Online Submission of Appeals Forms

There are two types of appeals forms under the Program: (1) the Notice of Appeal of Rejected Application form (Schedule 4), which applies if your Application has been rejected on the basis that it does not constitute a Receivable Claim; and (2) the Notice of Appeal of Denied Receivable Claim form (Schedule 5), which applies if your Application has been denied compensation under the Program.

All appeals forms should be completed and submitted in English, French or Spanish; any form completed or submitted in any other language will be rejected. However, documents and other information required to be provided together with the Notice of Appeal of Denied Receivable Claim form (as described in that form) may be submitted in other languages. All appeals forms must be duly completed, signed and dated when submitted, in order to be considered.

You can submit the appeals forms either: (i) online through this website (see the link provided below), or (ii) by email to covaxclaims@esis.com, or (iii) by regular mail to one of the Program’s Regional Centers.

IMPORTANT NOTE:  Both types of appeals forms described above can be uploaded and submitted online through this website by using the link below. However, please make sure that you download, complete and submit the correct appeals form (either Schedule 4 or Schedule 5), depending on the applicable situation. Please refer to the Frequently Asked Questions for more information about which appeals process and appeals form to use. 

If you wish to submit an appeals form online through this website, then:

  1. First download, print and complete the correct appeals form on paper (either Schedule 4 or Schedule 5, depending on the applicable situation) by clicking here. Please note that appeals forms cannot be completed directly on this website; and
  2. Then upload and submit the completed appeals form by clicking on the link provided below. You will need to input the Applicant’s name and the Application number in order to upload and submit an appeals form on this website, so please ensure that you have this information handy when you do so. Your Application number will be provided by the Administrator when it confirms receipt of your Application.

On-Line Submission of Appeals Forms requires input of Applicant’s name and the Application number.

Please see the Printable Forms section to download and print the appeals forms referenced above.