of death? N/A 13. Part(s) of body injured by accident or occupational disease: Right shoulder 14. Nature and extent of any permanent disability: 20 % of the right shoulder at the 232 week level 15. Compensation paid to-date for temporary disability: $\ 2,894.62 16. Value necessary medical aid paid to date by employer/insurer? $\ 4,693.68
Employee: Lieutenant Carter Injury No.: 05-019476 17. Value necessary medical aid not furnished by employer/insurer? N/A 18. Employee's average weekly wages: $\ 400.00 19. Weekly compensation rate: $\quad \$ 266.67 / \ 266.67 20. Method wages computation: Section 287.250.1.5