METRO CLERKING
YOUR COOK COUNTY CLERK RESOURCE CENTER
ORDER WORK COMP COVERAGE HERE
CHICAGO CALL COVERAGE 2:00 PM ONLY

THIS FORM WILL ONLY BE USED FOR RFH (REQUEST FOR HEARING)

19 B'S AND ALL MOTIONS NEED TO BE FAXED TO WORK COMP FAX #

312-212-4048 OR E-MAILED to Sam@MetroClerking.com



DATE TO COVER:
CASE NUMBER:
PETITIONER:
RESPONDENT:
TIME:
ARBITRATOR
REPRESENT PETITIONER
REPRESENT RESPONDENT
YOUR REQUEST FOR  HEARING
O/C REQUEST FOR HEARING
AVAILABLE DATES LISTING IN ORDER OF PREFERENCE:
LISTING AS MANY AS POSSIBLE
Your name:
Firm name:
Phone:
Fax:
E-mail address:
Additional information:
 




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