Workers’ Compensation Documents

Title Link to File
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
Corporate Officer Exclusion Form 14-0061corpofficerex.pdf
Conditional Table Release 2 Iowa Conditional Table.pdf
Concurrence Regarding Preference by Sara J. Sersland serslandpreference.pdf
2016 Iowa Workers' Compensation Manual - Ratebook (Excel) 2016-2017 Iowa Workers' Compensation Manual - Ratebook WEB.xlsx
2015 Iowa Workers' Compensation Manual - Rate Table rate2015.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