Government of New Brunswick

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Please complete and submit the online form below.
* Required fields

Full name

Claim number

Decision date(s)

Reason why you want to appeal this decision (maximum of 300 characters)

Medicare number

Mailing address

City

Postal code

Phone (home/cell/work)

Authority and consent to the collection and release of medical information pertaining to
my claim:

Required

I hereby authorize and consent to Advocates Services to discuss and obtain any medical information from any doctor, health professional, hospital or any other health institution.

I hereby authorize and consent to Advocates Services to release any information obtained, medical or otherwise, to Workplace, Health, Safety and Compensation Commission and/or the Workers’ Compensation Appeals Tribunal.

I hereby acknowledge that I understand an appeal must be made within one-year following my decision. If my appeal deadline falls within the next month, I will contact Advocates Services directly at 1-844-530-0282 and/or the Workers’ Compensation Appeals Tribunal at 1-844-738-6444.

Post-Secondary Education, Training and Labour

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