DWC-CA Form 10214 (A) Stipulations With Request for Award - California

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DWC-CA Form 10214 (A) Stipulations With Request for Award - California

What Is DWC-CA Form 10214 (A)?

This is a legal form that was released by the California Department of Industrial Relations - Division of Workers' Compensation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DWC-CA Form 10214 (A)?
A: DWC-CA Form 10214 (A) is a form used in California for stipulations with a request for an award.

Q: What is the purpose of DWC-CA Form 10214 (A)?
A: The purpose of DWC-CA Form 10214 (A) is to document the stipulations agreed upon by the parties involved in a workers' compensation case and to request an award based on these stipulations.

Q: Who uses DWC-CA Form 10214 (A)?
A: DWC-CA Form 10214 (A) is used by parties involved in a workers' compensation case in California, including the injured worker, the employer, and the insurance company.

Q: What information is included in DWC-CA Form 10214 (A)?
A: DWC-CA Form 10214 (A) includes information about the injured worker, the employer, the treating physician, the agreed-upon stipulations, and the request for an award.

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Form Details:

  • Released on November 1, 2008;
  • The latest edition provided by the California Department of Industrial Relations - Division of Workers' Compensation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DWC-CA Form 10214 (A) by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.

Download DWC-CA Form 10214 (A) Stipulations With Request for Award - California

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