Petition To Reinstate Case {IC23}

ILLINOIS WORKERS COMPENSATION COMMISSION PETITION TO REINSTATE CASE ATTENTION: This petition must be filed within 60 days of receipt of the dismissal order. _______________________________________________ Case # ________ WC ____________________ Employee/Petitioner v. _______________________________________________ Employer/Respondent On _____________________ , this case was dismissed for want of prosecution. I received the dism issal order on _____________________ . On _____________________ , I will present this petition to reinstate the case before Arbitrator ______________________________________ for the following reason: ___________________________________________________ Signature ___________________________________________________ Name (please print; attorneys, please include IC code number) _________________________________________________ Telephone number _________________________ Date IC23 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 Ro ckford 815/987-7292 Springfield 217/785-7084 American LegalNet, Inc. www.USCourtForms.com