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Justia - Wage Statement (For Injuries On Or After 07-01-2008) - Vermont - Workers Compensation - Free Legal Forms - Justia Forms. WAGE STATEMENT – For injuries occurring on or after July 1, 2008.The Workers Compensation Claim Forms listed in this Reference Guide include, but are not limited to, injury reports, claim denials, petitions, treating. The injured employee must have a doctor's statement for time out of work. Reporting Gross Pay: Complete all columns as applicable. The maximum weekly benefit is adjusted on July 1 of each year. It is money paid every two weeks while you are not working because of a job injury. Until the employee is able to return to work. What is permanent partial disability? Payment for a full office visit if the patient only received an injection.