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Workers’ Compensation Documents

Title Link to File
Order — Delegation — Health Fee Dispute Delegation Standing Order - Health Fee Dispute 02-16-2015.pdf
Order — Delegation — First Reports of Injury (FROI) Delegation Standing Order - FROI 02-16-2015.pdf
Order — Delegation — Appeals — July 24, 2023 Order of Delegation -- Appeals -- July 24, 2023.pdf
Order — Delegation — Appeals — January 21, 2022 2022.01.21 -- Order of Delegation -- Appeals.pdf
Order — Delegation — Alternate Care — July 21, 2023 Order of Delegation -- Alternate Care -- July 21, 2023.pdf
Order — Declaratory — Profit Sharing Bonus & Continuous Improvement Pay Plan — July 12, 2017 JOHN DEERE Declaratory Order Regarding Profit Sharing Bonus and Continuous Improvement Pay Plan.pdf
Order — Administrative — Hearings After October 28, 2022 Order -- Substituted -- Hearings After Oct. 28, 2022.pdf
Nonelection of Coverage Form 14-0175nonelection.pdf
How to Request a Hearing on WCES How to Schedule a Hearing -- WCES Filer Quick Start Guide -- 2019.1010.pdf
Form: Request for Waiver of Mandatory eFiling on WCES (Last Updated March 2023) Form 176 -- Request for Waiver of Requireiment to eFile on WCES -- March 2023.pdf
Form — Unrepresented Claimant's Statement — 14-0163 14-0163.pdf
Form — Settlements & Commutations — Payment Activity Report (PAR) — 14-0147 Settlements & Commutations -- Payment Activity Report (PAR) -- Form 14-0147.pdf
Form — Hearing Report — Second Injury Fund — 14-0047 Hearing Report -- Second Injury Fund -- Form 14-0047 - Word -- Sep. 2019.docx
Form — Hearing Report — No Second Injury Fund — 14-0047 Hearing Report -- No Second Injury Fund -- Form 14-0047 - Word -- Sep. 2019.docx
Form — First Report of Injury or Illness (FROI) — 14-0001 First Report of Injury -- 14-0001 -- 2023.03.pdf
Form — EDI & Compliance — Payment Activity Report (PAR) — 14-0147 EDI & Compliance -- Payment Activity Report (PAR) -- Form 14-0147.pdf
Form — Dispute Resolution Conference Report — 14-0041 14-0041.pdf
Form — Compromise Settlement — 14-0025 Compromise Settlement -- Form 14-0025 -- 2019.10.pdf
Form — Agreement for Settlement — 14-0021 Agreement for Settlement -- Form 14-0021 -- 2019.07 empty.pdf
Form 9A — Partial Commutation — 14-0017 Partial Commutation -- Original Notice & Petition -- Form 9A - 14-0017 --July 2019.pdf
Form 9 — Full Commutation of All Remaining Benefits of 10 Weeks or More — 14-0013 Full Commutation -- Original Notice & Petition -- Form 9 - 14-0013 -- July 2019.pdf
Form 14-0178 — Shorthand Reporter Identification Shorthand Reporter Identification -- Form 14-0178.pdf
Form 14-0169 — Authorization for the Iowa Division of Workers' Compensation to Release Information Authorization to Release Confidential Information to Thirty Party -- Form 14-0169.pdf
Form 14-0163 — Claimant's Statement Claimant's Statement -- Form 14-0163.pdf
Form 14-0161 — Contingent Settlement Contingent Settlement -- Form 14-0161.pdf