Alberta Advisor Office Alberta Advisor Office

Worker's Authorization

Personal information you provide to the Advisor Office 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 FOIP. The personal information you provide will be used by the Advisor Office for the purpose of reviewing claims within the workers’ compensation system (Workers’ Compensation Board - Alberta (WCB), Appeals Commission for Alberta Workers’ Compensation (Appeals Commission), and 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 for 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 Advisor Office: #200, 10405 Jasper Avenue, Edmonton, AB, T5J 3N4; advisoroffice@gov.ab.ca

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

I authorize the Advisor Office to collect information, including personal information, about my claim verbally, electronically, in writing and/or in person from the WCB for the purposes of reviewing and/or appealing a WCB decision and providing advocacy services. The WCB is authorized to disclose personal information to the Advisor Office that is necessary for the purpose of providing appeals and advocacy services. This includes, but is not limited to a copy of my claim file and copies of correspondence sent to me by the WCB.

I authorize the Advisor Office to share and discuss my medical records with my treating physician(s) to seek clarification or get an opinion on any medical matter relating to my claim.

  • This authorization will expire if rescinded by you.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.
  • hould 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.

A Formal Representative may access information about your claim directly from the WCB. They have the authority to make representations on your behalf, can request a copy of your claim file and will receive a copy of correspondence sent to you.

An informal representative may assist you by providing and receiving information about your claim with WCB employees. They do not have the authority to make decisions on your behalf, cannot request a copy of your claim and will not receive a copy of correspondence sent to you. If you would like to appoint an informal representative, you must submit an Informal Representative Consent Form.

I authorize the Advisor Office to act on my behalf for the purposes of assisting with my claim, which include reviewing and/or appealing a WCB decision. The Advisor Office may make representations 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.

Consent to Release Medical Information

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 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.

Note: If any of the below information is not provided or is incomplete, it may cause a delay in proceeding with your file review. You may be asked to provide an original signature on this form, if required. If you have questions about the collection and use of your medical information, please contact the Advisor Office toll-free at 1-866-427-0115 or advisoroffice@gov.ab.ca.

I, , authorize you to disclose my health information to the Advisor Office. I understand why I have been asked to disclose my health information and I am aware of the risks and benefits of consenting or refusing to consent. I understand I may revoke this consent in writing at any time.

I authorize you to release copies of all information and medical reports, including psychological and psychiatric reports, and work history reports to the Alberta Advisor Office for the purpose of reviewing my workers’ compensation claim and/or pursuing any related appeal. I also authorize you to communicate with the Advisor Office if additional information or clarification is required.

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Advisor Office Authorization Terms

Workers Authorization

I authorize the Advisor Office to collect information, including personal information, about my claim verbally, electronically, in writing and/or in person from the WCB for the purposes of reviewing and/or appealing a WCB decision and providing advocacy services. The WCB is authorized to disclose personal information to the Advisor Office that is necessary for the purpose of providing appeals and advocacy services. This includes, but is not limited to, a copy of my claim file and copies of correspondence sent to me by the WCB.

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Advisor Office Authorization Terms

Consent to Release Medical Information

I authorize the Advisor Office to obtain all information and medical reports, including psychological and psychiatric reports, and work history reports. The Advisor Office may use and disclose the information as required or authorized by law and pursuant to the Freedom of Information and Protection of Privacy Act.

Expiry of Authorization

The authorization will expire when one of the following occurs:

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

Should you wish to revise or rescind the 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 require 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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