Submit Worker Appeal

If you do not receive a letter confirming receipt of your appeal within 7 business days, please call the Appeals Department at 306.787.4549 or 1.800.667.7590. Thank you.
You are about to submit an appeal because:
  • you disagree with a decision that has been made by the WCB.
  • you and your case manager have tried to resolve the disagreement.
Click here to read about WCB's appeal process.
Date of Appeal: ש ינו 19, 2019 12:57:57 CST
Appeal Information
If no, please complete the Representative Section.
Representative Information
(Complete this only if you are representing the worker submitting this appeal.)
  • Alberta
  • British Columbia
  • Manitoba
  • New Brunswick
  • Newfoundland and Labrador
  • Northwest Territories
  • Nova Scotia
  • Nunavut
  • Ontario
  • Prince Edward Island
  • Quebec
  • Saskatchewan
  • Yukon Territory
  • Canada
  • USA

Appeal Information

1. What decision is being appealed?(date of decision,who made the decision,what was the decision)

2. Why do you believe the decision is wrong?

3. What do you expect from your appeal?

If you have any additional supporting documentation for this appeal, please fax or email this information to the Appeals Department at 306.787.1116 (fax) or
A printable version of this form will appear after you submit the appeal information.