I authorize the FPO 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 FPO WAAB 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 FPO to obtain all information and medical reports, including psychological and psychiatric reports, and work history reports. The Fair Practices 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:
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 FPO at firstname.lastname@example.org.
Should you require further assistance from the FPO following the expiry of this authorization; you will be required to submit a new authorization form.
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