Notice of Appeal

DOWNLOAD PRINTABLE NOTICE OF APPEAL FORM

WCAT strongly recommends that you appeal with the help of an experienced and professional representative, such as an advocate or a lawyer. Advocates are available free of charge—simply call 1-844-530-0282.

If you decide to appeal with an advocate or lawyer, do NOT complete this form—your representative will do it on your behalf. If you decide to appeal without a representative, then please complete the following form accurately and completely.

WCAT will forward your successfully-filed Notice of Appeal to all relevant parties. Note that it can take several months before an appeal hearing is scheduled.

Submit Notice of Appeal Online

Appellant type:

Worker

Employer

Appellant information:

Appellant Name or Company Name:

Provide the name and contact information for the person who will be responsible for the appeal.

Salutation:

Given name(s):

Last name:

Address:

City:

Province:

Postal Code:

Email address:

Phone number:

Facsimile number:

Mobile number:

Which language would you prefer be used for spoken communication?

English

French

Which language would you prefer be used for written correspondence?

English

French

Will someone be representing you during this appeal process?

I will represent myself

I don't currently have a representative, but intend to

I have a representative

If you do not have a representative and would like to speak with an advocate please call the following toll free number: 1-844-530-0282

Respresentative

Salutation:

Given name(s):

Last name:

Business name or organization:

Address:

City:

Province:

Postal Code:

Email address:

Phone number:

Facsimile number:

Mobile number:

I understand and agree

The representative listed above is duly appointed and/or authorized as a representative to act on behalf of the appellant in this appeal.

Provide the name and contact information of the person within the company who will be responsible for the appeal.

Decision(s) you wish to appeal

Complete the information below for each decision you wish to appeal.

Decision(s) you wish to appeal
Applicant: Claim Number: Date of Commission's decision: Attach a copy of the decision: One file only. 25 MB limit. Allowed types: pdf, jpeg, png, jpg, gif. Grounds for appealing decision: Are you challenging a WorkSafeNB policy? Yes No Policy, section, and reason for challenge: If you answered "no" to the previous question, please type N/A below.

Are you ready to proceed?

Yes, I am ready to have a hearing date scheduled.

No, I am not yet ready to have a hearing date scheduled.

If necessary, please use this section to provide any additional information you feel the Workers' Compensation Appeals Tribunal requires in processing your Notice of Appeal.

Additional information:

As required under subsection 21(2.2) of the Workplace Health, Safety and Compensation Commission and Workers’ Compensation Appeals Tribunal Act, your Notice of Appeal will be delivered/forwarded to the Commission, the Office of the Workers’ Advocate and the Office of the Employers’ Advocate.

I understand and agree

This form has been completed accurately and completely by the appellant and/or duly authorized representative. Notices submitted online via this form are governed by our Privacy Policy. Pressing ‘Submit’ will transmit this form to the New Brunswick Workers’ Compensation Appeals Tribunal.