FORM: Ask WCAT to Request the Assistance of an Independent Health Professional | Workers' Compensation Appeal Tribunal (WCAT)

A worker, employer, or dependant of a deceased worker participating in an appeal can ask the vice chair to arrange for a health professional to give independent assistance or advice.

The worker’s medical condition must be an issue in the appeal. The vice chair will decide if an opinion from a health professional will assist them in reaching a decision

Note: Getting assistance or advice from a health professional takes time to coordinate and complete. it may delay the decision of the appeal.

It takes about 5 to 10 minutes to complete this form. Questions marked (Required) must be filled out.

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.

Tell us about the appeal

Do you have an appeal number? (Required)

If your appeal has already been registered and you have received an acknowledgment letter from WCAT requesting your extension of time application, you will already have an appeal number.

Yes, I have an appeal number
No, I do not have an appeal number yet

Appeal number (Required)

In order to begin your appeal, you need to fill out a Notice of Appeal form. Depending on the type of decision you are appealing, you will need one of the following forms:

Notice of Appeal – Review Division Compensation Decision

Notice of Appeal – Review Division Assessment or Occupational Health and Safety

Tell us about yourself

What is your role in the appeal? (Required)

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

Your name (Required)

First Last

Your pronouns and title

Your pronouns and title will help us to address you respectfully during the appeal 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 business/firm name (Required)

WorkSafeBC employer account number (Required)

Enter “not applicable” if your business/firm is not registered with WorkSafeBC.

Your mailing address (Required)

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

Your phone (daytime) (Required)

Your phone (other)

Your fax

How would you like to receive information from WCAT about your request? (Required)

By email. I will sign up for WCAT Online Services to get information from WCAT
By mail

Reason for Request (Required)

Describe the worker’s medical condition that is an issue in the appeal.

Reason for Independent Health Professional (Required)

Tell us why you think independent advice from a health professional is needed.

Read about situations where independent advice is required.

Certification and authorization

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 authorize disclosure of my WorkSafeBC file(s) and information 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 314 of the Workers Compensation Act. I also authorize WCAT to obtain or view a copy of my medical and employment records from any source, including physicians, health practitioners, medical insurers, hospitals and employees.

Date signed

Email address for form confirmation

Enter an email address here if you would like to receive confirmation that WCAT received your form.

Enter email Confirm email

Phone

This field is for validation purposes and should be left unchanged.