Form 100D (14-0012A) — Answer Concerning Vocational Training & Education

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NAME

Answer Concerning Application for Vocational Training & Education

NUMBER

100D (14-0012A)

EFFECTIVE

July 1, 2023

OVERVIEW

A party completes and files this form in response to an Original Notice & Petition Concerning Application for Vocational Training & Education under Iowa Code section 85.70(2) and Rule 876 IAC 4.50.

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 Petition by filling out paragraphs 1, 2, 3, 4, and 5.
   • For Paragraph 2, provide only the address that is appropriate for you.
     • If you are the claimant, fill out only Paragraph 2(a).
     • If you are completing and filing the form on behalf of the employer and insurance carrier, fill out only Paragraphs 2(b) and 2(c).
     • If you are completing and filing the form on behalf of only the employer, fill out only Paragraph 2(b).
   • If there is not enough room under Paragraph 5, you may attach to the answer form a typewritten page of additional assertions.
4. Provide your information under the signature line for the attorney or representative of petitioner(s).
5. Sign the form electronically on the fillable PDF or by hand after printing out the completed form.
6. Complete the Proof of Service.
7. 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.
8. Electronically file (eFile) the form on the Workers' Compensation Electronic System (WCES).
9. Serve a copy to the opposing party or parties. eFiling on WCES will serve the opposing party or parties if they have not been granted an eFiling waiver by DWC.

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.