Alberta Advisor Office Alberta Advisor Office

Employer's Authorization

Personal information you provide to the Advisor Office for Alberta Workers’ Compensation (AO) is collected under the authority of section 33(c) of the Freedom of Information and Protection of Privacy Act (FOIP) and is managed in accordance with Part 2 of the Act. The personal information you provide will be used by the AO for the purpose of reviewing claims within the workers’ compensation system (Workers’ Compensation Board - Alberta (WCB), Appeals Commission for Alberta Workers’ Compensation (AC), and the Medical Panels (MP)), and to provide recommendations as a result of its review. The information will also be used for providing appeals and advisory services on your WCB claim.

Your personal information may also be used to contact you to complete a survey and will not be used or disclosed for any other purpose, without your written consent or unless required to do so by law. Should you have any questions pertaining to the collection of your personal information please contact the Advisor Office toll-free at 1-866-427-0115, or advisoroffice@gov.ab.ca.

AN AUTHORIZATION MUST BE COMPLETED FOR EACH EMPLOYER ACCOUNT.


I authorize the Advisor Office to represent the employer listed above with respect to all claims and account matters.

(One form per worker)

I authorize the Advisor Office to represent the employer listed above with respect to all claims and account matters and to collect information, including personal information about my claim or account verbally, electronically, in writing and/or in person from the WCB for the purposes of representing the employer in relation to all WCB claims and account matters. The WCB is authorized to disclose personal information to the Advisor Office that is reasonably necessary for the purposes of providing appeals and advisory services.

  • This authorization will expire if rescinded by you. Should you wish to revise or rescind your authorization, you are responsible for submitting a written notification to the Advisor Office at advisoroffice@gov.ab.ca.
  • Once the issue(s) of appeal on this form has been resolved, this authorization will remain in effect for 12 months from the date it is signed to allow for repeat or additional services pertaining to this claim within this time period.
  • Should you require further assistance on this claim from the Advisor Office following the expiry of this authorization, you will be required to submit a new authorization form.

This form is to be used when an employer wishes to authorize the Advisor Office to act as formal representative with respect to a claim or account matter.

An employer is limited to authorize one (1) formal representative for a single claim or account matter. The Advisor Office policy precludes the employer advisor from acting on a file where there is another authorized representative.

I am an Authorized Officer of the company and have the authority to sign this form on behalf of the Employer named in Part A.

Important Note: If any of the above information is not provided or is incomplete, it will cause a delay in proceeding with your file.

Form is not submitted

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Advisor Office Authorization Terms

Employers Authorization

I authorize the Advisor Office to collect information, including personal information about my claim or account verbally, electronically, in writing and/or in person from the WCB for the purposes of representing the employer in relation to all WCB claims and account matters. The WCB is authorized to disclose personal information to the Advisor Office that is reasonably necessary for the purposes of providing appeals and advisory services. I authorize the Advisor Office to act on my behalf for the purposes of assisting with my claim(s), which include reviewing and /or appealing a WCB decision. The Advisor Office may make representation on my behalf and proceed with a documentary or in person hearing in my absence if the Advisor Office considers this action to be appropriate in the circumstances.

I am the Authorized Officer of the company and have the authority to represent the Employer named in Part A.

Expiry of Authorization

This authorization will expire when one of the following occurs:

  • The appeal matter has been concluded
  • The services of the Advisor Office has been concluded and are no longer required: or
  • You rescind the authorization

Should you wish to revise or rescind this authorization, you are responsible for submitting a written notification to your appeal advisor. You may also submit the request in writing to the Advisor Office at advisoroffice@gov.ab.ca.

Should you required further assistance from the Advisor Office following the expiry of this authorization; you will be required to submit a new authorization form.

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