Stipulation With Request For Award (For Injury Prior To 1-1-2013) {DWC-CA 10214(a)} | Pdf Fpdf Doc Docx | California

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Stipulation With Request For Award (For Injury Prior To 1-1-2013) {DWC-CA 10214(a)} | Pdf Fpdf Doc Docx | California

Last updated: 5/30/2015

Stipulation With Request For Award (For Injury Prior To 1-1-2013) {DWC-CA 10214(a)}

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Description

DWC-CA form 10214 (a), STIPULATIONS WITH REQUEST FOR AWARD (For Injury Prior To 1-1-2013). This form is used in California's workers' compensation system. Stipulations with a request for an award are agreements between the injured worker and the employer or their insurance company regarding the payment of workers' compensation benefits. The form stipulates to the issuance of an Award and/or Order, based upon the facts stated, and waives the requirements of Labor Code section 5313. The stipulations outline the terms of the agreement, including the amount of compensation to be paid, the duration of the payments, and any other relevant terms. (Rev 11/2008). www.FormsWorkflow.com

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