Online Form Submission

Notice of Appeal

ATTENTION: Once you start to complete the Notice of Appeal application, 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 #1 – Filing an Appeal 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?

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.

What are you appealing?

I am appealing the following Dispute Resolution and Decision Review Body (DRDRB) decision(s):

Claim/ Account #

Date of WCB Review Body decision/WCB determination

Attach a copy of the decision/determination

Additional Information

Please use this section to provide any additional information you feel the Appeals Commission needs to process your Notice of Appeal.

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

You may attach any additional documents or submissions you believe need to be included with your Notice of Appeal. Please note, you will be given additional opportunities to submit documents before your hearing. Your appeal will be assigned to an Appeals Officer who will contact you with further instructions

A representative may submit this application only if they are authorized as a representative in this appeal. The appellant can authorize a representative by completing the Notice of Representation section of this application form or submitting a Notice of Representation form to the Appeals Commission.

By my clicking SUBMIT on the online form, I appeal the issue(s) in the decision(s) or determination described in my application.