This form will be your formal notice of participation in an appeal. Submit this form to WCAT within 14 days of our invitation letter. If we do not receive a response from you within 14 days, the appeal will proceed without your participation.
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: Notice of Participation (PDF, 94KB).