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I ELECT NOT TO BE COVERED UNDER THE ILLINOIS WORKERS COMPENSATION ACT. NAME TITLE SOCIAL SECURITY NUMBER POLICY NUMBER SIGNATURE Form WC 88 12 01 A Printed in U.S.A. ABCDEFGHIJ ILLINOIS WORKERS COMPENSATION COVERAGE ELECTION/REJECTION FORM If you are a sole proprietor or partner you must check off one and only one box in either section A or B.

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How to fill out the Insurance and Illinois Election Rejection Forms online

This guide provides clear, step-by-step instructions for completing the Insurance and Illinois Election Rejection Forms online. With this information, you can navigate the process confidently, whether you are a sole proprietor or partner.

Follow the steps to fill out the form accurately and efficiently.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Identify whether you are a sole proprietor or partner and check only one box in either section A or B. Section A is for acceptance of coverage, while Section B is for waiver of rights under the Illinois Workers' Compensation Act.
  3. If you choose Section A, read the statement regarding acceptance of coverage under the Illinois Workers’ Compensation Act. This indicates your preference to be covered for accidental injuries arising from your employment.
  4. If you choose Section B, acknowledge the waiver of rights. This means you are electing not to be covered under the Illinois Workers’ Compensation Act, thereby waiving all rights related to accidental injuries sustained during employment.
  5. Fill in your personal information, including your name, title, social security number, and policy number.
  6. Provide your signature to validate the information you have submitted.
  7. Include the date of signing the form.

Take control of your insurance decisions by completing your forms online today.

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The State of Illinois requires businesses to carry workers' compensation insurance if they have at least one part- or full-time employee. Certain types of employees don't need to have coverage and are excluded from state law, such as: Sole proprietors. Corporate officers.

To appeal a denial, file an Application for Adjustment of Claim with the IWCC. If you are unable to work and need your case heard sooner, you can file a Petition for Immediate Hearing. With this avenue, you will have your final decision within 180 days.

Steps to Filing Workers Comp in Illinois Seek medical care. It is important that you seek medical care as soon as you know that you have sustained a workplace injury. ... Notify your employer. ... Employer response. ... Regularly report to your employer. ... Check the status of your claim.

If workers' comp denies your claim, you will be liable for covering your treatment cost. This situation can be scary, particularly if you required a costly surgery, a prolonged hospital stay, or a lengthy treatment period to treat your injuries or condition.

Sole Proprietors and Partners are included under coverage if they meet the definition of an employee. Otherwise they are excluded. Owners can elect to have coverage. Corporate Officers and LLC Members are automatically included in coverage, but may elect to be exempt.

What Is the Waiting Period for Workers' Compensation in Illinois? There is a three workday waiting period for workers' compensation in Illinois. This means hurt or sick employees get benefits on the fourth day if they're still hurt or sick.

Petition for Reconsideration. An employee may file this appeal with the Workers' Compensation Appeals Board (WCAB) to request a review of the decision made by the claims administrator or insurance carrier. This petition must be filed within one year of the date of denial.

Appellate Court Appeal in Illinois Both the insurance company and claimant have the option of appealing to the Illinois Workers' Compensation Commission Division of the Illinois Appellate Court.

The Commission must issue a decision within 60 days of the hearing.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232