Forms & Publications
The following forms are available for your convenience in either Microsoft Word (doc) or portable document formats (pdf).
- Industrial Insurance Notice of Appeal (pdf)
- Firm Notice of Appeal (pdf)
- Crime Victim Notice of Appeal (pdf)
- WISHA Notice of Appeal (pdf)
- Notice of Appearance Form (doc)
- Notice of Intent to Withdraw (doc)
- Notice of Withdrawal - Superior Court Civil Rule (doc)
- Provider Appeal Form
- Request for Dismissal of Appeal Form (doc)
- Attorney Withdrawal Checklist (doc)
- WISHA Certification (pdf)
- Declaration Form
Pamphlets
- Filing a Workers' Compensation Appeal
- Filing an Assessment Appeal
- Filing a WISHA Appeal
- Filling a Crime Victim Appeal
Brochures
- Your Right to Be Heard - IndustrialInsurance English Version pdf format
Su Derecho Aser Escuchado Spanish Version
- Your Right to Be Heard - WISHA English Version pdf format
- Gives an overall look at the appeal process at the BIIA in Washington Industrial Safety and Health Act (WISHA) cases, designed for the lay person.
SU DERECHO A SER ESCUCHADO - WISHA Spanish Version
- Rules of Practice and Procedure Before the Board of Industrial Insurance Appeals of the State of Washington
- Lists the Rules and Regulations (RCW 51.52 and WAC 263-12) that govern the Board of Industrial Insurance Appeals.
Video - DVD
- The Appeal Process
- A 30-minute DVD designed to aid people who pursue a workers' compensation appeal before the Board of Industrial Insurance Appeals and who do not have the aid of an attorney. It discusses what happens after the appeal has been granted and the steps that the party can expect. This video is available in either English, captioned or in Spanish. You may request this by e-mail. Be sure to include your complete mailing address. mailto:Video@biia.wa.gov
To view these forms, you will need to have Microsoft Word® (or a Word viewer), or Adobe Acrobat® Reader installed on your computer. You can download either of these viewers from the following links:
Download Microsoft Word® Viewer
Download Adobe Acrobat Reader®
The Board of Industrial Insurance Appeals believes in non-discrimination and providing equal access in all areas of employment and service. Persons with disabilities who need assistance to receive the services of the Board, or need Board documents in an alternate format may call (360) 753-6823. Text telephone (TTY) and Telebraille users, please call the Board through the Washington State Telecommunications Relay Service: TTY 1-800-833-6388 and Telebraille 1-800-833-6385.