Submitting this form gives WCAT permission to obtain information about you (the worker) relating to an appeal currently being heard at WCAT. The information WCAT obtains will be released to other parties or participants in the appeal.
Questions marked with the * are required.
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.
If you’d prefer to mail or fax a printed copy, use this version: Authorization to Obtain and Release Information (PDF, 41KB).