Forms
The most important form that needs to be filled out is the Notice of Appeal form. This form must be completed and faxed or delivered to the Automobile Injury Compensation Appeal Commission no later than 90 days from the day you received your Internal Review decision letter. Upon receipt of this form, the Commission will begin the process for hearing your appeal.
Appeal Applications
Notice of Appeal Online Submission (you will receive an automated reference/confirmation number and the option to print upon submission)
- Printable PDF version (mail/fax submission)
Notice of Withdrawal Applications
- Notice of Withdrawal - Appellant Represented
- Notice of Withdrawal - Appellant Self-represented
- Notice of partial withdrawal - Self-represented
- Notice of partial withdrawal - Represented
Subpoena
The fax number for the AICAC is: 1 (204) 948-2402
We are located at:
301-428 Portage Avenue
Winnipeg, MB
R3C 0E2
If you need assistance filling out this form, please call 204-945-4155 or 1-855-548-7443 (ask for the Automobile Injury Compensation Appeal Commission).