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  • 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.

  • 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
  • Employer Report of Injury or Illness
    Type: Employers
    Date: August 6, 2020 Last Revised: August 11, 2022
    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: August 11, 2022
    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.

  • Report contractors and subcontractors Form
    Type: Employers
    Date: June 16, 2022
    Description:

    Form to report contractors and subcontractors must be completed and returned no later than February 28, 2021.

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