LTD Benefit Calculation Report
As of: mm/dd/yyyy
Contract: 123456 - Admin Unit: 0011
Name
SSN/Claim Number		 Hire Date Disability Date Approval Date Work Related Monthly Salary
LINDA SMITH
xxx-00-2222 / 00020002		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy No $2,748.97
Maximum LTD Benefit: $1,649.38
Offsets: $1,203.00     SOCIAL SECURITY DISABILITY
Net Monthly Benefit (Pre-Tax):    $446.38  
JOHN LEWIS
xxx-00-3333 / 00030003		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy No $3,688.53
Maximum LTD Benefit: $2,213.12
Net Monthly Benefit (Pre-Tax): $2,213.12  
SARAH WARNER
xxx-00-4444 / 00040004		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy No $5,059.50
Maximum LTD Benefit: $3,035.76
Net Monthly Benefit (Pre-Tax): $3,035.76  
GINA JOHNS
xxx-00-5555 / 00050005		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy No $1,925.70
Maximum LTD Benefit: $1,155.44
Net Monthly Benefit (Pre-Tax): $1,155.44  
TOM SEYMOUR
xxx-00-6666 / 00060006		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy Yes $2,860.78
Maximum LTD Benefit: $1,721.07
Offsets: $1,695.00     SOCIAL SECURITY DISABILITY
     $866.60     WORKERS COMP. - PERMANENT
HARRY WILLIAMS
xxx-00-7777 / 00070007		 mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy No $3,005.91
Maximum LTD Benefit: $1,800.10
Offsets:    $475.00     WORK EARNINGS OFFSET
Net Monthly Benefit (Pre-Tax): $1,325.10