Arbitration Case Information Sheet {IC41}

IC41 - ARBITRATION CASE INFORMATION SHEET. This form from the Illinois Workers’ Compensation Commission is used to provide the assigned arbitrator with a current summary of the status of a workers’ compensation case before or during a hearing. This form must be completed jointly by both parties—typically the attorneys representing the employee (petitioner) and the employer (respondent)—and submitted to the arbitrator without interrupting proceedings. It includes important case details such as whether the petitioner is receiving temporary total disability (TTD) benefits, is still undergoing medical treatment (along with the provider’s name and date of last treatment), or is receiving vocational rehabilitation services. The form also asks for updates on depositions, trial readiness, tentative settlements, Medicare set-aside approvals, and prior trial activity. Both attorneys must sign the form, print their names, and provide email contact information. www.FormsWorkflow.com