Only use this form if you want to assign someone to act as your representative. You are not required to have one. This form authorizes the Workers’ Compensation Appeal Tribunal (WCAT) and WorkSafeBC (including the Review Division), to give confidential information about you or your business to your representative. It takes about 5 to 10 minutes to complete.
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.
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.
Representative's pronouns and title
Your representative's pronouns and title will help us to address them 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 representative's gender or title in the WorkSafeBC or Review Division file(s), we will use that when choosing how to address them.
If you’d prefer to mail or fax a printed copy, use this version: Authorize a representative (PDF, 83KB).