STATE OF ILLINOIS ) Injured Workers’ Benefit Fund (§4(d)) Rate Adjustment Fund (§8(g) ) COUNTY OF _________________) Second Injury Fund (§8(e)18) None of the above ILLINOIS WORKERS’ COMPENSATION COMMISSION DECISION Case # WC Employee/Petitioner v. Employer/Respondent The petitioner on filed a petition or motion for , and properly served all parties. The matter came before me on in the city of . After hearing the parties' arguments and due deliberations, I hereby grant A record of the hearing was not the petition. made. FINDINGS OF FACT AND CONCLUSIONS OF LAW: Unless a Petition for Review is filed within 30 days from the date of receipt of this order, and a review perfected in accordance with the Act and the Rules, this order will be entered as the decision of the Workers’ Compensation Commission. ______________________________________________ Signature of arbitrator Date IC34d 11/08 100 W. Randolph Street #8-200 Chicago, IL 60601 312/814-6611 Toll-free 866/352-3033 Web site: www.iwcc.il.gov Downstate offices: Collinsville 618/346-3450 Peoria 309/671-3019 Rockford 815/987-7292 Springfield 217/785-7084 American LegalNet, Inc. www.FormsWorkflow.com