Common Contracts

Contract

September 20th, 2019

• Filed
  September 20th, 2019

B E F O R E T H E I O W A W O R K E R S ’ C O M P E N S A T I O N C O M M I S S I O N E R , File No( s ) . : Claimant, v s . , Employer, , Agreement for Settlement UnderIowa Code § 85.35(2) Insurance Carrier, , Defendant( s ) . The undersigned parties submit this Agreement Settlement to the Workers’ Compensation Commissioner under Iowa Code section 85.35(4). In support of it, the parties agree: 1. Claimant sustained an injury that arose out of and in the course of employment on the following date: 2. Jurisdiction exists because:  The injury occurred in Iowa  Iowa Code section 85.71( ) applies. 3. Claimant:a. Is  Single  Married.b. Is entitled to exemption(s). c. Claimant’s gross weekly earnings are $ using Iowa Code section 85.36( ). d. Has a rate of weekly compensation of $ . (If the rate for PPD differs, it is$ per week.) 4. The injury caused Claimant to sustain the following disability and resulting entitlement to compensation:a. Temporary total disability/tempor

Contract

July 18th, 2019

• Filed
  July 18th, 2019

B E F O R E T H E I O W A W O R K E R S ’ C O M P E N S A T I O N C O M M I S S I O N E R , File No( s ) . : Claimant, v s . , Employer, , Agreement for Settlement UnderIowa Code § 85.35(2) Insurance Carrier, , Defendant( s ) . The undersigned parties submit this Agreement Settlement to the Workers’ Compensation Commissioner under Iowa Code section 85.35(4). In support of it, the parties agree: 1. Claimant sustained an injury that arose out of and in the course of employment on the following date: 2. Jurisdiction exists because:  The injury occurred in Iowa  Iowa Code section 85.71( ) applies. 3. Claimant:a. Is  Single  Married.b. Is entitled to exemption(s). c. Claimant’s gross weekly earnings are $ using Iowa Code section 85.36( ). d. Has a rate of weekly compensation of $ . (If the rate for PPD differs, it is$ per week.) 4. The injury caused Claimant to sustain the following disability and resulting entitlement to compensation:a. Temporary total disability/tempor

Contract

July 18th, 2019

• Filed
  July 18th, 2019

B E F O R E T H E I O W A W O R K E R S ’ C O M P E N S A T I O N C O M M I S S I O N E R , File No( s ) . : Claimant, v s . , Employer, , Agreement for Settlement UnderIowa Code § 85.35(2) Insurance Carrier, , Defendant( s ) . The undersigned parties submit this Agreement Settlement to the Workers’ Compensation Commissioner under Iowa Code section 85.35(2). In support of it, the parties agree: 1. Claimant sustained an injury that arose out of and in the course of employment on the following date: 2. Jurisdiction exists because:  The injury occurred in Iowa  Iowa Code section 85.71( ) applies. 3. Claimant:a. Is  Single  Married.b. Is entitled to exemption(s). c. Claimant’s gross weekly earnings are $ using Iowa Code section 85.36( ). d. Has a rate of weekly compensation of $ . (If the rate for PPD differs, it is$ per week.) 4. The injury caused Claimant to sustain the following disability and resulting entitlement to compensation:a. Temporary total disability/tempor