Workers’ Compensation Documents

Title Link to File
First Report of Injury or Illness 14-0001 First Report of Injury 14-0001 May 2015.pdf
Event Table Release 2 Iowa Event Table.pdf
Element Requirements Table R3elementrequirementtable (1).xls
Element Requirements Release 2 Element Requirements Table.pdf
Edit Matrix Release 2 Edit Matrix.pdf
EDI Release 3 Event Table R3eventtable.xls
EDI Release 3 Element Requirements R3elementrequirementtable (1).xls
EDI Annual Reporting Requirement Activated edicannualreportingrequirement.pdf
EDI Annual Reporting Requirement edicannualreportingrequirement.pdf
EDI Amendment Letter EDI Amendment.pdf
EDI 2002.03.01 Revisions: Iowa First Report of Injury changelist.pdf
Dispute Resolution Conference Report 14-0041 14-0041.pdf
Delegation Standing Order - Settlements Delegation Standing Order - Settlements.pdf
Delegation Standing Order - IME Delegation Standing Order - IME 03-14-2016.pdf
Delegation Standing Order - Health Fee Dispute Delegation Standing Order - Health Fee Dispute 02-16-2015.pdf
Delegation Standing Order - FROI Delegation Standing Order - FROI 02-16-2015.pdf
Delegation Standing Order - Appeals Delegation Standing Order - Appeals.pdf
Delegation Standing Order - Alternate Medical Care Delegation Standing Order - Alternate Medical Care 02-16-2015.pdf
Corporate Officer Exclusion Form 14-0061corpofficerex.pdf
Copy Fee Schedule 2017 COPY-PROCESS FEE2017.pdf
Contingent Settlement — Form 14-0161 Contingent Settlement -- Form 14-0161 -- July 2019.pdf
Conditional Table Release 2 Iowa Conditional Table.pdf
Concurrence Regarding Preference by Sara J. Sersland serslandpreference.pdf
Compromise Settlement — Form 14-0025 Compromise Settlement -- Form 14-0025 -- August 2019.pdf
Combination Settlement — Form 14-0159 Combination Settlement -- Form 14-0159 -- July 2019.pdf