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.
1939A
To improve the process, file your request online (available in French only).
