INJURED WORKER'S ADVOCATE
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          Online Inquiry Form

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          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



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           Give us a call or send us a fax!


          Toll Free: 1-877-858-5252

          Fax: (807)-329-5642



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          Send us an email!


          injuredworkersadvocate@gmail.com



          Copyright 2017 INJURED WORKER'S ADVOCATE


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