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If you missed more than one week of work you must have your physician complete the attached DISABILITY VERIFICATION form and attach it to the claim form when complete. Otherwise only one week can be reimbursed* If you are self-employed you must copy your tax return from the year of the crime incident and any contract bids estimates or other documents which might help verify your earnings and attach them to this claim form* If you are not self-employed you must have your employer complete the at ...

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How do I write a letter of lost wages?

How to Write a Lost Wage & Income Demand Letter Make a list of the lost income and wages to get an accurate total. ... Ask the treating physician for a letter stating the dates you could not work. ... Ask your employer for a lost wage and income statement if possible. ... Describe the accident in the first section of the letter.

What is a wage document?

Form W-2, also known as the Wage and Tax Statement, is the document an employer is required to send to each employee and the Internal Revenue Service (IRS) at the end of the year. A W-2 reports employees' annual wages and the amount of taxes withheld from their paychecks.