Workers’ Compensation Documents

Title Link to File
Claimant's Statement (Non-Represented Claimant Only) 14-0163 14-0163.pdf
Claimant's Confidential Information Sheet 14-0171 14-0171-CONFIDENTIAL.pdf
Charge Account Application 14-0093.pdf
Authorization to Release Information Regarding Claimants Seeking Workers' Compensation Benefits 14-0043 14-0043.pdf- patients waiver-.pdf
Application for Payment of Benefits — Form 14-0037 Application for Payment of Benefits -- Form 14-0037 -- July 2019.pdf
Application for eFiling Exception — Form 14-0177 Application for eFiling Exception -- Form 14-0177 -- July 2019.pdf
Answer Concerning Vocational Rehabilitation Program Benefit — Form 100B (14-0009A) Vocational Rehabilitation Program Benefit -- Answer -- Form 100B - 14-0009A -- July 2019.pdf
Answer Concerning Independent Medical Examination — Form 100A (14-0007A) Form -- Independent Medical Examination -- Answer -- July 2019.docx_.pdf
Answer Concerning Application for Alternate Care -- Form 100C (14-0011A) Alternate Care -- Answer -- Form 100C - 14-0011A -- July 2019.pdf
AMA Guides Task Force – Report of Member Matthew Dake dakereport.pdf
AMA Guides Sixth Edition Report by R. Saffin Parrish-Sams psamsreport.pdf
Agreement for Settlement — Form 14-0021 Agreement for Settlement -- Form 14-0021 -- Sept. 2019.pdf
2017-2018 Questions and Answers Brochure - Ratebook 2017-2018_Q&A_Brochure.pdf
2016 Iowa Workers' Compensation Manual - Ratebook (Excel) 2016-2017 Iowa Workers' Compensation Manual - Ratebook WEB.xlsx
2015-2016 Questions and Answers Brochure 00-0026 Workers Compensation Question and Answers Brochure 2015 06 Color.pdf
2015 Iowa Workers' Compensation Manual - Rate Table rate2015.pdf
2014-2015 Workers' Compensation Questions and Answers Brochure 00-0026 qa14-15.pdf
2014-2015 Ratebook rb14-15.pdf
2014 Iowa Workers' Compensation Manual - Ratebook rb2014-15.xlsx
2013-2014 Ratebook 2013-2014ratebook.pdf
2013 Iowa Workers' Compensation Manual - Ratebook Rate Book 2013-14 Web (1).xlsx
2012-2013 Ratebook 12ratebookcover.pdf
2012 Iowa Workers' Compensation Manual - Ratebook 2012-13ratebooktable.xlsx
2011-2012 Ratebook 2011ratebook.pdf
2011 Iowa Workers' Compensation Manual - Ratebook RateBook2011_Web.xls