Petition For An Immediate Hearing Under Section 19b Of The Act {IC7}

IC7 - PETITION FOR AN IMMEDIATE HEARING UNDER SECTION 19(b) OF THE ACT. This form is used by an injured employee (the petitioner) to request an expedited hearing before the Illinois Workers’ Compensation Commission. This petition is typically filed when the employee is unable to return to work due to a job-related injury or disability, and is not receiving temporary total disability (TTD) benefits or necessary medical benefits from the employer. The form requires detailed information about the accident, including the date, time, location, description of the incident, the nature of the injuries sustained, and whether notice was given to the employer. It also asks whether the employer has refused to pay compensation or medical benefits, whether the employee was treated by an employer-selected medical provider, and if any medical bills are in dispute. The form includes documentation of attempts to notify the employer of the inability to work, such as a statement from a medical provider, and records the last date TTD benefits were paid, if at all. Additionally, the petitioner must confirm that they attempted to resolve the issue with the employer or their representative prior to filing. The respondent (employer) is required to respond to the petition within 15 days of service. A Proof of Service section ensures proper delivery of the petition to all relevant parties and the assigned arbitrator. www.FormsWorkflow.com