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Instructions for Original Notice & Petition Concerning Application for Alternate Care — Form 100C (14-0011) |
Instructions for Form -- Alternate Care -- Original Notice & Petition -- 2019.10.15.pdf |
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Instructions for Answer Concerning Independent Medical Examination — Form 100A (14-0007A) |
Instructions for Form -- Independent Medical Examination -- Answer -- July 2019.pdf |
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Instructions for Answer Concerning Application for Alternate Care, Form 100C (14-0011A) |
Instructions for Form -- Alternate Care -- Answer -- July 2019.pdf |
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How to Request a Hearing on WCES |
How to Schedule a Hearing -- WCES Filer Quick Start Guide -- 2019.1010.pdf |
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Form — Unrepresented Claimant's Statement — 14-0163 |
14-0163.pdf |
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Form — Shorthand Reporter Identification — 14-0178 |
Shorthand Report Identification -- Form 14-0178 -- July 2019.pdf |
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Form — Settlements & Commutations — Payment Activity Report (PAR) — 14-0147 |
Settlements & Commutations -- Payment Activity Report (PAR) -- Form 14-0147.pdf |
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Form — Medical Report Transmittal — 14-0141 |
14-0141medtransmit.pdf |
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Form — Information Request — 14-0083 |
Information Request -- Form 14-0083 -- 2020.01.pdf |
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Form — Hearing Report — Second Injury Fund — 14-0047 |
Hearing Report -- Second Injury Fund -- Form 14-0047 - Word -- Sep. 2019.docx |
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Form — Hearing Report — No Second Injury Fund — 14-0047 |
Hearing Report -- No Second Injury Fund -- Form 14-0047 - Word -- Sep. 2019.docx |
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Form — EDI & Compliance — Payment Activity Report (PAR) — 14-0147 |
EDI & Compliance -- Payment Activity Report (PAR) -- Form 14-0147.pdf |
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Form — Dispute Resolution Conference Report — 14-0041 |
14-0041.pdf |
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Form — Contingent Settlement — 14-0161 |
Contingent Settlement -- Form 14-0161 -- July 2019.pdf |
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Form — Compromise Settlement — 14-0025 |
Compromise Settlement -- Form 14-0025 -- 2019.10.pdf |
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Form — Combination Settlement — 14-0159 |
Combination Settlement -- Form 14-0159 -- July 2019.pdf |
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Form — Claimant's Confidential Information Sheet — 14-0171 |
14-0171-CONFIDENTIAL.pdf |
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Form — Authorization to Release Information Regarding Claimant Seeking Workers' Compensation Benefits — 14-0043 |
Form -- Authorization to Release Claimant's Information -- 14-0043.pdf |
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Form — Authorization for the Iowa Division of Workers' Compensation to Release Information — 14-0169 |
Authorization to Release Information -- Form 14-0196 -- Updated July 2019 -- Iowa Division of Workers' Compensation.pdf |
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Form — Application to Defer Payment of Filing Fees & Financial Affidavit — 14-0075 |
Application to Defer Payment of Filing Fees -- Form 14-0075 -- July 2019.pdf |
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Form — Application for Payment of Benefits — 14-0037 |
Application for Payment of Benefits -- Form 14-0037 -- July 2019.pdf |
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Form — Application for eFiling Exception — 14-0176 |
Application for eFiling Exception -- Form 14-0176 -- July 2019.pdf |
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Form — Agreement for Settlement — 14-0021 |
Agreement for Settlement -- Form 14-0021 -- 2019.07 empty.pdf |
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Form 9A — Partial Commutation — 14-0017 |
Partial Commutation -- Original Notice & Petition -- Form 9A - 14-0017 --July 2019.pdf |
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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 |
