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C622 REV MAY 2012.xdp - wcb ab

C622 REV MAY 2012.xdp - wcb ab-2026

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The document is a form (C622) for workers in Alberta to authorize a representative, either formal or informal, to assist with their claims. It outlines the definitions of both types of representatives, the responsibilities of the worker regarding authorizations, and provides sections for claimant and representative information, scope of representation, validity period, and acknowledgment of responsibilities.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out Part A: Claimant Information. Enter your surname, first name, initial, address, city/town, postal code, province, telephone number, and fax number.
Proceed to Part B: Representative Information. Choose whether you authorize a person or a company as your representative by checking the appropriate box. Fill in their full name and contact details.
In Part C: Scope / Representative, specify if the authorization covers all claims or just one specific claim by entering the claim number if applicable.
For Part D: Validity Period, indicate the expiry date of this authorization. If left blank, it remains valid until rescinded in writing.
Finally, complete Part E by signing and dating the form to acknowledge your responsibilities regarding online access management.

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How do I request a claim file from WCB Alberta?

To ensure you are fully informed about your claim and decision, please contact our Claims Contact Centre by phone at 780-498-3999 to request a copy of your claim file. You may be asked the following questions to verify your identity: Name. Date of birth.

What is the Workers Compensation Act in Alberta?

The Workers Compensation Act creates the Workers Compensation Board (WCB) as a corporation and grants it authority to administer a system of workplace injury insurance for the workers and employers of the province of Alberta.

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