Last updated on Feb 20, 2026
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ILLINOIS WORKERS COMPENSATION COMMISSION REQUEST FOR HEARING ATTENTION. Please give this form to the Arbitrator after you obtain a trial date. Case WC Consolidated cases Employee/Petitioner v* Setting Employer/Respondent Petitioner and Respondent are prepared to try this matter to completion on approves other arrangements. unless the Arbitrator 1. Petitioner claims that on Compensation or Occupational Diseases Act and their relationship was one of employee and employer. Respondent agrees...disputes. occupational disease that arose out of and in the course of employment. notice was given to. If in dispute Petitioner states that on with the job title average weekly wage calculated pursuant to Section 10 of the Act was 6. At the time of injury Petitioner was children* and the and claims years old married single with dependent Attach a list if necessary. Respondent claims it paid in medical bills through its group medical plan for which credit may be allowed under Section 8 j of the...Act. Petitioner agrees IC9 2/10 100 W* Randolph Street 8-200 Chicago IL 60601 312/814-6611 Toll-free 866/352-3033 Web site www. iwcc*il*gov Downstate offices Collinsville 618/346-3450 Peoria 309/671-3019 Rockford 815/987-7292 Springfield 217/785-7084 TTD period s representing weeks. First day of lost time through Last day of lost time Attach a sheet if necessary to list additional periods. First day through Last day Maintenance period s in maintenance in TTD in TPD in nonoccupational indemnity...disability benefits and in other benefits for which credit may be allowed under 8 j of the Act. 10. The nature and extent of the injury is is not in dispute. Petitioner has has not filed a penalty petition* 12. A petition for attorney s fees by a former attorney is notified the former attorney of the date of this hearing. 19 l and/or 16 pending. Petitioner s attorney has 13. Other issues not listed above are 14. STENOGRAPHIC STIPULATION* Both parties agree that if either party files a Petition...for Review of Arbitration Decision and orders a transcript of the hearings and if the Commission s court reporter does not furnish the transcript within the time limit set by law the other party will not claim the Commission lacks jurisdiction to review the arbitration decision because the transcript was not filed timely. A written decision including findings of fact and conclusions of law is requested pursuant to Section 19 b. Date submitted Name of Respondent s insurance or service company...Attorney s name and IC code Name of law firm Street address City State Zip code Signature of Petitioner or Petitioner s attorney Telephone number Email address Signature of Respondent or Respondent s attorney NOTE The arbitration decision will be sent by certified mail to the addresses listed above. Case WC Consolidated cases Employee/Petitioner v* Setting Employer/Respondent Petitioner and Respondent are prepared to try this matter to completion on approves other arrangements. unless the...Arbitrator 1. Petitioner claims that on Compensation or Occupational Diseases Act and their relationship was one of employee and employer.
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What is request for hearing for
A request for hearing is a formal document submitted to ask for a hearing in a legal or administrative matter.
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Who needs request for hearing for?
Explore how professionals across industries use pdfFiller.
Request for hearing for is needed by:
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Individuals seeking legal recourse.
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Parties involved in administrative hearings.
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Lawyers representing clients in hearings.
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Anyone disputing a decision made by a government agency.
How to file a request for hearing for form form
What is the request for hearing process?
A request for hearing is a formal procedure in workers’ compensation cases that allows claimants to challenge decisions made by insurance companies or employers. This process serves as a vital aspect of the dispute resolution system in the Illinois Workers Compensation Commission framework. Timeliness and adherence to legal requirements are critical; submitting your request within stipulated deadlines is essential for ensuring your case is heard.
What forms and documents are required?
When filing a request for hearing, certain forms and documentation are crucial. The main form you will need is the Illinois Workers Compensation Commission Request for Hearing form, which is designed to communicate your intent and provide necessary details about your case.
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These forms are officially recognized documents necessary for processing your workers' compensation claim.
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This form specifically details the nature of your dispute and facilitates the scheduling of a hearing.
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Include supporting documents such as medical records and reports that substantiate your claims.
How do file a request for hearing?
Filing a request for hearing involves several key steps you must follow to avoid common pitfalls. Familiarizing yourself with the requirements will streamline the process and increase your chances for a favorable outcome.
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Ensure all sections are completed accurately, providing clear details regarding your case.
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Double-check for any missing information or signatures before submission, as incomplete forms can lead to delays.
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Follow the submission guidelines provided by the Illinois Workers Compensation Commission to ensure your form reaches the appropriate entity.
What are the key sections of the form?
Understanding the key sections of the form will help you provide accurate information that is critical for your case. Key sections include details about the employee petitioner, the employer respondent, claims related to accidental injuries, and notices regarding occupational diseases.
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This section includes personal information of the claimant, ensuring that the Workers’ Compensation Commission can correctly identify your case.
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This requires information about the employer, which is essential for establishing who is involved in the dispute.
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Clearly outline the nature of your claim, including details about the accident and the resulting injuries or conditions.
What disputes might arise during the hearing process?
Disputes during the hearing process can stem from various areas, such as disagreements over accident details or the extent of injuries. It's essential to be prepared for potential issues that may arise and have strategies in place to address them effectively.
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Usually revolve around the validity of claims, the severity of injuries, or employer liability.
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Consider mediation or negotiation tactics to facilitate resolution prior to a formal hearing.
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An arbitrator acts as a neutral party to help resolve disputes, guiding the proceedings and ensuring fairness.
Where can find resources for further assistance?
Access to the right resources when filing your request for hearing can make the process significantly easier. Both the Illinois Workers Compensation Commission and various online portals offer extensive support aimed at helping you navigate your claims.
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Provides a wealth of information including downloadable forms and guidelines for filing.
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Reach out to local offices for personalized assistance related to your case.
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Browse various online platforms offering tips and shared experiences from others who have filed similar forms.
How can pdfFiller help with document management?
Using pdfFiller can significantly enhance your experience in managing the Request for Hearing form and other related documents. With features designed for seamless PDF editing and eSigning, pdfFiller empowers users with tools to collaborate effectively on documents.
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Take advantage of cloud-based storage to access your documents from anywhere, ensuring you are always prepared.
How to fill out the request for hearing for
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2.Upload your blank request for hearing form or select a template from the library.
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3.Fill in your personal details, including name, address, and contact information, at the top of the form.
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4.Provide information about the hearing you are requesting, including the case number and relevant dates.
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5.Clearly state the reasons for your request for a hearing, ensuring to include any pertinent facts or evidence.
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6.Review the filled form for accuracy and completeness, checking all sections are filled out as needed.
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7.Save your completed request for hearing as a PDF or a fillable document.
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8.Submit the form through the required channels, either electronically via pdfFiller or through mail, as specified in the guidelines.
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