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IR EconLoss[NAR]

IR Economic Loss information. Required information is bold. (only if EconLoss is yes)
  • IR EconLoss Claim
    • Is economic loss being claimed? (yes/no)
  • IR EconLoss WageAmount
    • Amount of Last Annual Wages
  • IR EconLoss WagesDate
    • Date last wages received
  • IR EconLoss Full-Time
    • yes/no
  • IR EconLoss Part-Time
    • yes/no
  • IR EconLoss Retired
    • yes/no
  • IR EconLoss PartiallyDisabled
    • yes/no
  • IR EconLoss TotallyDisabled
    • yes/no
  • IR EconLoss Deceased
    • yes/no
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