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  • Instructions for completing Form 100
    Type: Employers
    Date: February 1, 2023
    Description:

    The pre-printed Form 100 must be completed (even if the employer ceased operating) and returned no later than February 28, 2023. Any Form 100 received after this deadline will be subject to a late filing penalty.

  • Long-term Disability Questionnaire
    Type: Workers
    Date: March 10, 2020 Last Revised: January 26, 2023
    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.

  • Permanent Partial / Total Disability
    Type: Workers
    Date: March 10, 2020 Last Revised: January 26, 2023
    Description:

    In accordance with the Workers' Compensation Act, a review of your Permanent Partial/Total Disability award will be made on the anniversary month of your accident and if applicable, adjusted in accordance with the changes in the New Brunswick Industrial Aggregate Earnings.

  • Surviving Spouse Questionnaire – Dependents
    Type: Workers
    Date: March 10, 2020 Last Revised: January 26, 2023
    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: January 26, 2023
    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.

  • Application for Optional Personal Coverage
    Type: Employers
    Date: January 1, 2023
    Description:

    Proprietors, partners and spouses of non-incorporated businesses and non-salaried officers of limited or incorporated companies are not automatically covered for compensation purposes under the Workers’ Compensation Act of New Brunswick. To obtain coverage for these individuals, optional personal coverage must be purchased from WorkSafeNB. Please read the Terms and Conditions of Optional Personal Coverage before completing the application.

  • Contractors and Subcontractors Form
    Type: Employers
    Date: January 1, 2023
    Description:

    Form to report contractors and subcontractors must be completed and returned no later than February 28, 2023.

  • Initial Psychology Assessment Report (IPAR) | Word Version
    Type: Health Care
    Date: June 18, 2020 Last Revised: December 7, 2022
    Description:

    The Initial Psychological Assessment Report (IPAR) asks for information necessary for WorkSafeNB to make an acceptance decision on a claim. WorkSafeNB must determine whether the worker’s injury meets requirements for acceptance under the Workers’ Compensation Act.

  • Medical Aid Request
    Type: Workers
    Date: November 1, 2022
    Description:

    Use this form if you had an approved claim that is now closed (you're no longer receiving any benefits from WorkSafeNB such as loss of earnings or medical aid) and require medical aid for your previously approved work-related (compensable) injury or illness. 

  • SUCCEED Satisfaction Survey
    Type: Workers
    Date: September 16, 2022

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