FORM: Notice of Appeal – WorkSafeBC decision to reopen a matter | Workers' Compensation Appeal Tribunal (WCAT)

If you’d prefer to mail or fax a printed copy, use this version: Notice of Appeal – WorkSafeBC decision to reopen a matter (PDF, 104KB).

Notice of Appeal – WorkSafeBC decision to reopen a matter

This form will be your formal notice of appeal. Submit it within 90 days of your WorkSafeBC reopening decision. If it’s been more than 90 days, also submit a request for an extension of time.
It takes about 10 to 15 minutes to complete this form. Make sure you have the following information ready:
- The WorkSafeBC claim number for the decision you are appealing
- The contact information for your representative (if you have one)
Questions marked (Required) must be filled out so that WCAT can start your appeal. You don’t need to argue your appeal at this time. Only basic information is required to start your appeal. You can provide more details later.

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.
What would you like to appeal?
Tell us about your WorkSafeBC reopening decision. If you don’t have a reopening decision from WorkSafeBC, find out what you need to do before you can start an appeal.
WorkSafeBC claim number (Required)
WorkSafeBC reopening decision date (Required)
YYYY dash MM dash DD
Tell us about yourself
What is your role in the WorkSafeBC claim? (Required)
- I am the worker
- I am the employer
- I am the dependant of a deceased worker
Worker's full name (Required)
This will help WCAT to identify the correct claim.
Your business/firm name (Required)
Your WorkSafeBC employer account number (Required)
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 file(s), we will use that when choosing how to address you.
Your pronouns
Your pronouns will help us to address you respectfully during the appeal process.
- 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 job title/position
How WCAT can send you information
Your email address for form confirmation and claim file (Required)
WCAT will use this email address to send you confirmation of this form. WorkSafeBC will also use this address to provide you disclosure, which is a copy of the claim file. Videos, photographs, and audio statements will be delivered by mail on a DVD up to two weeks after the claim file is available online. If you are represented, the claim file will be sent to your representative.
Enter Email Confirm Email
Can WCAT share your email with WorkSafeBC for disclosure? (Required)
- WCAT can share my email address with WorkSafeBC so they can send me disclosure
- I prefer to receive my copy of the claim file by mail
Can WCAT share your email with WorkSafeBC for disclosure? (Required)
- WCAT can share my email address with WorkSafeBC so they can send me disclosure
- I prefer to receive my copy of the claim file by mail
Can WCAT share your email with WorkSafeBC for disclosure? (Required)
- WCAT can share my email address with WorkSafeBC so they can send me disclosure
- WCAT can share a different email address with WorkSafeBC (I will enter it in a new field below)
Your alternate email for disclosure
Enter Email Confirm Email
How would you like to receive appeal information from WCAT? (Required)
- By Email. WCAT can send me information at the email address I provided above
- By Mail. WCAT can send me information at the mailing address I provide below
How would you like to receive appeal information from WCAT? (Required)
- By email. WCAT can send me information at the email address I provided above
- By mail. WCAT can send me information at the mailing address I provide below
How would you like to receive appeal information from WCAT? (Required)
- By email. WCAT can send me information at the email address I provided above.
- By mail. WCAT can send me information at the mailing address I provide below
WCAT will only use your email address to send you a confirmation of this form.
WCAT will only use your email address to send you a confirmation of this form.
Your mailing address (Required)
Please provide a mailing address even if you have provided an email address above.

