2. Fill out your Intent to Object Form

To appeal a decision you have to submit a form called the Intent to Object Form. If you have more than one decision that would like to appeal, you must submit an Intent to Object Form for each of them. The Intent to Object Form is available online, or you can call the Workplace Safety and Insurance Board (WSIB) and ask them to mail you one.

The form has instructions on it about how to fill it out. The basic information you will have to give is:

• your claim number
• the date of the decision that you disagree with
• the reasons why you disagree

If you need help, someone else can fill out the form for you, but you must sign it yourself.

If you are using a paper form, you should fax it with your supporting documents to the WSIB. The fax number is 1-888-313-7373 or 416-344-4684.

If you don’t have a fax machine, you can mail your form and copies of your documents to:

Workplace Safety and Insurance Board

200 Front Street West

Toronto ON M5V 3J1