Sample Summons and Complaint forms for filing an Appeal of a LIRC Worker's Compensation Decision to Circuit Court --

This page provides links to sample summons and complaint forms to be used to appeal a LIRC Worker's Compensation Decision to Circuit Court

DISCLAIMER: The sample summons and complaint forms made available by the Labor and Industry Review Commission are intended solely as a guideline for those appealing decisions of the commission to the circuit court. It is not meant to be legal advice, nor is it legal advice in any fashion. The forms do not in any way remove from the individual the responsibility to research and comply with all applicable statutory requirements for the filing and processing of an appeal of a commission decision with the circuit court. For legal advice, you may want to contact an attorney.

Please note
: Merely printing out set of these forms from this website does not start an appeal.  You cannot start an appeal of a LIRC WC Decision "on line".  To start an appeal you must prepare, file, and serve actual paper sets of the summons and complaint, as required by law (including service on LIRC of "authenticated  pleadings").

These forms are provided here in .pdf format,  and they are intended to be printed out. When they are printed out, you may either fill in the blanks in the forms by hand, or use them as models to prepare your own summons and complaint with the necessary information entered.

Sample summons & complaint form  for Applicants (Employees) in Worker's Compensation cases.

Further information about how to start an appeal of a LIRC WC Decision to Circuit Court can be found here:

Description of Appeal Rights And Procedures (En Español)

Frequently Asked Questions ("FAQs") On Appealing A LIRC WC Decision To Circuit Court