Notice of Appeal Form

Definition

The Appeals Commission is the final level in the WCB appeal process. In accordance with the Workers’ Compensation Act, the Appeals Commission can only hear appeals that have already been decided by a WCB review body (formerly known as the Claims Services Review Committee (CSRC) or the Assessment Review Committee (ARC)).

The best method of providing notice of appeal is to:

1. complete a Notice of Appeal Form and

2. attach a copy of the decision being appealed

It will assist in the prompt processing of your appeal if you use and properly complete the Notice of Appeal form. You may submit your appeal in a letter; however, all information required on the form must be provided.

The Notice of Appeal Form can be used by both injured workers and employers.

Instructions

Please refer to Instructions for Filing an Appeal for details about how to complete the Notice of Appeal Form.

To submit your appeal:

1. Print the Notice of Appeal Form by clicking on the icon below
2. Fill in the required information
3. Mail to the Edmonton office at:

Appeals Commission
#901, 10109 - 106 Street
Edmonton, Alberta T5J 3L7

OR

Fax your form to:
(780) 412-8701

If you need any assistance completing this form, please refer to the Instructions for Filing an Appeal.

Notice of Appeal Form