Form 14-0041 - Dispute Resolution Conference Report - Iowa Workers' Compensation Commissioner
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2BEFORE 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 to
the 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.
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