Worker Appeal of Claims Decision

Should you have any questions when completing this form, please call the Assistant Scheduling Co-ordinator at (204) 925-6116 or toll free at 1 (855) 925-6110.

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Fields marked with (*) are required.

If you will be represented on your appeal, you must provide a separate signed and dated authorization naming your representative.

Any required interpretation services will be arranged by the Appeal Commission.

Maximum length: 800 characters

Maximum length: 800 characters

Please indicate by which method you wish to pursue your appeal (select one)

Maximum length: 800 characters

Once the request has been sent, you will also receive a copy of your application via email. Please save or print the PDF for your records.