Order To Dismiss Or Withdraw Petition Under Section 19(B-1) Of The Act Template

Download a blank fillable Order To Dismiss Or Withdraw Petition Under Section 19(B-1) Of The Act Template in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Order To Dismiss Or Withdraw Petition Under Section 19(B-1) Of The Act Template with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

STATE OF ILLINOIS
)
)
______________
COUNTY OF
)
ILLINOIS WORKERS' COMPENSATION COMMISSION
ORDER TO DISMISS OR WITHDRAW
PETITION UNDER SECTION 19(b-1) OF THE ACT
____________________________________________
Case #
WC
________
____________________
Employee/Petitioner
v.
____________________________________________
Setting ____________________________
Employer/Respondent
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____ The petition is withdrawn, in response to the petitioner's request.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 If the petition was withdrawn, or if the parties agree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 petitioner or petitioner's attorney
Signature of respondent or respondent'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:
Downstate offices: Collinsville 618/346-3450 Peoria 309/671-3019 Rockford 815/987-7292 Springfield 217/785-7084

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Response To Petition For Immediate Hearing Under Section 19(b-1) Of The Act Form Response To Petition For Immediate Hearing Under Section 19(b-1) Of The Act Form Legal
Petition For Review Under Section 19(h) Or 8(a) Of The Act Template Petition For Review Under Section 19(h) Or 8(a) Of The Act Template Legal
Illinois Workers' Compensation Commission Petition For An Immediate Hearing Under Section 19(b) Of The Act Form Illinois Workers' Compensation Commission Petition For An Immediate Hearing Under Section 19(b) Of The Act Form Legal
Form D - Form Of Memorandum Of Appeal To The First Appellate Authority Under Section 19 (1) Of The Act Form D - Form Of Memorandum Of Appeal To The First Appellate Authority Under Section 19 (1) Of The Act Legal
Form 42 - Notice To Person Under Subsection 38.1 Of The Act Of Application For Psychiatric Assessment Form 42 - Notice To Person Under Subsection 38.1 Of The Act Of Application For Psychiatric Assessment Legal
Form Mcs-90 - Endorsement For Motor Carrier Policies Of Insurance For Public Liability Under Sections 29 And 30 Of The Motor Carrier Act Of 1980 Form Mcs-90 - Endorsement For Motor Carrier Policies Of Insurance For Public Liability Under Sections 29 And 30 Of The Motor Carrier Act Of 1980 Legal
Form 7036 - Election Under Section 1101(g)(4) Of The Bipartisan Budget Act Of 2015 Form 7036 - Election Under Section 1101(g)(4) Of The Bipartisan Budget Act Of 2015 Financial
Application For Certificate For Purposes Of Claiming Exemption Under Section 42(2)(c) Of The Income Tax Act - Trinidad And Tobago Housing Development Corporation Application For Certificate For Purposes Of Claiming Exemption Under Section 42(2)(c) Of The Income Tax Act - Trinidad And Tobago Housing Development Corporation Legal
Form 6069 - Return Of Excise Tax On Excess Contributions To Black Lung Benefit Trust Under Section 4953 And Computation Of Section 192 Deduction Form 6069 - Return Of Excise Tax On Excess Contributions To Black Lung Benefit Trust Under Section 4953 And Computation Of Section 192 Deduction Financial
Form 6069 - Return Of Excise Tax On Excess Contributions To Black Lung Benefit Trust Under Section 4953 And Computation Of Section 192 Deduction Form 6069 - Return Of Excise Tax On Excess Contributions To Black Lung Benefit Trust Under Section 4953 And Computation Of Section 192 Deduction Financial

Related Categories

Parent category: Legal
Download
Go