Free IC14d - Illinois

STATE OF ILLINOIS

) ) COUNTY OF ______________ )

ILLINOIS WORKERS' COMPENSATION COMMISSION
ORDER TO DISMISS OR WITHDRAW PETITION UNDER SECTION 19(b-1) OF THE ACT

____________________________________________
Employee/Petitioner v.

Case # ________ WC ____________________

____________________________________________
Employer/Respondent

Setting ____________________________

On ______________________ , this case was set for a trial ____ pretrial ____ under Section 19(b-1) of the Act in the city of ________________________________ , Illinois. I hereby order the following: ____ The petition is dismissed for the following reasons: _______________________________________ _________________________________________________________________________________ ____ The petition is withdrawn, in response to the petitioner's request. A record of the hearing was ____ was not ____ made. This order shall not be a bar to any further hearings on this case or any subsequent petitions under Section 19(b) or 19(b-1) of the Act. Unless the parties appeal this order within 30 days of its receipt and perfect the review in accordance with the Act and Rules, this order will be entered as the decision of the Commission. If the petition was withdrawn, or if the parties agree below, the order may not be appealed. If this order is appealed, and the order is not affirmed by the Commission, the time limit provided by law for filing the final decision shall be tolled until the Commission issues its decision.
_______________________________________________ Signature of arbitrator ____________________________ Date

S TIPULATION ____ ____ The parties agree this order should be entered. The parties agree that the petitioner may refile the Petition for an Immediate Hearing at the arbitrator's status or trial date on __________________________ , as long as the petitioner gives the respondent some prior notice. The parties do not need to refile or re-serve any of the original documents that were attached to the original petition.
_____________________________________________ Signature of respondent or respondent's attorney

_______________________________________________ Signature of petitioner or petitioner's attorney

_______________________________________________ Name of petitioner or petitioner's attorney (please print)

_____________________________________________ Name of respondent or respondent's attorney (please print)

IC14d 12/04 100 W. Randolph St. #8-200 Chicago, IL 60601 312/814-611 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