INJURED WORKER'S ADVOCATE
Menu
    • External link opens in new tab or window
  • External link opens in new tab or window

Online Inquiry Form

94154
Invalid Form properties detected

If you are an injured worker and feel that you might benefit from our services and would like to learn more, please complete the form below for your FREE case assessment.

Once your inquiry has been received our Licensed Paralegal specialized in W.S.I.B. and C.P.P.D. claims (who is also an injured worker) will be in contact with you to discuss your case further.

* All fields are required to be completed to enable us to better assist you and assess your needs.

Name

Name


Street Address

Street Address


City

City


Province

Province


Postal Code

Postal Code


Phone Number

Phone number


What is the best time to reach you?

Best time to reach


Email Address:

Email address


Date of Workplace Injury

Date of Workplace Injury


Do you have multiple claim numbers for more than one injury?

YesYes No No


Type of Injury or injuries

Type of injury or injuries


How did this injury or injuries occur? Please explain.


Have you returned to work after your injury / injuries?

YesYes No No


Have you participated in a Labour Market Re-entry (LMR) or Work Transition plan?

YesYes NoNo


Have you received Loss of Earnings (LOE) benefits?

YesYes NoNo


Have you been awarded a Non Economic Loss (NEL) or Future Economic Loss (FEL) award?

YesYes NoNo


Are you appealing a decision made by the Board?

YesYes NoNo


What would you like to see Injured Worker's Advocate do for you? Please explain.

What would you like to see Injured Worker's Advocate do for you?


How did you hear about us?

How did you hear about us



Column


 Give us a call or send us a fax!


Toll Free: 1-877-858-5252

Fax: (807)-285-0215



Column

Send us an email!


injuredworkersadvocate@gmail.com



Copyright 2017 INJURED WORKER'S ADVOCATE


  • External link opens in new tab or windowClick to edit
close lightbox