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  • Surviving Spouse Questionnaire – Dependents
    Type: Workers
    Date: March 10, 2020 Last Revised: March 10, 2025
    Description:

    The benefits you receive from WorkSafeNB are reviewed annually on the anniversary of your spouse’s death and adjusted in accordance with the percentage increase established by WorkSafeNB.

  • Surviving Spouse Questionnaire – New Spouse
    Type: Workers
    Date: March 10, 2020 Last Revised: March 10, 2025
    Description:

    The benefits you receive from WorkSafeNB are reviewed annually on the anniversary of your spouse’s death and adjusted in accordance with the percentage increase established by WorkSafeNB.

  • Travel Expense Form
    Type: Workers
    Date: March 20, 2016 Last Revised: February 7, 2025
    Description:

    Medical expense related travel is any visit to a medical professional such as visits to physicians, physiotherapists, chiropractors and any other treatment provided to help you recover from your workplace injury.

    Non-medical expense related travel may include appointments with WorkSafeNB staff, at the staff members’ request, appointments for vocational testing or training and WCAT hearings.

  • Long-term Disability Questionnaire
    Type: Workers
    Date: March 10, 2020 Last Revised: February 5, 2025
    Description:

    In accordance with the Workers' Compensation Act, adjustments to Long-Term Disability (LTD) benefits are made on the anniversary month of your injury or recurrence of injury.

  • Employer Report of Injury or Illness
    Type: Employers
    Date: August 6, 2020 Last Revised: February 5, 2025
    Description:

    Complete this form if an employee experiences a work-related injury or illness. You must submit this to WorkSafeNB within three days of the: date of the accident if the injury or illness may entitle the worker and/or their dependent(s) to wage  replacement or medical treatment under New Brunswick’s Workers’ Compensation Act; date the employee is diagnosed with an occupational disease; or date you are notified of the accident/injury or illness by the employee.

  • Application for Workers' Compensation Benefits
    Type: Workers
    Date: August 6, 2020 Last Revised: February 5, 2025
    Description:

    Submit this form when applying for WorkSafeNB benefits, such as lost wages and/or medical treatment (physiotherapy, medication, etc.), due to a workplace injury or illness. You must complete this form and send it to WorkSafeNB within one year from the date of the accident/injury or illness.

  • Employer Report of Occupational Hearing Loss
    Type: Employers
    Date: November 2, 2020 Last Revised: February 5, 2025
  • Application for Benefits Occupational Hearing Loss
    Type: Workers
    Date: November 2, 2020 Last Revised: February 5, 2025
  • Caregiver Receipt
    Type: Workers
    Date: January 10, 2022 Last Revised: February 5, 2025
    Description:

    Use this receipt template for recording informal home care services performed for a worker (the client) receiving WorkSafeNB benefits.

  • Caregiver Disclosure Statement
    Type: Workers
    Date: January 10, 2022 Last Revised: February 5, 2025
    Description:

    Complete this disclosure statement if you plan to perform informal home care services for a worker (the client) receiving WorkSafeNB benefits.

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