Get Request For Assistance Form

Filling out the Request For Assistance Form online can be straightforward when you understand each component. This guide will walk you through the process step-by-step to ensure your submission is clear and complete.

Follow the steps to successfully complete your form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the claim number field. This is where you enter the specific number assigned to your workers' compensation claim, which helps to identify your case.
3. Enter the accident date. Fill in the date of your workplace incident using the format (Year / Month / Day) to ensure accuracy.
4. In the name section, provide your surname followed by your given name, ensuring proper capitalization where necessary.
5. Fill out your address section completely, including the apartment/unit number if applicable, street name, city/town, province, and postal code.
6. Include your residence telephone number and an alternate phone number for contact purposes.
7. Specify your date of birth using the (Year / Month / Day) format.
8. Input your work telephone number to allow for communication regarding your appeal.
9. Describe the decision you wish to review or appeal. Be as detailed as possible to support your case.
10. Attach any letters you have received from the Workers' Compensation Board related to your appeal. If you do not have these letters, contact your case manager to obtain copies before submitting.
11. Provide a reason for your appeal. Clearly state why you believe the decision should be reviewed.
12. Sign and date the form to confirm your request for assistance from the Office of Appeals Advisor.
13. Decide how you wish to submit the form. You can save changes, download, print, or share the form based on your preference.

Ensure your assistance request is submitted promptly by filling out the form online now.