Online Form Submission

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Disclosure Agreement
Who Is Completing
Step
Why applying
Step
Claim & Decision Information
Step
Contact Information
Step
Appointing a Representative
Step
Representation
Step
Reconsideration Details
Step
Hearing Details
Step
Addtional Information

Application to Reconsider a Decision

ATTENTION: Once you start to complete the Application to Reconsider a Decision, 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 #5 – Application to Reconsider a Decision for information that will help you complete your application.

Please make sure you have the items below before starting the application:

an email address; and
The Notice of Representation form if you have a representative, in either JPEG or PDF format.
Note: The form must be signed and dated by the person being represented within two (2) years of being submitted to the Appeals Commission.

Are you ready to continue?

Who is completing the Application to Reconsider a Decision?

Why are you applying to have an Appeals Commission decision reconsidered?

Claim & Decision Information
Enter a claim account number

I am making application for reconsideration of the following Appeals Commission Decision(s):

Decision Number

Decision Date

Worker's Information 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:

Appointing a Representative

You have the option of representing yourself or finding someone to help with an appeal to the Appeals Commission.

A representative is someone who is authorized, in writing, to act on your behalf (preparing your appeal and making arguments during your hearing).

You will need to provide your representative with written permission to get a copy of your file and act as your representative.

Notice of Representation form:

The Notice of Representation form gives us permission to discuss your appeal with your representative.

After you have a chosen a representative, you need to sign a Notice of Representation form and send it to the Appeals Commission.

Please submit a complete Notice of Representation form.

The form must be signed by the person who is being represented.
The date on the form must be no more than 2 years earlier than the date the form is submitted.

Representative’s Information

Representative's Email Address:

Please complete the 'Notice of Representation' form. This form must then be signed and dated before uploading. The form must be signed and dated by the person being represented within two (2) years of being submitted to the Appeals Commission.

Notice of Representation:

Upload the 'Notice of Representation' form in either PDF or JPEG format.

Document 1 ►	New Evidence Significant Defect New Evidence Application Details (Document 1) Document Number: Document Date: Document Author: Upload Document: Description of the Document Why is the document new evidence? What issues of appeal does the document refer to? Why didn’t you submit the document at the initial hearing? Why is this document relevant to the decision? How would it change the decision that was made? A Significant Defect in the Appeal Process or Content of the Decision (Document 1) What issue of appeal has the defect? What are the specific ways you believe there was a significant defect in the process or content of the decision? How do you suggest this defect might be corrected?

Document 1 ►

New Evidence

Significant Defect

New Evidence Application Details (Document 1)

Document Number:

Document Date:

Document Author:

Upload Document:

Description of the Document

Why is the document new evidence?

What issues of appeal does the document refer to?

Why didn’t you submit the document at the initial hearing?

Why is this document relevant to the decision?

How would it change the decision that was made?

A Significant Defect in the Appeal Process or Content of the Decision (Document 1) What issue of appeal has the defect?

What are the specific ways you believe there was a significant defect in the process or content of the decision?

How do you suggest this defect might be corrected?

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 to have a decision reconsidered.

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