Claimants Statement {14-0163} | Pdf Fpdf Doc Docx | Iowa

 Iowa   Workers Compensation 
Claimants Statement {14-0163} | Pdf Fpdf Doc Docx | Iowa

Last updated: 9/20/2023

Claimants Statement {14-0163}

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Description

Form 14-0163 - CLAIMANT'S STATEMENT. The Iowa Division of Workers’ Compensation (DWC) requires a claimant who is not represented by counsel to attach this completed and signed form with any proposed settlement documents. DWC will use the information you give on this form when considering your proposed settlement. www.FormsWorkflow.com

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