Get Before The Iowa Industrial Commissioner. Original Notice And Petition

This guide provides clear and supportive instructions for completing the BEFORE THE IOWA INDUSTRIAL COMMISSIONER. Original Notice And Petition form online. Whether you are familiar with legal processes or new to document management, this step-by-step guide will assist you in successfully navigating this essential form.

Follow the steps to fill out the Original Notice and Petition form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the file number at the top of the form. This number is critical for tracking your case.
3. Complete the employer's address section, ensuring to include all necessary details such as street address, city, state, and zip code.
4. Fill in the insurance carrier's address following the same format as the employer's address.
5. Indicate the date of injury or injuries in the designated field.
6. Provide a clear description of how the injury occurred, detailing any relevant circumstances.
7. List the parts of the body affected or disabled as a result of the incident.
8. Specify whether voluntary weekly payments have been made by checking ‘Yes’ or ‘No’.
9. Indicate the duration of time disabled by providing the specific dates.
10. Detail the nature and extent of any permanent disability if applicable.
11. Document any 85.27 expenses incurred, including the provider's information and amount.
12. Clearly state the dispute in your case to help clarify the issues at hand.
13. Complete the county and judicial district information where the injury occurred.
14. Fill in the requested judicial district for where you would like the hearing to be held.
15. If applicable, provide details related to second injury fund benefits and include all necessary information in the given fields.
16. If filing for death benefits, include the deceased's name, relationship to the claimant, date of death, and funeral expenses.
17. List any dependents and their relationships to the claimant.
18. Ensure the petitioner's attorney fields are completed, and sign where indicated. If you are unrepresented, sign under the appropriate section.
19. Review all the completed sections for accuracy and ensure legibility. It is important to type or print clearly.
20. After completing the form, save changes, and download a copy for your records. You should print and share the form as needed for filing.

Complete your BEFORE THE IOWA INDUSTRIAL COMMISSIONER. Original Notice And Petition form online today to ensure timely processing of your case.