Workers’ Compensation Documents

Title Link to File
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 100D — Original Notice & Petition — Vocational Training & Education for Shoulder Injuries — 14-0012 Form 100D -- Vocational Training & Education -- Original Notice & Petition --14-0012 -- Dec. 2019.pdf
Form 100D — Answer — Vocational Training & Education — 14-0012A Form 100D -- Vocational Training & Education -- Answer -- 14-0012A.pdf
Form 100C — Original Notice & Petition — Alternate Care — 14-0011 Alternate Care -- Original Notice & Petition -- Form 100C - 14-0011 -- July 2019.pdf
Form 100C — Answer — Alternate Care — 14-0011A Alternate Care -- Answer -- Form 100C - 14-0011A -- July 2019.pdf
Form 100B — Original Notice & Petition — Vocational Rehabilitation Program Benefit — 14-0009 Vocational Rehabilitation Program Benefit -- Form 100B - 14-0009 -- July 2019.pdf
Form 100B — Answer — Vocational Rehabilitation Program Benefit — 14-0009A Vocational Rehabilitation Program Benefit -- Answer -- Form 100B - 14-0009A -- July 2019.pdf
Form 100A — Original Notice & Petition — Independent Medical Examination — 14-0007 Independent Medical Exam -- Original Notice & Petition -- Form 100A - 14-0007 -- July 2019.pdf
Form 100A — Answer — Independent Medical Examination (IME) — 14-0007A Form -- Independent Medical Examination -- Answer -- July 2019.docx_.pdf
Form 100 — Original Notice and Petition — 14-0005 14-0005 form100fillable.pdf
First Report of Injury or Illness 14-0001 First Report of Injury 14-0001 May 2015.pdf
Fee Schedule for Information Requests Fee Schedule for Information Requests.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
CourtCall Overview 2020 CourtCall -- Overview -- 2020.pdf
CourtCall Hearings Now Available CourtCall -- Video Hearings Now Available.pdf