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Payment Activity Report (PAR) for Settlements & Commutations
This form is used to submit a Payment Activity Report (PAR) to the Iowa Division of Workers' Compensation (DWC) as part of settlement documents or for a commutation.
To complete this form:
- In Section A, provide the complete names and addresses of the insurance carrier, employer, and employer.
- In Section B, provide the information concerning any changes in payment status or any comments pertinent to the handling of the claim.
- In Section C, provide the information relating to the rate calculation.
- In Section D, indicate whether:
- The PAR is a Commencement of Payment Notice.
- The PAR is a Denial of Liability.
- Benefits are not being paid and the reason.
- In Section E, provide the requested information to report the benefits paid to date, and to indicate whether an "Interim Report" (disability benefits are continuing; enter the estimated completion date) or "Final Report" (disability benefits have been terminate; enter the date of last payment) is being filed. You may attach a separate sheet if necessary.
- Identify the person who prepared the PAR and the date on which it was prepared.
Note: Do not provide personally identifiable information such as the claimant's Social Security Number in the PAR when submitting it as part of a settlement or for a commutation.