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:
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 firstname.lastname@example.org.
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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