Alberta Fair Practices OfficeAlberta Fair Practices Office

Employer Appeal Authorization

Employer's Authorization

Personal information you provide to the Alberta Fair Practices Office (FPO) 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 FPO 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 the Medical Panels Office (MPO)), 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 Fair Practices office: Suite 1000, 10th Fl, 10123 – 99th St NW, Edmonton, AB T5J 3H1; info@fpo.alberta.ca or 1-866-427-0115.

AN AUTHORIZATION MUST BE COMPLETED FOR EACH EMPLOYER ACCOUNT.


I authorize the FPO Employer Appeals Advisor Branch (EAAB) to represent the employer listed above with respect to all claims and account matters.

I authorize the FPO EAAB 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 FPO EAAB that is reasonably necessary for the purposes of providing appeals and advisory services.

This authorization will expire when whichever of the following occurs first:

  • the services of the EAAB has been concluded and is 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 FPO at info@fpo.alberta.ca.

Should you require further assistance from the FPO 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 FPO EAAB 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. FPO policy precludes the appeals 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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FPO Authorization Terms

Employers Authorization

I authorize the FPO 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 FPO that is reasonably necessary for the purposes of providing appeals and advisory services. I Authorize FPO to act on my behalf for the purposes of assisting with my claim(s), which include reviewing and /or appealing a WCB decision. The FPO may make representation on my behalf and proceed with a documentary or in person hearing in my absence if the FPO 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 EAAB 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 FPO at info@fpo.alberta.ca.

Should you required 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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