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Decision Review Application

WHEN TO USE THIS FORM:

Use this form if you disagree with a WorkSafeNB decision related to New Brunswick’s Workers’ Compensation Act; Workplace Health, Safety and Compensation Commission and Workers' Compensation Appeals Tribunal Act; or the Firefighters' Compensation Act. To learn more about the decision review process, please visit worksafenb.ca .


BEFORE YOU START:

Please ensure you meet the required criteria for a decision review. You must have a written decision from WorkSafeNB to start. The decision must be related to one of the acts listed above.

Completing the application takes about 10-15 minutes. If you close your browser or leave this page without finishing and submitting your application, you will have to restart the process.

Please ensure you have all information you need.


PROTECTING YOUR PRIVACY:

The information you provide on this form will be used by WorkSafeNB as authorized by the Right to Information and Protection of Privacy Act and the Personal Health Information Privacy and Access Act to process your application. If you have any questions about the collection, use or disclosure of this information, please visit our Access to Information and Privacy.


Preferences

Intent

Your Information

Decision Review

Please submit an additional Decision Review Application if you have more than 10 decisions you would like reviewed for a claim.

Declaration and Consent

For Your Records

File Attachments