Dispute Resolution Conference Report {14-0041} | Pdf Fpdf Doc Docx | Iowa

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Dispute Resolution Conference Report {14-0041} | Pdf Fpdf Doc Docx | Iowa

Dispute Resolution Conference Report {14-0041}

This is a Iowa form that can be used for Workers Compensation.

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BEFORE THE IOWA WORKERS COMPENSATION COMMISSIONER____________________________________________________________________ : : : Claimant, : : File No. ____________vs. : : : : DISPUTE RESOLUTION Employer, : CONFERENCE REPORT :and : : : : Insurance Carrier, : Defendants. : ____________________________________________________________________The parties, in compliance with the Order setting this matter for conference, report tothe deputy that: 1. Claimant (is) (is not) currently receiving weekly benefits. If not, state whether claimant has received any benefits since the date of injury, when those benefits ceased and why; or why benefits have not been initiated, if applicable.2. The principal dispute(s) in this matter is (are):3. The parties contention for each disputed issue identified in paragraph 2, above, including a brief summary of the testimony expected to be presented to support the contentions, is attached hereto. <<<<<<<<<********>>>>>>>>>>>>> 24. The parties can, for the purposes of this conference only, agree that:5. The parties wish to bring the following information to the deputys attention: 6. The parties certify that they have made a good faith attempt to settle the disputed issues. See, rule 876 IAC 10.1. If no attempts have been made, the deputy may cancel the mediation. Submitted by,____________________________ __________________________________ Claimant Attorney for Claimant___________________________ _________________________________Representative of Attorney for Defendant Employer/Insurance Carrier 14-0041 09/98

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