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Worker's claim

Use this form to apply for benefits under the Loi sur les accidents du travail et les maladies professionnelles or to claim reimbursement of medical assistance costs, travel expenses or accommodation expenses. Workers or their representatives should return the duly completed and signed form by fax or mail to their regional CNESST office and remit a copy to their employer.

Use this form to apply for benefits under the Loi sur les accidents du travail et les maladies professionnelles or to claim reimbursement of medical assistance costs, travel expenses or accommodation expenses. Workers or their representatives should return the duly completed and signed form by fax or mail to their regional CNESST office and remit a copy to their employer.

Theme(s) :
Compensation
Sector :
Santé et sécurité du travail
Release date :
Type :
Form
Number of pages :
8
Language of publication :
English
Document number :

1939A

Notes :

Also available in French : Réclamation du travailleur (RTR).