Form 100C (14-0011A) — Answer Concerning Application for Alternate Care

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NAME

Answer Concerning Application for Alternate Care

NUMBER

100C (14-0011A)

EFFECTIVE

July 1, 2023

OVERVIEW

It is not necessary to file an answer due to time constraints. If no answer is filed, the defendant(s) will be required to provide a response at a hearing. Failure to participate may impact your rights and responsibilities under Iowa Code section 85.27.

An attorney representing the defendant(s) or non-attorney representative of the employer may file this completed form in response to a claimant's petition concerning application for alternate care. 

This procedure is not available if the employer disputes liability on the claim generally. If liability is disputed, this case will be dismissed without prejudice. 

The information provided in this case will be open for public inspection under Iowa Code section 22.1.

INSTRUCTIONS

1. Download the form by clicking on the link above. Complete the form by typing the information into the fill-able fields on the PDF or by printing the form and handwriting in print the information on the printed form.
2. Complete the caption by providing in the corresponding blank the:
   • Name of the claimant
   • Name of the employer
   • Name of any insurance carrier
   • Name(s) of any other defendant(s)
   • Any agency file number(s)

NOTE:  In some cases, there is not an insurance carrier (e.g., when the employer is self-insured) or any other defendant(s).

3. Complete the form by filling out paragraphs 1, 2, 3, 4, 5, and 6.
4. Provide your information under the signature line.
5. Sign the form using an electronic signature or by hand after printing out the completed form.
6. If you use an electronic signature under agency rules, lock or "flatten" the PDF document after completing the form fields to ensure the document can be viewed on all devices and to prevent other users from manipulating or editing the information.
7. Complete the proof of service.
8. Electronically file (eFile) the completed and signed form on the Workers' Compensation Electronic System (WCES), which will serve a copy to the claimant or claimant’s attorney.

EFILING ON WCES

DWC requires parties and attorneys to electronically file (eFile) documents on the Workers' Compensation Electronic System (WCES) in contested case proceedings.

You must eFile on WCES documents, such as this completed form, unless the DWC has granted you an eFiling exception.

For more information about eFiling, click here.