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Application for Interim Relief

ATTENTION: Once you start to complete the Application for Interim Relief, you will NOT be able to save the information and come back to submit it later. It will not save or be submitted until you click the SUBMIT button.

Please see Practice Guideline #7 – Requesting Interim Relief for information that will help you complete your application.

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Are you a worker or employer applying for Interim Relief?

Interim Relief for Worker's Information Interim Relief for Employer's Information

Last Name:

First Name:

Name of Contact:

Contact Phone:

Address

Street:

Apartment/Unit#:

City/Town:

Province:

Postal Code:

Email Address:

Home Phone:

Mobile Phone:

Work Phone:

Fax Number:

Messages:

Claim Information

Claim Number(s):

Application for Interim Relief

NOTE: You must answer all questions below for us to accept your application.

Does the workeremployer have an arguable case? (Arguable case is a case that presents sufficiently detailed facts, identifies legal or factual issues that are plausible and which, if accepted by the decision maker, could substantially affect the decision in the case.)

Does the decision under review or appeal affect the entitlement to current wage loss benefits, and the sum in question is greater than $500? Does the decision under review or appeal impact assessed premiums by more than $500? Please provide documents that show the decision being appealed to the Appeals Commission may impact your assessed premiums by more than $500. These documents can include financial statements, a letter from a bookkeeper, a letter from an accountant, or anything else you think is relevant.

Does the employer demonstrate that the waiting time to have the matter resolved will place the employer in significant financial hardship such as the inability to continue operations, or the employer being forced to lay off a significant portion of its workforce? Please provide documents to support your answer, such as:

Documents that show you will not be able to continue operating while waiting for the Appeals Commission’s decision.
Documents that show you will have to lay off a significant number of employees while waiting for the Appeals Commission’s decision.

These documents can include financial statements, a letter from a bookkeeper, a letter from an accountant, or anything else you think is relevant.

Is the worker, spouse or adult interdependent partner ineligible for any other financial support? Please include documents to support your answer. These can include documents that show you, your spouse or partner are not able to get financial support, like money or benefits, from anywhere else. For example, a document from a government agency or organization which provides money or other benefits to people, like Employment Insurance, Assured Income for the Severely Handicapped or Income Support.

Without interim relief, would the worker and his/her family be placed in necessitous circumstances such as probable inability to afford basic necessities of life such as food, clothing and shelter, or face probable forfeiture or seizure of assets (for example, the family home)? Please include documents to support your answer.
These documents can include:

Financial records such as bank and credit card statements.
Documents showing information about mortgage, rent or lease payments and about your ability to make the payments.
A monthly income and expense statement. This includes a list of how much money you receive each month and from where. It also includes a list of how much money you spend each month and what you spend it on.

Hearing Information

Note that interim relief applications are usually heard on a documentary basis so that we can make a decision as soon as possible. You may request an in-person hearing but this could delay the process and increase the time you will wait for a decision. The Appeals Commission will make the final decision on how to hear your application.

Hearing Type

What type of hearing do you want?:

Documents-only

In-person

Teleconference

Video Conference

Additional Information

Please use this section to provide any additional information you feel the Appeals Commission needs to process your request for Interim Relief.

You can type the information or upload a file in either PDF or JPEG format.