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Jul 19, 2026 14:31 (UTC-07) From: WWW.FAX.PLUS (mark holand)

D. Please give your reasons

itis Inportantto be as specific as possible about the reasons for requesting @ Review Number:
raview of the decision(s). The more information you provide, the better we will be
able to respond to your request. (You can give us your reasons by completing RO360901

the section below or by attaching a fetter containing your reasons}

The Review Officer can change your Board decision for a variety of reasons. The most common ones are Ested below. You must
check (/} at least one of the five boxes below that best applies to your case and then explain mt the bottom of the section why
you think that reason applies fo your case. If you prefer, you can simply check the last box marked “Other reasons” and explain in.
detall why you think the Board decision is wrong. You can attach a separate letter If there ts not enough room on this form.

a a . CIA tottoris) is attached.
| ballave that the Board deciston of March 23, 2026 is wrong because:
(1 i nave evidence that is not in the Board’s records that should be considered and is attached to this form. (E.g. Medical

report, statement from.co-warkers, records of employment). f wil explain at the end of this section why this evidence should
change the decision.

The evidence Is:

Wh the following evidence contained in the Board's records has net been considered at all or has not been property considered
when the Board made its decision. { wil explain at the end of this section why this evidence should change the decision.
‘The Jan 30, 2026 ER record where the treating ENT identified the work environment as the migraine trigger.

The evidence Is:

1 the Workers Compensation Act [WCA"} was not properly followed in my casa. (The Workers Compensation Act cen bs
accessed at any public brary or at hitos:/wyww.worksalebe. conveniaw-pollcyworkers-compensation lawiworkers-
pompensation-act). i wil explain at the end of this section why | belleve Rapplies to my case,

The section(s) of the WCA that the Board did not follow is:

CI The wee policy has not heen applied or has been applied Incorrectly. the WCB policies can be accessed at any public
library or at htips'/Aww.worksafebo.com/enflavepoticy). | wilt explain at tha end of this section why ! believe it applies fo my
case.

The policy number(s) not appiled/applied incorrectly is:

Other reasons (please specify)

My explanation for the abave is

Please see the attached Medical Evidence

Rebuttal and Consolidated Evidentiary Record for fult details on the ignored

medical findings, misapplied mechanism of injury, and the employer's administrative
falsifications regarding the site testing.

Name (please print)
Mark Hofand

Address:
311-318 Agnes St. New Westminster

City
New Westminster
Organization name (ff applicable}

The information given on this form and In any documents
attached ts to my knowledge correct and complete.

t

Sianature Yanks Noland
Jtis a serious offence to knowingly provide false information fa
onder to induce the Board to make a particular decision.

Telephone Date signed (yy/nm/dd}
94-3376 26/07/19

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