Application For Payment Of Benefits Under Iowa Code Section 85.21 {14-0037} | Pdf Fpdf Doc Docx | Iowa

 Iowa   Workers Compensation 
Application For Payment Of Benefits Under Iowa Code Section 85.21 {14-0037} | Pdf Fpdf Doc Docx | Iowa

Last updated: 9/19/2023

Application For Payment Of Benefits Under Iowa Code Section 85.21 {14-0037}

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Description

Form 14-0037 - APPLICATION FOR PAYMENT OF BENEFITS UNDER IOWA CODE § 85.21. This form is used in Iowa Workers' Compensation cases. It is completed by the employer or insurance carrier and is used to apply for an order from the Iowa Workers' Compensation Commissioner to require the payment of weekly benefits and authorized medical benefits under Iowa Code chapter 85, 85A, or 85B. The form includes information about the date of the injury, the claimant's address, employer's address, insurance carrier's address, and any other parties involved in the dispute. The employer or insurance carrier applies for these benefits without admitting liability, and the payment of benefits is subject to termination under Iowa Code section 10A.315. www.FormsWorkflow.com

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