Iowa Administrative Code › Agency 876 - Workers' Compensation Division › Chapter 4 - Contested Cases › Rule 876-4.6 - Original Notice and Petition

Current through Register Vol. 47, No. 3, July 24, 2024
A petition or application must be delivered or filed with the
				original notice unless original notice Form 100, Form 100A, Form 100B, or Form
				100D of the division of workers' compensation is used.
The original notice Form 100, Form 100A, Form 100B, Form 100C,
				Form 100D, or a determination of liability reimbursement for benefits paid and
				recovery of interest form shall provide for the data required in Iowa Code
				section 17A.12(2)  and shall contain factors relevant to the contested case
				proceedings listed in rule 876-4.1 (85,85A,85B,86,87,17A). Form 100 is to be
				used for all contested case proceedings except as indicated in this rule. Form
				100A is to be used for the contested case proceedings provided for in subrule
				4.1(12). Form 100B is to be used for the contested case proceeding provided for
				in subrule 4.1(8). Form 100C is to be used for the contested case proceeding
				provided for in subrule 4.1(15) and rule 876-4.48 (17A,85,86). Form 100D is to
				be used for the contested case proceeding provided for in rule 876-4.50 (85).
				The application and consent order for payment of benefits under Iowa Code
				section 85.21 is to be used for contested case proceedings brought under Iowa
				Code section 85.21. When a commutation is sought, Form No. 14-0013 or Form No.
				14-0017 must be filed in addition to any other document. The petition for
				declaratory order, approval of attorney fees, determination of compliance and
				other proceedings not covered in the original notice forms must accompany the
				original notice.
At the same time and in the same manner as service of the
				original notice and petition, the claimant shall serve a patient's waiver using
				Form 14-0043 (authorization for release of information regarding claimants
				seeking workers' compensation benefits), or a substantially equivalent form,
				which shall not be revoked until conclusion of the contested case. The claimant
				shall provide the patient's waivers in other forms and update the patient's
				waivers as necessary to permit full disclosure of discoverable information
				whenever requested by a medical practitioner or institution.
A separate original notice and petition shall be filed for each
				claim that seeks benefits due to the occurrence of an injury, occupational
				disease or occupational hearing loss. The original notice and petition shall
				allege a specific date of occurrence consisting of a day, month and year.
				Alternate or multiple dates of occurrence may be alleged in the same original
				notice and petition if the claim or claims arose from the same occurrence or
				series of occurrences and uncertainty exists concerning the correct date of
				occurrence or the number of occurrences. An employee may join any number of
				employers or insurance carriers in the same original notice and petition if the
				claim is made against them jointly, severally or in the alternative. The remedy
				for misjoinder must be requested by motion within a reasonable time after the
				grounds become known, but in no event later than the claimant's case
				preparation completion date. All remedies will be applied without prejudice to
				any claim or defense. In addition to the remedies contained in Iowa Rule of
				Civil Procedure 1.236, the workers' compensation commissioner may order that
				parts of a claim be severed and proceeded with separately or that separate
				related claims be joined or consolidated for administrative convenience or for
				any good cause. If a correction is ordered but not made by a date specified in
				the order, the original notice and petition may be dismissed without further
				notice. If the correction is made within the specified time, the correction
				relates back to the date of the initial filing for purposes of the statute of
				limitations.
This rule is intended to implement Iowa Code sections 85.27,
				85.45, 85.48, and 17A.12.