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
Are you an Indigenous person (includes a person of Indigenous ancestry: Inuit, Metis, First Nations, non-status, status, and anyone with First Nations ancestry)?
- Yes
- No
- I prefer not to answer
If you self-identify, you can work with a WCAT Navigator to tell your story. These experienced staff members can offer neutral support and make sure that cultural sensitivities are respected. This service is part of implementing the Truth and Reconciliation Commission’s Calls to Action. Learn more about self-identifying as Indigenous.
Reason for appeal
Briefly tell us why the WorkSafeBC reopening decision is wrong. You will have a chance to provide more information later.
The decision is wrong or should be changed because: (Required)
Change requested from appeal
Briefly tell us what you would like to have changed in the reopening decision. You will have a chance to provide more information later.
This is what I would like to have happen: (Required)
Method of appeal
WCAT will decide how your appeal will proceed. Tell us what your preference is: (Required)
- In writing (through written submissions)
- Verbally (by oral hearing)
Please tell us why an oral hearing is necessary: (Required)
Oral hearing method (Required)
An oral hearing can be held by videoconference on Microsoft Teams or in person in one of twelve cities in BC. If you select “in person,” you can then tell us your location preference.
- By videoconference
- In person
Oral hearing location
- Richmond (at WCAT)
- Castlegar
- Courtenay
- Cranbrook
- Fort St. John
- Kamloops
- Kelowna
- Nanaimo
- Prince George
- Terrace
- Victoria
- Williams Lake
If an oral hearing is held, do you need an interpreter?
WCAT provides professional interpreters for oral hearings. Family and friends may not interpret for you.
- Yes
- No
The language (and dialect) I speak is: (Required)
If an oral hearing is held, will you bring witnesses?
- Yes
- No
- Unsure
List of witnesses
If you are ready, please provide the name of each witness you plan to bring to an oral hearing, if one is held. Use the “plus sign” icon to add another witness. This is just an early list. You will be able to change it later.
First Name Last Name
Representation
You may appoint a person or an organization (with or without a specific contact) to represent you, or you may represent yourself. If your representative has signed up for WCAT Online Services, or has previously provided e-mail consent, WCAT will send appeal information by email. Otherwise, WCAT will send information by mail.
Do you have a representative? (Required)
- No, I will be representing myself
- Yes, I have a professional representative
- Yes, I have a friend/family member representing me
As you are represented, notice of disclosure of the claim file will be sent to your representative at the information you provide below.
Please note that family and friend representatives are not authorized to receive a copy of the disclosure file. It will need to be sent to you instead.
As you are represented, notice of disclosure of the claim file will be sent to your representative at the information you provide below.
Please note that family and friend representatives are not authorized to receive a copy of the disclosure file. It will need to be sent to you instead.
As you are represented, notice of disclosure of the claim file will be sent to your representative at the information you provide below.
Please note that family and friend representatives are not authorized to receive a copy of the disclosure file. It will need to be sent to you instead. To receive information about appeal
Name of representative's organization/firm (Required)
Representative's name (Required)
First Last
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 file(s), we will use that when choosing how to address them.
Representative's pronouns
- They/Them
- She/Her
- He/Him
- Pronouns not listed
Representative's pronouns (Required)
Please tell us your representative’s pronouns.
Representative's title
- Mx.
- Ms.
- Mr.
- Mrs.
- Dr.
- Title not listed
Representative's title
Please tell us how to address your representative.
Representative's relationship to me (Required)
How would your representative like to receive appeal information from WCAT? (Required)
- By email
- By mail
Representative's email address (Required)
WCAT Online Services is not available for appeals of WorkSafeBC decisions on reopening appeals. Enter your representative’s address to receive appeal information by encrypted email.
Enter Email Confirm Email
How would your representative like to receive disclosure?
- WorkSafeBC can send disclosure to same email as for appeal information
- WorksafeBC can send disclosure to a different email address
Representative's email for disclosure (Required)
Enter Email Confirm Email
Representative's mailing address (Required)
Street address Address line 2 City Province / State / Region Postal / Zip code Country
Representative's phone number (daytime) (Required)
Representative's phone number (other)
Representative's fax number
Certification and authorization
Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?
- Yes
- No
Operating independently of WorkSafeBC, the Workers’ Advisers Office provides free advice and assistance to workers and their dependants on disagreements they may have with WorkSafeBC decisions.
Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?
- Yes
- No
Operating independently of WorkSafeBC, the Workers’ Advisers Office provides free advice and assistance to workers and their dependants on disagreements they may have with WorkSafeBC decisions.
Adviser's name
First Last
This form must be signed by the appellant or by their authorized representative. If signed by an authorized representative, WCAT requires an authorization form less than 2 years old that is signed by the appellant.
Authorization of Representative (Required)
- I will fill out an Authorization of Representative form and submit it online.
- An Authorization of Representative should be on file with WorkSafeBC.
- This form authorizes the person/firm named above as my representative (appellant must sign the form below)
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 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. I authorize my representative named above to act on my behalf in this appeal. For workers: I authorize disclosure of my claim 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 from any source a copy of my employment or medical records or any other documents that may relate to this appeal or the decision(s) being appealed.
Date signed
YYYY dash MM dash DD

You will receive a confirmation of this form at the email address you provided above.
Representative's email for form receipt only
If your representative would like to receive an email confirming that WCAT has received this form, enter an email address here. It does not have to be the same as the address for disclosure provided above.
Enter Email Confirm Email
Name
This field is for validation purposes and should be left unchanged.

First Name	Last Name

FORM: Notice of Appeal – WorkSafeBC decision to reopen a matter

Notice of Appeal – WorkSafeBC decision to reopen a matter

What would you like to appeal?

Tell us about yourself

How WCAT can send you information

Reason for appeal

Change requested from appeal

Method of appeal

Representation

Certification and authorization