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This version of the form is not currently in use and is provided for reference only. Download this version of
DWC-CA Form 10214 (A)
for the current year.
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.
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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