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Illinois Form Center -

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Form

Description

ic-45.pdf Employer's First Report of Injury
ic-85.pdf Employer's Supplementary Report of Injury
ia-1.pdf Workers' Compensation - First Report of Injury or Illness
ia-2.pdf Workers' Compensation - Subsequent Report
paragraphs.pdf Arbitration Decision Order Paragraphs
ic-arb-dec.pdf Arbitration Decision
ic-crb.pdf Commission Review Board Complaint Form
arb-19b.pdf 19(b) Arbitration Decision
arb-19b-1.pdf 19(b-1) Arbitration Decision
arb-fatal.pdf Fatal--Arbitration Decision
arb-NE.pdf Nature and extent-Arbitration Decision
ic-34d.pdf Decision (Short Form-Appeal-able)
ic-34o.pdf Order (Short Form-Interlocutory)
ic-34s.pdf Order Removing Settled Case from Call
ic-01.pdf Application for Adjustment of Claim (Application for Benefits)
ic-04.pdf Notice of Motion and Order
ic-05.pdf Settlement Contract Lump Sum Petition and Order (Submit on Pink Paper)
ic-06.pdf Appearance of Representative
ic-07.pdf Petition for an Immediate Hearing under Section 19(b) (Submit on Blue Paper)
ic-08.pdf Response to Petition for an Immediate Hearing under Section 19(b) (Submit on Goldenrod Paper)
ic-09.pdf Request for Hearing
ic-10.pdf Attorney Representation Agreement
ic-11.pdf Petition for Review of Arbitration Decision (Submit on Orchid Paper)
ic-11a.pdf Petition for Review of Arbitration Decision under Section 19(b-1) (Submit on Orange Paper)
ic-14.pdf Petition for Review under Section 19(h) or 8(a) (Submit on Aqua Paper)
ic-14a.pdf Petition for Immediate Hearing under Section 19(b-1) (Submit on Gray Paper)
ic-14b.pdf Response to Petition for Immediate Hearing under Section 19(b-1) (Submit on Green Paper)
ic-14d.pdf Order to Dismiss or Withdraw Petition under Section 19(b-1)
ic-15.pdf Proof of Service (Submit on Pink Paper)
ic-16.pdf Subpoena (Submit on Yellow Paper)
ic-17.pdf Motion to Voluntarily Dismiss Case
ic-19.pdf Order to Dismiss Case for Want of Prosecution
ic-23.pdf Petition to Reinstate Case
ic-25.pdf Notice of Intent to File for Review in Circuit Court
ic-26.pdf Notice of Change of Address
ic-27.pdf Motion to Dismiss Attorney of Record
ic-28.pdf Motion to Withdraw as Attorney of Record
ic-29.pdf Stipulation to Substitute Attorneys
ic-31.pdf Rehabilitation Plan
ic-32.pdf Notice of Rejection of Settlement Contract
ic-33.pdf Dedimus Potestatem
ic-36.pdf Request for Voluntary Arbitration
ic-41.pdf Arbitration Information Sheet
ic-50.pdf Application for Self-Insurance
ic-50e.pdf Public Insurer Election To Self Insure
ic-50s.pdf Application for Self-Insurance for Subsidiary or Affiliate or Current Self-Insured Company
ic-51.pdf Petition for Reconsideration of Application for Self-Insurance
ic-52.pdf Self-Insurer's Surety Bond
ic-53.pdf Self-Insurer's Surety Bond: General Purpose Rider
ic-55.pdf Self-Insurer's Surety Bond: Self-Administered Claims Endorsement
ic-56.pdf Self-Insurer's Surety Bond: Cancellation Amendment and Acknowledgement
ic-62.pdf Self Insurer's Escrow Agreement
ic-63.pdf Self Insurer's Escrow Agreement Amendment
ic-64.pdf Self Insurer's Escrow Agreement: Release of Escrow Deposit
ic-72.pdf Self-Insurer's Agreement to Post Letter of Credit
ic-73.pdf Self-Insurer's Agreement to Post Letter of Credit: Schedule of Supplement
ic-80.pdf Certificate of Excess Insurance
ic-81.pdf Multiple Security Endorsement
ic-90.pdf Parent Guaranty Agreement in Connection with Self-Insurance Privilege
ic-91.pdf Parent Guaranty Agreement in Connection with Self-Insurance Privilege: Amendatory Schedule of Additional Employers
ic-44.pdf Injured Workers' Benefit Fund: Request for Benefits and Affidavit
ic-46.pdf Request for Information on Employers Insurance Coverage
ic-ac.pdf Application for IWCC Attorney Code Number
ic-pn.pdf POSTER - Workplace Notice
ic-pn-sp.pdf POSTER - Workplace Notice (Spanish)
handbook.pdf Brochure -Handbook on Workers' Compensation and Occupational Diseases for Injuries and Illnesses
handbooksp.pdf Brochure -Handbook on Workers' Compensation and Occupational Diseases for Injuries and Illnesses (Spanish)
PPP.pdf Preferred Provider Program notice. (Required if PPP is being used)
PPPsp.pdf Preferred Provider Program notice. (Required if PPP is being used)(Spanish)
PPPadv.pdf Preferred Provider Program advisory notice (Required if PPP is being used)
PPPadvsp.pdf Preferred Provider Program Advisory Notice (Required if PPP is being used) (Spanish)