Direction of Authorization – Claims (Form 1824A) – WSIB in Ontario

The “Direction of Authorization – Claims” (Form 1824A) is used to authorize a legal representative or organization to access and manage claim-related information on behalf of a worker or employer with the Workplace Safety and Insurance Board (WSIB). This form ensures that authorized representatives have the necessary permissions to act on behalf of a worker or employer concerning WSIB claims.

Follow these step-by-step instructions to complete this form. This form authorizes a legal representative or organization to access and manage claim-related information with the Workplace Safety and Insurance Board (WSIB).

Section-by-Section Instructions

Contact Information

• WSIB Contact: If you need this form in an alternative format, email accessibility@wsib.on.ca or visit the WSIB website at wsib.ca.

Claim Information

• Claim Numbers: Enter the relevant claim numbers associated with the worker.
• Worker Details: Provide the worker’s name and date of birth in the format (dd/mmm/yy).

Part A – Worker or Employer Directing Authorization

• Name: Enter the full name of the worker or employer directing the authorization.
• Employer/Company Name: Enter the name of the employer or company, if applicable.
• Contact Information: Fill in the address, city/town, postal code, telephone number, and fax number.
• Language: Indicate the preferred language (English, French, or other).

Part B – Representative Information

• Name of Authorized Person/Organization: Enter the name of the person or organization being authorized.
• Contact Information: Fill in the address, city/town, postal code, telephone number, and fax number.
• Signature: The authorized representative must sign this section.

Licensing Information

• Option 1: If the representative has a Law Society of Upper Canada or Application ID number, enter it here.
• Option 2: If the representative is exempt from the paralegal licensing requirement, check the appropriate exemption box:
  • In-house legal services provider or paralegal
  • Student legal aid services society
  • Acting for family or friend
  • Office of the Worker Adviser
  • Articling student
  • Legal clinic
  • Constituency assistant
  • Office of the Employer Adviser
  • Trade union
  • Other profession or occupation (specify)
• Option 3: If the representative is excluded from the paralegal licensing requirements, provide an explanation.

Part C – Extent of Authorization and Expiration

• Authorization Scope: This section confirms that the representative is authorized to access and manage all WSIB claim-related information.
• Effective Period: The authorization is effective indefinitely until revoked in writing or upon the death of the worker.

Part D – Approval by Worker or Employer

• Approval: The worker or employer must sign this section to validate the authorization.
• Details: Provide the name, position/title (if applicable), and date of signing (dd/mmm/yy).

Additional Information

• Cancelling or Changing Authorization: To change an authorization, complete a new Direction of Authorization form. To cancel an authorization, send a written request or fax to the Claims Adjudicator responsible for the claim.
• Code of Conduct for Representatives: Visit wsib.ca/repconduct for more information on the expected standards of behavior.
• Additional Space: If additional space is needed, add a note on page 1 and attach the extra pages to the form.

Submission Instructions

• Mail: Send the completed form to Workplace Safety and Insurance Board, 200 Front Street West, Toronto, Ontario M5V 3J1.
• Fax: Send to 416-344-4684 or 1-888-313-7373.

Ensure all sections are completed accurately and print in black ink to avoid delays in processing. If you need assistance, contact the Claims Adjudicator responsible for the claim.