FORM: Notice of Participation | Workers' Compensation Appeal Tribunal (WCAT)

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.

It takes about 5 to 10 minutes to complete this form. You’ll need to have the following information ready:

The number for the appeal you are participating in
The WorkSafeBC claim number, worker’s name, employer’s name, or employer account number for the appeal you are participating in (the information you need is on the letter WCAT sent to you inviting your participation in the appeal)
The contact information for your representative (if you have one)

Questions marked (Required) must be filled out so that WCAT can add your participation in the appeal.

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 appeal or application have you been invited to participate in?

You have received a letter from WCAT inviting you to participate in an appeal or application. Please provide some details about the appeal or application to help us identify it.

WCAT appeal/application number (Required)

The appeal or application was started by: (Required)

Please provide the name or business name of the appellant/applicant.

Date of decision being appealed or reconsidered (Required)

Please provide the date of the Review Division decision or WorkSafeBC prohibited action decision under appeal, or the WCAT decision under reconsideration.

Is it a compensation claim appeal? (Required)

Compensation claim appeals relate to a worker’s claim with WorkSafeBC. They are different from prohibited action, assessment, or occupational health & safety appeals, which relate to an employer’s account or actions.

Yes
No

Additional information about the appeal/application

If you like, please provide any other identifying details about the decision under appeal or reconsideration (e.g. the Review Division decision number, the WorkSafeBC claim or employer account number, the appeal number of the appeal being reconsidered, your preferred method of hearing etc.)

Participation

Will you participate in the appeal or application? (Required)

If you participate, you will receive a copy of the WorkSafeBC file related to the appeal or application as well as any documents or evidence WCAT has received for the appeal. You will have a chance to provide written submissions and evidence and WCAT will invite you to attend an oral hearing if one is held. If you decide not to participate, WCAT will send you only a copy of the final decision for the appeal or application.

Yes, I will participate
No, I do not want to participate

Tell us about yourself

You must tell us about any changes in this information, or the appeal may proceed without your participation.

What is your role in the original WorkSafeBC or Review Division decision? (Required)

I am the employer
I am the worker
I am the dependant of a deceased worker
I am the owner
I represent the union
I am a supplier
I am an independent operator

What is your role in the original WorkSafeBC or Review Division decision? (Required)

I am the employer
I am the worker
I am the dependant of a deceased worker

WorkSafeBC employer account number (Required)

This is the number for your business/firm as registered with WorkSafeBC. If you are not registered with WorkSafeBC, please enter “not applicable.”

Business/firm name (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 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

Your title (Required)

Please tell us how you would like to be addressed.

Your job title/position

How WCAT can send you information

To get appeal information by email, please sign up for WCAT Online Services. If you have not signed up for WCAT Online Services, WCAT will send you appeal information by mail to the address you provided.

If the appeal cannot be accessed through WCAT Online Services, WCAT will send you information by email if you have provided consent.

Your email address for form confirmation and claim file (Required)

WCAT will use this email address to tell you we have received 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.

If you are not signed up for WCAT Online Services, WCAT may also send videoconference invitations to this address.

Enter Email Confirm Email

Can WCAT share your email with WorkSafeBC for disclosure? (Required)

WorkSafeBC will only use your email address to send you an email when the claim file is ready to be downloaded from their online portal. WCAT can share the email address you provided above. If you have a representative, they can receive the notification.

WCAT can share the email address I entered with WorkSafeBC
I prefer to receive my copy of the claim file by mail

Can WCAT share your email with WorkSafeBC for disclosure? (Required)

WorkSafeBC will only use your email address to send you an email when the claim file is ready to be downloaded from their online portal. WCAT can share the email address you provide below, or, if you have a representative, they will receive the notification email. You also have the option of receiving your copy of the claim file by mail.

WCAT can share the email address I entered with WorkSafeBC
I prefer to receive my copy of the claim file by mail

WCAT will only use your email address to send you a confirmation of this form.

Dependant Email for Appeal Information (Required)

WCAT Online Services is not available for dependants of a deceased worker at this time. Can WCAT use the email you entered above to send you appeal information?

Yes, send appeal information to my email address
No, send appeal information to the mailing address I enter below

Can WCAT share your email with WorkSafeBC for disclosure? (Required)

WorkSafeBC will only use your email address to send you an email when the claim file is ready to be downloaded from their online portal. WCAT can share the email address above, you can provide a different email address, or if you have a representative, they will receive the notification email.

WCAT can share my email address above with WorkSafeBC
WCAT can share a different email address with WorkSafeBC (I will enter it in a new field below)

Your alternate email address for disclosure (Required)

Enter Email Confirm Email

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.

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)

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 appeal 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

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.

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 or Review Division 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

Representative's title (Required)

Please tell us how to address your representative.

Representative's relationship to me (Required)

Can WCAT send emails to your friend or family representative about appeals they are participating in?

Yes, please send appeal information to my representative by email
No, my representative prefers to receive appeal information by mail

Representative email for appeal information (Required)

WCAT will send appeal information to your friend or family representative at this email address.

Enter Email Confirm Email

Representative's email address for disclosure (Required)

Representatives must provide an email address so WorkSafeBC can send them a copy of the claim file(s).

To get appeal information by email, your representative should sign up for WCAT Online Services. Otherwise, WCAT will send them appeal information by mail. If the appeal cannot be accessed through WCAT Online Services, WCAT will send them information by email if you have provided consent.

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?

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.

Yes
No

Is a workers' adviser from the Workers' Advisers Office submitting this form on your behalf?

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.

Yes
No

Adviser's name (Required)

First Last

This form must be signed by the respondent or by their authorized representative. If signed by an authorized representative, WCAT requires an authorization form signed by the respondent that is less than two years old.

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 (respondent 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 or the appeal/application will proceed without my participation. I authorize my representative named above to act on my behalf in this appeal/application. 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/application 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 the this appeal/application or the decision(s) being appealed/reconsidered.

Date signed

You will receive a confirmation of this form at the email address you provided above.

Representative's email address 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.

Enter Email Confirm Email

Name

This field is for validation purposes and should be left unchanged.