FORM: Application for extension of time to appeal a Review Division decision

Notices of appeal for Review Division compensation decisions or Review Division assessment or occupational health & safety decisions must be submitted to WCAT within 30 days after the Review Division issues their decision.

Learn more about the different types of appeals.

If you have submitted your notice of appeal outside the 30-day time limit, you must complete and submit this form before your appeal can proceed.
It takes about 5 to 10 minutes to complete this form. Make sure you have the following information ready:
- The Review Division decision number and date for the decision you are appealing
- The WorkSafeBC claim or employer account number for the decision you are appealing
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.
WorkSafeBC file information
Help us to identify the decision(s) you are appealing late.
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.
In order to begin your appeal, you also need to fill in 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 & safety decision
Appeal number (Required)
What type of Review Division decision are you appealing? (Required)
- Compensation (claim) decision
- Assessment decision
- Occupational health & safety (prevention) decision
Review Division decision date (Required)
What date was the Review Division decision issued?
YYYY dash MM dash DD
Review Division decision reference number (Required)
A Review Division decision reference number begins with the letter R followed by seven digits.
Additional Review Division reference numbers
A Review Division decision might refer to multiple reference numbers. Please list below any additional Review Division reference numbers that you are appealing.
WorkSafeBC claim number (Required)
Please enter the WorkSafeBC claim number related to the Review Division compensation decision that you are appealing.
Additional decision information (optional)
Provide any additional number(s) related to your appeal, such as a request for sanction (RFS) number, administrative penalty order number, or inspection report number.
Tell us about yourself
To keep your application active, you must tell us about changes in this information.
Your role (Required)
- I am the worker
- I am the employer
- I am a dependant of a deceased worker
Your role (Required)
- I am the worker
- I am the employer
- I am the owner
- I am the dependant of a deceased worker
- I represent the union
- I am a supplier
- I am an independent operator
Worker's name (Required)
Please provide the name of the worker affected by the Review Division compensation decision you are appealing.
Employer business/firm name
If you know it, please provide the business/firm name of the employer affected by the Review Division assessment decision you are appealing.
Employer WorkSafeBC account number
If you know it, please provide the WorkSafeBC employer account number for the employer affected by the Review Division assessment decision you are appealing.
Employer business/firm name
If you know it, please provide the business/firm name of the employer affected by the Review Division occupational health & safety (prevention) decision you are appealing.
Employer WorkSafeBC account number
If you know it, please provide the WorkSafeBC employer account number for the employer affected by the Review Division occupational health & safety (prevention) decision you are appealing.
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
- Mx.
- Ms.
- Mr.
- Mrs.
- Dr.
- Title not listed
Your title (Required)
Please tell us how you would like to be addressed.
Your business/firm name (Required)
Your WorkSafeBC employer account number (Required)
Your name (as the firm contact) (Required)
First Last
Your mailing address (Required)
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
Your phone number (daytime) (Required)
Your phone number (other)
Your fax number
Explain why you did not appeal in time
These are the special circumstances that prevented me from filing my notice of appeal during the 30 days after the Review Division decision: (Required)
If this appeal is not allowed to proceed, the following injustice would result: (Required)
My appeal was further delayed beyond the 30-day time limit for appealing because:
Providing supporting documentary evidence
If you have documents that show why your notice of appeal was submitted late, please contact WCAT to provide those documents by email, mail, or fax as soon possible after submitting this form.
Depending on the circumstances of your application, supporting documents might include such things as:
- a postmarked envelope or facsimile (fax) confirmation sheet,
- documents proving that you were travelling,
- a doctor’s note or report, or other evidence to prove you were unable to appeal because of medical reasons relating to you or a close family member,
- a signed statement from a witness, or
- significant new evidence about the appeal that did not exist, or was unavailable, when the time to appeal expired.
I will be sending supporting documents to WCAT (Required)
- Yes
- No
My supporting documents will include: (Required)
List the documents you intend to send.
Certification
Full name of the person signing this form: (Required)
Authorization of representative (Required)
This form must be signed by the appellant or an authorized representative. If signed by an authorized representative, we need an authorization less than 2 years old signed by the appellant. Please indicate how authorization has been provided.
- I do not have a representative
- An authorization of representative form will be submitted online
- An authorization of representative should be on the WorkSafeBC or WCAT file
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 appeal active.
Date signed
YYYY dash MM dash DD
Email address for form confirmation
Enter an email address here if you would like to receive confirmation that WCAT received your form. WCAT will send you a copy of the completed form by mail or email (depending on your preferences as shown on the notice of appeal form).
Enter email Confirm email
Name
This field is for validation purposes and should be left unchanged.

If you’d prefer to mail or fax a printed copy, use this version: Application for extension of time to appeal – Review Division decision (PDF, 81KB).

WorkSafeBC file information

Tell us about yourself

Explain why you did not appeal in time

Providing supporting documentary evidence

Certification