Notice of Representation (Form CS4)

A party at a conciliation conference may be represented by a legal practitioner, an authorised agent or another person authorised by the rules (s 365(2) of the Workers Compensation and Injury Management Act 2023 (WA); r 10 of the Conciliation Rules 2024 covers officers of body corporates and public sector employees). Under r 11 of the Workers Compensation and Injury Management Conciliation Rules 2024, a representative must notify the Director of their appointment either in the first document they lodge for the party or by a notice of appointment within 3 working days after being appointed, and must notify the Director within 3 working days of ceasing to act. The Director then notifies each other party (r 11(3)). CS4 is the paper form; the form says representatives should use WorkCover WA Online instead whenever it is available.

When you need it

• You are a legal practitioner or authorised agent and WorkCover WA Online is unavailable during the Conciliation Service's business hours, so you cannot notify your appointment or cessation online.
• You have been appointed for a worker, employer, dependant or other party and the appointment was not notified in the first document you lodged.
• You have ceased to act and must tell the Director within 3 working days (r 11(2)).

1. 1

   Section A - case details

   Enter the case number, the applicant and the respondent.

2. 2

   Section B - representative details

   Give the company name, the name of the legal practitioner or authorised agent, postal address, phone, mobile and email, and tick which party you represent.

3. 3

   Section C - type of representative

   Tick legal practitioner or authorised agent. The form refers to an authorised agent under s 303(a), which in the Act means a registered independent agent.

4. 4

   Section C - appointment or cessation

   Complete Q7 with the effective date of appointment or Q8 with the effective date of cessation, and name any previous representative.

5. 5

   Section D - signature

   The representative signs, prints their name and dates the form.

• Notify within 3 working days after the appointment or cessation (r 11(1)(b) and (2)).
• If WorkCover WA Online is available, the form says legal practitioners and authorised agents must lodge the notice through it rather than use this form.
• If WorkCover WA Online is unavailable during the Conciliation Service's normal business hours, the form may be emailed to conciliation@workcover.wa.gov.au (form notes; r 28).

• Use WorkCover WA Online first. CS4 is a fallback for when the system is down.
• You do not need a separate notice on appointment if you notify it in the first document you lodge for the party (r 11(1)(a)).
• WorkCover WA's conciliation guide notes that a family member or friend cannot act as a party's representative.