WSIAT Case Assessment Questionnaire
To help us assess whether you have a viable Workplace Safety & Insurance Appeals Tribunal (WSIAT) case and your readiness to proceed, please answer the following questions.
Name
*
Address
*
Street Address
Street Address Line 2
City
Province
Postal Code
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Part 1: Jurisdiction & Finality
Do you have a final decision letter from a WSIB Appeals Resolution Officer (ARO)?
*
Yes
No
If yes, what is the date listed on that final ARO decision letter?
-
Month
-
Day
Year
Date
If the decision is older than 6 months, do you have an "unusual circumstance" that prevented you from filing? (e.g., serious health problems or not receiving the letter)
*
Yes
No
Part 2: Identifying the Grounds for Appeal
Why do you believe the ARO’s final decision was incorrect?
*
Is there new medical or witness evidence that was not available during your previous WSIB hearings?
*
Yes
No
Does your case involve complex issues like chronic mental stress, occupational disease, or permanent impairment (NEL) ratings?
*
Yes
No
Part 3: Readiness & Documentation
Do you have a copy of your complete WSIB Claim File (the "Case Record")?
*
Yes
No
Are you currently receiving any other disability benefits? (e.g., CPP Disability or Long-Term Disability)
*
Yes
No
Are you prepared to attend an oral hearing (online or in-person) to give testimony?
*
Yes
No
Please upload the Appeals Resolution Officer's decision
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