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.
Q: What is DWC-CA Form 10214(D)?
A: DWC-CA Form 10214(D) is a Compromise and Release form specifically for Dependency Claim in the state of California.
Q: What is a Compromise and Release?
A: A Compromise and Release is a legal document that resolves and settles a workers' compensation claim.
Q: What is a Dependency Claim?
A: A Dependency Claim is a claim filed by the dependents of a deceased worker for workers' compensation benefits.
Q: Who can file a Dependency Claim?
A: The dependents of a deceased worker, such as a spouse, children, or certain family members, can file a Dependency Claim.
Q: What does DWC stand for in DWC-CA Form 10214(D)?
A: DWC stands for Division of Workers' Compensation, which is a California state agency.
Q: How do I fill out DWC-CA Form 10214(D)?
A: You should carefully read the instructions on the form and provide all the requested information, including details about the deceased worker, the dependent claimants, and the nature of the claim.
Q: What happens after I submit DWC-CA Form 10214(D)?
A: Once you submit the form, it will be reviewed by the workers' compensation insurer and the Division of Workers' Compensation. They will determine whether to approve or deny the claim.
Q: Are there any fees or costs associated with filing DWC-CA Form 10214(D)?
A: There may be filing fees and costs associated with filing DWC-CA Form 10214(D). It is recommended to check with the appropriate authorities for the current fee schedule.
Q: Can I negotiate the terms of the Compromise and Release?
A: Yes, you can negotiate the terms of the Compromise and Release with the workers' compensation insurer. It is advisable to consult with an attorney to ensure your rights are protected.
Form Details:
Download a fillable version of DWC-CA Form 10214(D) by clicking the link below or browse more documents and templates provided by the California Department of Industrial Relations - Division of Workers' Compensation.