(On-the-Job Injury or Illness)
Have a Claim - Need Help?
After reporting an injury, you may want to ask the Board to assist you in certain situations. In some instances, the best way to ask the Board for help will be to use Form RFA-1W - Request for Assistance by Injured Worker. This form should be used if you have a claim that is accepted by the carrier or employer. It is not appropriate for claims that are actively controverted by the carrier or for claims that the carrier has not yet accepted. If you are not sure whether or not the carrier has controverted or accepted your claim, call the Workers' Compensation Board and we will be happy to assist you. 1-877-632-4996
If you would like the Board to take action on your claim, you can file form RFA-1W. Here are some reasons why you may want to file this form:
- You are out of work (and have been out of work for more than seven days) and are not receiving compensation benefits.
- You have returned to work and are earning less money because of your work-related accident or injury and seek a reduced earnings award.
- Your payments have been stopped or reduced and you don't think they should have been.
- You attended a hearing where the Judge directed the carrier to pay you an award but more than ten days have passed and you have not received the award.
- Your doctor wants to perform medical treatment but has not received the necessary authorization from the carrier.
- You have medical documents that indicate your condition is permanent or your medical condition has changed.
- You submitted a request for medical and transportation reimbursement [Form C-257] which was denied by the carrier or not responded to.
- You have been released from incarceration and your compensation benefits should resume.
- You have returned to work at full pay and want to notify the Workers' Compensation Board.
Form RFA-1W can be mailed, faxed or e-mailed to the Board. See the back of the form for the addresses and the fax number that you should use.