5. RESULT/BENEFIT REQUESTED FROM APPEAL
Provide a brief answer for each Review Reference # you wish to appeal.
6. WORKPLACE POSTING REQUIREMENT
Proceed to question 7 if this is not an administrative penalty appeal (there is
no posting requirement for other types of appeals).
7. METHOD OF APPEAL
WCAT will decide how your appeal will proceed. Please indicate your preference below:
*
If requesting an oral hearing, tell us why an oral hearing is necessary:
8. REPRESENTATION
You may appoint one person or an organization to represent you or choose to represent
yourself. Please indicate your choice below.
This form must be signed by the appellant or an authorized representative. If signed
by an authorized representative we need an authorization less than 2 years old signed
by the appellant. An Authorization of Representative form can be found on
our website (www.wcat.bc.ca).
That Authorization
9. CERTIFICATION AND AUTHORIZATION
I confirm the information on this form is correct and complete. I will notify WCAT
if I change my address or phone number. I understand that WCAT must have my current
address to keep my appeal active. I authorize my representative named above to act
on my behalf in this appeal.
For workers: I authorize disclosure of the WorkSafeBC file(s) and
information from any source relating to this appeal to WCAT, my representative,
and other parties to this appeal for the purposes of this appeal and as allowed
under section 260 of the Workers Compensation Act .
10. FORM CHECK-LIST
Extension of Time To Appeal form(found at www.wcat.bc.ca or call us for one)?
Application for a Stay form if you want to
apply for a stay (found at www.wcat.bc.ca or call us
Personal information on this form is collected for the processing of an appeal to
WCAT under the Workers Compensation Act and the Freedom of Information and Protection
of Privacy Act . For further privacy information, please contact WCAT's Freedom of Information
Coordinator at the address or telephone number provided above.
4, continued:
5, continued:
7, continued:
