FORM: Application for a reconsideration of a WCAT decision

IMPORTANT: Learn more about applying for a reconsideration before completing this form.

This form will be submitted to the WCAT Tribunal Counsel Office for preliminary review. WCAT decisions are “final and conclusive” but we can reconsider our decisions on two limited grounds:

new evidence not previously available or discovered; and,
a jurisdictional defect (error).

Complete a separate application for each WCAT decision you want us to reconsider. You may apply for reconsideration on each ground (new evidence or jurisdictional defect) only once.

It takes about 20 to 30 minutes to complete this form. Make sure you have the following information ready:

The WCAT appeal number (e.g. A1909999 or 159999-A) or decision number (only for decisions made prior to June 2016, e.g. 2015-99999) for the decision you would like us to reconsider
The date of the WCAT decision you would like us to reconsider
The contact information for your representative (if you have one)

Questions marked (Required) must be filled out so that WCAT can start your application.

Collection and use of personal information: Personal information on this form is collected for the processing and adjudication of a WCAT matter under the Workers Compensation Act and the Freedom of Information and Protection of Privacy Act. Contact the Freedom of Information Coordinator at WCAT if you have questions.

What WCAT decision do you want us to reconsider?

Tell us about your WCAT decision. If you don’t have a WCAT decision, find out what you need to do before you can apply for a reconsideration.

WCAT appeal number (Required)

e.g. A1609999 (for appeals registered in 2016 or later) or 999999-A (for appeals registered in 2015 or earlier)

WCAT decision date (Required)

WCAT decision number

Only decisions made before June 2016 will have a separate decision number.

Was the appeal decision that you want us to reconsider about a worker's compensation claim? (Required)

Compensation claim appeals are different than appeals about employer accounts or actions.

Yes
No

WorkSafeBC claim number (Required)

Please provide the main claim number associated with the WCAT decision you want us to reconsider.

WorkSafeBC employer account number (Required)

Please provide the WorkSafeBC registered employer account number associated with the WCAT decision you want us to reconsider.

Tell us about yourself

What was your role in the WorkSafeBC claim? (Required)

I am the worker
I am the employer
I am the dependant of a deceased worker

What was your role in the WorkSafeBC prohibited action, assessment, or occupational health & safety matter? (Required)

I am the worker
I am the employer
I am the dependant of a deceased worker
I am the owner
I represent the union
I am a supplier
I am an independent operator

Your name (Required)

First Last

Your pronouns and title

Your pronouns and title will help us to address you respectfully during the application process. If you choose “not listed”, a new field will open where you can tell us your pronouns and/or title.

You are free to skip these questions. If there is information about your gender in the WorkSafeBC or Review Division file(s), we will use that when choosing how to address you.

Your pronouns

They/Them
She/Her
He/Him
Pronouns not listed

Your pronouns (Required)

Please tell us your pronouns.

Your title

Your title (Required)

Please tell us how you would like to be addressed.

Your job title/position

Your business/firm name (Required)

If you do not have a business/firm name, please enter “not applicable.”

Your WorkSafeBC employer account number (Required)

This is the number for your business/firm as registered with WorkSafeBC. If you are not registered with WorkSafeBC, please enter “not applicable”.

How WCAT can send you information

Please note: WCAT Online Services is not available for applications for a reconsideration. If you want to receive information about your application by email, please enter an email address below. Otherwise, WCAT will send you information by mail.

Your email address for firm confirmation and claim file (Required)

WCAT will use this email address to confirm that we have received this form.

If the matter being reconsidered is about a claim, WorkSafeBC can also use this address to provide you disclosure, which is a copy of the claim file. Videos, photographs, and audio statements will be delivered by mail on a DVD up to two weeks after the claim file is available online.

If you are represented, the claim file will be sent to your representative. You can enter your representative’s email address later.

Enter email Confirm email

Can WCAT share your email address with WorkSafeBC? (Required)

WorkSafeBC can use the email address you entered above to provide you disclosure, which is a copy of the claim file. If you are represented, the claim file will be sent to your representative.

WCAT can share the email address I entered above with WorkSafeBC
I prefer to receive my copy of the claim file by mail

Can WCAT share your email address with WorkSafeBC? (Required)

WorkSafeBC can use the email address you entered above to provide you disclosure, which is a copy of the claim file. If you are represented, the claim file will be sent to your representative.

WCAT can share the email address I entered above with WorkSafeBC
I prefer to receive my copy of the claim file by mail

Can WCAT share your email address with WorkSafeBC? (Required)

WorkSafeBC can use the email address you entered above to provide you disclosure, which is a copy of the claim file. If you are represented, the claim file will be sent to your representative.

WCAT can share the email address I entered above with WorkSafeBC
WCAT can share a different email with WorkSafeBC (I will enter it in a new field below)

Your alternate email address for disclosure (Required)

Enter email Confirm email

Can WCAT use your email address to send you information about your applications for a reconsideration? (Required)

Please note: WCAT Online Services is not available for applications for a reconsideration.

Yes, please send me email
No, I prefer mail

WCAT will send information about your Application for a Reconsideration to the mailing address you enter below.

Your mailing address (Required)

Please provide a mailing address even if you have provided an email address above.

Street address Address line 2 City Province / State / Region Postal / Zip code Country

Your phone number (daytime) (Required)

Your phone number (other)

Your fax number

Are you an Indigenous person (includes a person of Indigenous ancestry: Inuit, Metis, First Nations, non-status, status, and anyone with First Nations ancestry)?

Yes
No
I prefer not to answer

If you self-identify, you can work with a WCAT Navigator to tell your story. These experienced staff members can offer neutral support and make sure that cultural sensitivities are respected. This service is part of implementing the Truth and Reconciliation Commission’s Calls to Action. Learn more about self-identifying as Indigenous.

Representation

Do you have a representative? (Required)

No, I will be representing myself
Yes, I have a professional representative
Yes, I have a friend/family member representing me

As you are represented, notice of disclosure of the claim file will be sent to your representative at the information you provide below.

Please note that family and friend representatives are not authorized to receive a copy of the disclosure file. It will need to be sent to you instead.

As you are represented, notice of disclosure of the claim file will be sent to your representative at the information you provide below.

Please note that family and friend representatives are not authorized to receive a copy of the disclosure file. It will need to be sent to you instead.

As you are represented, notice of disclosure of the claim file will be sent to your representative at the information you provide below.

Please note that family and friend representatives are not authorized to receive a copy of the disclosure file. It will need to be sent to you instead. To receive information about appeal

Name of representative's organization/firm (Required)

Representative's name (Required)

First Last

Representative’s pronouns and title

Your representative’s pronouns and title will help us to address them respectfully during the application process. If you choose “not listed”, a new field will open where you can tell us your pronouns and/or title.

You are free to skip these questions. If there is information about your representative’s gender or title in the WorkSafeBC or Review Division file(s), we will use that when choosing how to address them.

Representative's pronouns

They/Them
She/Her
He/Him
Pronouns not listed

Representative's pronouns (Required)

Please tell us your representative’s pronouns.

Representative's title

Representative's title (Required)

Please tell us how to address your representative.

Representative's relationship to me (Required)

Can WCAT send emails to your representative about appeals and applications they are participating in? (Required)

Yes, please send email to my representative
No, my representative prefers correspondence by mail

Representative's email address for application information (Required)

WCAT will send information about your application to your representative at this email address. You can choose if your representative should receive a confirmation of this form later.

Enter email Confirm email

Email for disclosure (Required)

If the matter being reconsidered is related to a claim, WorkSafeBC will use your representative’s email address to send disclosure, which is a copy of the claim file.

WorkSafeBC can use the email address entered above to send disclosure
WorkSafeBC can use a different email address (I will add it below)

Representative's email address for disclosure (Required)

Representatives must provide an email address so WorkSafeBC can send them disclosure, which is a copy of the claim file.

Enter email Confirm email

Representative's mailing address (Required)

Street address Address line 2 City Province / State / Region Postal / Zip code Country

Representative's phone (daytime) (Required)

Representative's phone (other)

Representative's fax

Reasons for reconsideration

You must explain the specific grounds (reasons) for reconsideration. Please fill in A. New Evidence Not Previously Available, B. Jurisdictional Defect (Error), or both (if applicable).

A. New evidence not previously available

For each piece of new evidence, complete either (i) or (ii), and complete (iii). After submitting this form, please send a copy of your new evidence to WCAT.

(i) New evidence that did not exist

I have the following new evidence that did not exist before my WCAT decision:

(ii) Evidence existed but was not found (list the evidence and explain why you were not able to find it)

The following new evidence did exist before my WCAT decision, but I did not submit it because I did not know about it and I could not have found it if I tried:

(iii) New evidence substantial and material:

For each piece of new evidence, explain why the new evidence is substantial to the decision (has weight and supports a different conclusion than the WCAT panel) and how it is material (relevant) to the decision.

The new evidence is substantial because:

The new evidence is material because:

B. Jurisdictional Defect (Error)

The decision contains the following jurisdictional error(s):

(i) The procedure at WCAT was unfair because:

(ii) There was a jurisdictional error because

(a) WCAT decided a matter that it had no power to decide
(b) WCAT failed to decide a matter that it was required to decide.

Please explain:

Certification and authorization

Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?

Yes
No

Operating independently of WorkSafeBC, the Workers’ Advisers Office provides free advice and assistance to workers and their dependants on disagreements they may have with WorkSafeBC decisions.

Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?

Yes
No

Operating independently of WorkSafeBC, the Workers’ Advisers Office provides free advice and assistance to workers and their dependants on disagreements they may have with WorkSafeBC decisions.

Adviser's name (Required)

First Last

This form must be signed by the applicant or by their authorized representative. If signed by an authorized representative, WCAT requires an authorization less than 2 years old that is signed by the appellant.

Authorization of Representative (Required)

I will fill out an Authorization of Representative form and submit it online
An Authorization of Representative should be on file with WCAT
This form authorizes the person/firm named above as my representative (applicant must sign the form below)

Full name of person signing this form (Required)

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the following: (Required)

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 reconsideration application active. I authorize my representative named above to act on my behalf in this appeal. For workers: I authorize disclosure of my claim file(s) and information relating to this reconsideration application to WCAT, my representative, and other parties to this application for the purposes of this application and as allowed under section 314 of the Workers Compensation Act. I also authorize WCAT to obtain or view from any source a copy of my employment or medical records or any other documents that may relate to the reconsideration application.

Date signed

You will receive a confirmation of this form at the address you provided above.

Representative's email address for form receipt only

If your representative would like to receive an email confirming that WCAT has received this form, enter an email address here. WCAT will not send your representative any further emails.

Enter email Confirm email

What WCAT decision do you want us to reconsider?

Tell us about yourself

How WCAT can send you information

Representation

Reasons for reconsideration

Certification and authorization

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