| Worker Last Name | Fill in the worker's last name, even if you are starting this appeal as a dependent of a deceased worker, or as an employer. |
| Worker First Name | Fill in the worker's first name, even if you are starting this appeal as a dependent of a deceased worker, or as an employer |
| WorkSafeBC Claim Number | What is a WorkSafeBC claim number?
When a claim is made with WorkSafeBC for a work related injury or disease, a claim number is assigned to the worker by WorkSafeBC that is unique to a claim.
Old format is an eight digit number (example 11234561). New format is a nine digit number (example 123456789)
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| WorkSafeBC Customer Care Number | What is a WorkSafeBC Customer Care Number?
A WorkSafeBC Customer Care number is an 11 digit number that begins with a 9, which WorkSafeBC gives to a worker for life to identify the worker.
A worker may have many claim numbers but only one Customer Care number. |
| Worker BC Care Card Number | You will find the personal health care number on the worker's BC CareCard. 
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| Mailing Address | You must be sure that the address you give is correct because this is where our registry will send any further notices or information to you. If your address changes at any time, notify us at WCAT immediately. You should also notify WorkSafeBC if your address changes. |
| City | Example: Victoria |
| Province | Example: BC |
| Postal Code | Example: A1B 2C3 |
| Daytime Phone | Example: (250) 123-4567 |
| Other Phone | Example: (250) 123-4567 |
| Fax | Example: (250) 123-4567 |
| Date of Review Division Decision | You must identify the date of the Review Division decision that you are appealing. Where do I find the date of the Review Division decision? You will find this date on the first page of the Review Division decision. If you are appealing more than one Review Division decision, list the date of each decision. 
Format for the Date of Review Division Decision is: yyyy/mm/dd |
| Review Decision Reference Number | You must identify the reference number of the decision that you are appealing. Where do I find the Review Division reference number? You will find the reference number on the first page of the Review Division decision. There may be more than one reference number listed on a Review Division decision. Each reference number refers to one WorkSafeBC decision that is being reviewed. List only the reference number(s) that you want to appeal. 
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| Reason for Appeal | This is where you provide a brief explanation about why you think the decision you are appealing is incorrect or should be changed. You only need to include the basic information on this form to start your appeal. We will give you the opportunity later to provide more information and evidence, either through written or verbal submissions. If you are appealing more than one Review Division reference number, explain why you think each decision is incorrect or should be changed. |
| Result/Benedit Requested from Appeal | This is where you tell us what results or benefits you want from your appeal. You should relate the results or benefits you are requesting to the issues raised by the decision you are appealing. If you are appealing more than one decision, state what results or benefits you are requesting for each decision. |
| Disclosure | Disclosure is an updated copy of your claim file. If you are a worker and your employer is participating in your appeal, WorkSafeBC will also send your employer disclosure. You can choose whether you would like to receive disclosure of your claim file on a CD or in a paper format. Please check which method of disclosure you prefer. |
| Method of Appeal - Written | This method is often suitable for appeals that deal with medical, legal, or policy issues. |
| Method of Appeal - Oral | Normally, we use oral hearings for appeals involving significant issues of credibility, multiple appeals of a complex nature, complex issues with important implications for the compensation system and significant factual issues are in dispute. Other compelling reasons for having an oral hearing include where an appellant or respondent has difficulty communicating in written English. |
| Oral Hearing Location | WCAT holds oral hearings in the towns and cities throughout the province of British Columbia which are listed here. If WCAT decides to hold an oral hearing, please choose the town or city where you would like the oral hearing to take place. |
| Interpreter | WCAT will provide an interpreter at no charge at the oral hearing if you need one. You cannot use a friend or relative as an interpreter. Your hearing may be rescheduled if your vice chair believes an interpreter Is necessary. If you need an interpreter please check Yes. If you do not need an interpreter please check No. |
| Witnesses | Both you and the respondent may bring witnesses to give evidence at the hearing. Please send us the names and addresses of the witnesses you will be bringing at least 21 days before your hearing. |
| Language | Example: Chinese |
| Dialect | Example: Mandarin |
| Will you be representing yourself? | You may appeal on your own, or you may want to ask for assistance from someone familiar with the workers' compensation system, such as a compensation consultant, a lawyer, an employers' association or a union representative. You can get free help with your appeal from a workers' adviser if you are a worker, or an employer's adviser if you are an employer. |
