Notice Of Rejection Of Settlement Contract {IC32}

ILLINOIS WORKERS COMPENSATION COMMISSION NOTICE OF REJECTION OF SETTLEMENT CONTRACT __________________________________________ Case # ________ WC ____________________ Employee/Petitioner v. __________________________________________ Employer/Respondent This settlement contract was presented to me on ____________________ . I am rejecting it for the following reason: ________________________________________________________________________ ______________ ________________________________________________________________________ ______________ ________________________________________________________________________ ______________ ________________________________________________________________________ ______________ The parties have ____ have not ____ been advised that, after assignment by the Review Unit, they may have the rejected contract reviewed by a commissioner, who may approve or reject the contract. _________________________________________________ ____________________________ Signature of arbitrator Date ARBITRATOR: if you reject a contract, please attach this form to the contract. ATTORNEY: if you wish to have the rejected contract reviewed by a commissioner, please bring it to the Review Unit for assignment.COMMISSIONER: if you reject this contract, please return it to Data Entry for the ca se to be returned to the call. IC32 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