Shall not be used to reduce or discontinue benefits on a date subsequent to the date signed. sign until employee signs and returns. Don’t Compensation payments are due within 10 calendar days after all parties have signed. May be used to establish Average Weekly Wage (AWW) at a mutually ageed upon amount. All wage forms are still required to be filed. Shall not be used when an order or award is entered under 205(9)(B)(2). Signing the WCB-4A does not by itself create a compensation scheme. If a WCB-8 21-day discontinuance has already been filed, a WCB-4A can not discontinue benefits prior to the expiration of the 21-day period. (21 DAY) CERTIFICATE OF DISCONTINUANCE OR REDUCTION OF COMPENSATION WCB-8 – Use if benefits are discontinued or reduced for any reason other than those which allow the filing of a WCB-4 unless indemnity is being paid pursuant to an order or award, or compensation scheme. DUE DATE File by certified mail no later than 21 days prior to the effective date of the – discontinuance or modification. Box 18 - Reason for discontinuance Enter reason and attach any supporting documentation. – Box 19 Period of incapacity – date should be same as Box 23 of the MOP. “From” date should be date payment for the incapacity will end (no earlier than 21 days from “To” Box 28). Only one period of incapacity should be entered per form. Box 20 WCR If more than one rate was used, enter last rate used. – – Box 21 - Compensation paid Total amount paid or due to the date the form is mailed for the – current period of incapacity. This should be a dollar amount. Do not reduce by any recoveries. For salary continuation, do not include amounts paid by the employer.
Shall not be used to reduce or discontinue benefits on a date subsequent to the date signed. Don’t sign until employee signs and returns. Compensation payments are due within 10 calendar days after all parties have signed. May be used to establish Average Weekly Wage (AWW) at a mutually ageed upon amount. All wage forms are still required to be filed. Shall not be used when an order or award is entered under 205(9)(B)(2). Signing the WCB-4A does not by itself create a compensation scheme. If a WCB-8 21-day discontinuance has already been filed, a WCB-4A can not discontinue benefits prior to the expiration of the 21-day period. (21 DAY) CERTIFICATE OF DISCONTINUANCE OR REDUCTION OF COMPENSATION – WCB-8 Use if benefits are discontinued or reduced for any reason other than those which allow the filing of a WCB-4 unless indemnity is being paid pursuant to an order or award, or compensation scheme. DUE DATE – File by certified mail no later than 21 days prior to the effective date of the discontinuance or modification. Box 18 - Reason for discontinuance – Enter reason and attach any supporting documentation. Box 19 – Period of incapacity “From” date should be same as Box 23 of the MOP. “To” date should be date payment for the incapacity will end (no earlier than 21 days from Box 28). Only one period of incapacity should be entered per form. Box 20 – WCR – If more than one rate was used, enter last rate used. Box 21 - Compensation paid – Total amount paid or due to the date the form is mailed for the current period of incapacity. This should be a dollar amount. Do not reduce by any recoveries. For salary continuation, do not include amounts paid by the employer.
Forms_Training_Mini-Manual_Feb2016.docx