Revised Forms Effective July 22, 2019

The Iowa Division of Workers' Compensation (DWC) is implementing mandatory electronic filing (eFiling) in contested cases via the Workers' Compensation Electronic System (WCES) effective July 22, 2019. 

The DWC has changed some of its forms due to the transition to WCES. All of the new DWC forms are listed below. Click on a form's name to download a fill-able PDF version of the form.

You must use Adobe Acrobat Reader to complete DWC forms electronically. Other PDF readers might not render the forms correctly. To get Adobe Acrobat Reader for free, click here.

Hearing Report in Microsoft Word Format

Hearing Report - No Second Injury Fund — Form 14-0047 

Hearing Report - Second Injury Fund — Form 14-0047

Shorthand Reporter Identification

Shorthand Reporter Identification — Form 14-0178

Alternate Care

Original Notice & Application for Alternate Care — Form 100C (14-0011)

Answer to Application for Alternate Care — Form 100C (14-0011A)

Settlement

Agreement for Settlement — Form 14-0021

Compromise Settlement — Form 14-0025

Combination Settlement — Form 14-0159

Contingent Settlement — Form 14-0161

Commutation

Original Notice & Petition for Full Commutation — Form 9 (14-0013)

Original Notice & Petition for Partial Commutation — Form 9A (14-0017)

Independent Medical Examination (IME)

Original Notice & Application for Independent Medical Exam — Form 100A (14-007)

Answer to Application for Independent Medical Exam — Form 100A (14-007A)

Defer Payment of Filing Fees

Application to Defer Payment of Filing Fees — Form 14-0075

Payment of Benefits

Application for Payment of Benefits — Form 14-0037

Vocational Rehabilitation Program Benefit Under Iowa Code section 85.70(1)

Original Notice & Petition Concerning Vocational Rehabilitation Program Benefit — Form 100B (14-0009)

Answer Concerning Vocational Rehabilitation Program Benefit — Form 100B (14-0009A)

eFiling Exception

Application for eFiling Exception — Form 14-0177

All DWC Forms

To search all DWC forms, click here.