Dispute Resolution Services Forms

Effective August 1, 2011, FSCO’s Dispute Resolution Forms A and B have been revised to reflect recent amendments to the Statutory Accident Benefits Schedule – Effective September 1, 2010.  Forms A ,  B, C, D,  E,  G,  I,  J, K, L, M and P have been amended to provide for the mandatory inclusion of email addresses of the parties’ representatives. Previous versions of these forms will not be accepted.

 

Please refer to Bulletin A-04/11, Revisions to the Fourth Edition of the Dispute Resolution Practice Code and Revised Forms.

 

If additional information is required, please contact FSCO’s Dispute Resolution Services:

 

For information about mediation forms call:

In Toronto: 416-590-7210 or

Toll Free: 1-800-517-2332 ext. 7210

 

For information about arbitration forms call:

In Toronto: 416-590-7202 or

Toll Free: 1-800-517-2332 ext. 7202 

 

For information about appeal forms call:

In Toronto: 416-590-7222 or

Toll Free: 1-800-517-2332 ext. 7222 

 

 

 

Form A - Application for Mediation  Size: 280 kb​ (Guide)  Size: 475 kb​ (Released: August 1, 2011) ​

Form B - Response to an Application for Mediation Size: 223 kb​ (Released: August 1, 2011)  ​

Form C - Application for Arbitration  Size: 272 kb​ (Guide)  Size: 72 kb​ (Released: August 1, 2011)  ​

Form D - Agreement to Neutral Evaluation at the Commission Size: 158 kb​ (Released: August 1, 2011) ​

Form E - Response by Insurer to an Application for Arbitration Size: 318 kb​ (Released: August 1, 2011) ​

Form F - Statement of Service Size: 62 kb​ (Latest Release: March 1, 2001) ​

Form G - Reply by the Applicant for Arbitration Size: 139 kb​ (Released: August 1, 2011) ​

Form H - Joint Statement for Neutral Evaluation at the Commission Size: 34 kb​ (Latest Release: March 1, 2001) ​

Form I - Notice of Appeal Size: 198 kb​ (Guide)  Size: 77 kb​ (Released: August 1, 2011)  ​

Form J - Response to Appeal  Size: 192 kb​ (Guide) Size: 94 kb​ (Released: August 1, 2011)  ​

Form K - Application for Intervention Size: 197 kb​ (Released: August 1, 2011) ​

Form L - Application for Variation/Revocation  Size: 198 kb​ (Guide) Size: 107 kb​ (Released: August 1, 2011) ​

Form M - Response to Application for Variation/Revocation  Size: 191 kb​ (Guide) Size: 93 kb​ (Released: August 1, 2011) ​

Form N - Summons to Witness Size: 86 kb​ (Latest Release: March 1, 2001) ​

Form O - Affidavit of Service for a Summons to Witness Size: 37 kb​ (Latest Release: March 1, 2001)  ​

Form P - Representing Minors and Mentally Incapable Persons Size: 134 kb​ (Released: August 1, 2011)