Notice of Appeal
(Washington State Workers' Compensation or Industrial Insurance Tax Assessment Appeals)

Welcome to the Board of Industrial Insurance Appeals electronic filing system. Workers, employers, and other interested parties have a right to file an appeal with the Board of Industrial Insurance Appeals from decisions of the Department of Labor and Industries. RCW 51.52.060. Ordinarily, one must file an appeal with the Board WITHIN 60 DAYS of the date of receiving the Department's decision. The appeal period can be as little as 30 days in Industrial Insurance tax assessment cases and as little as 20 days if the Department in demanding repayment of sums paid to a treatment or vocational provider. Please refer to the Department order for additional information.

The Board's electronic filing system is designed to simplify and speed the process of filing an appeal, while still providing the Board the necessary information to process it. If you wish to appeal a decision of the Department, you may complete the form and submit it electronically, or you can choose to print the electronic form and deliver it in person at 2430 Chandler Court SW, Olympia, Washington, or by mail at BIIA, P.O. Box 42401, Olympia, WA 98504-2401. If you submit your appeal electronically you do not need to submit a paper copy, either in person or through the mail, although you should keep a copy for your records.

Public Disclosure: Please note that information provided in an appeal may be subject to public disclosure under RCW 42.56.070(1).

Warnings:

(1)You have 15 minutes to complete this form. A warning will appear with 2 minutes left. Click continue or all your data will be lost and must be reentered.
(2) You must enter an email address to receive an email confirmation of successful submission.
(3) Unless you see "Your notice of appeal form has been submitted" your electronic appeal has NOT been received by the BIIA.

* indicates required field to display detail information
Appeal Type Selection Privacy Policy
Appeal Filed By:*
Appeal Filed On Behalf Of:*