Workers’ Compensation Documents

Title Link to File
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 Form 100 -- Original Notice & Petition -- 2023.03.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
Corporate Officer Exclusion Form 14-0061corpofficerex.pdf
Conditional Table Release 2 Iowa Conditional Table.pdf
Concurrence Regarding Preference by Sara J. Sersland serslandpreference.pdf
Amended Order of the Commissioner:  Impact of Coronavirus/COVID-19 on Regular Procedure Hearings From July 24, 2021, Through October 29, 2021 (July 29, 2021) Amended Order -- COVID-19 -- Impact on Hearings -- July 29, 2021.pdf