Use this worksheet to record accident-related expenses and work losses as they occur. Keep the supporting bill, receipt, statement, or employer record for every entry. A number written in a spreadsheet is easier to verify when it can be traced to a source document.
Expense ledger
| Date | Payee or provider | Expense | Amount billed | Amount paid by you | Receipt saved? |
|---|---|---|---|---|---|
| Yes / No | |||||
| Yes / No | |||||
| Yes / No | |||||
| Yes / No |
Possible categories include copays, deductibles, prescriptions, medical equipment, parking, tolls, transportation, towing, storage, rental expenses, vehicle costs, and reasonable replacement services. Whether an item is recoverable depends on the claim and supporting proof.
Medical and claim payment log
| Date | Bill or claim | Original charge | PIP paid | Health insurer paid | Adjustment | Patient balance |
|---|---|---|---|---|---|---|
Work-loss log
| Date or pay period | Hours or work missed | Reason | Gross income lost | PTO used | Supporting record |
|---|---|---|---|---|---|
Documents for an employee
- Pay stubs before and after the crash
- Work schedule, timecards, attendance records, and missed-shift notices
- Employer wage-verification form or letter
- Job description and physical requirements
- Medical work-status notes and restrictions
- PTO, sick leave, vacation, or unpaid-leave records
- Bonus, commission, overtime, or promotion records when specifically affected
- Tax forms when needed to confirm longer-term earnings
Documents for a self-employed person
- Invoices, contracts, calendars, and project records
- Business and personal tax returns with supporting schedules
- Profit-and-loss statements and bank deposit records
- Customer cancellations or communications tied to missed work
- Payments to substitute workers or subcontractors
- Records distinguishing gross revenue from actual net income
PIP and lost income
Florida Statute § 627.736(1)(b) generally provides disability benefits equal to 60% of qualifying loss of gross income and earning capacity caused by the injury, within the combined PIP benefit and subject to the policy and statute. Some policies exclude the work-loss benefit. Ask the carrier which forms and proof it requires.
Do not total the same expense twice or treat a billed charge as an out-of-pocket payment. Keep separate columns for charges, insurer payments, adjustments, and what you actually owe or paid.