Form OC-110A Claimant's Authorization to Disclose Workers' Compensation Records - New York

Form OC-110A Claimant's Authorization to Disclose Workers' Compensation Records - New York

What Is Form OC-110A?

This is a legal form that was released by the New York State Workers' Compensation Board - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form OC-110A?
A: Form OC-110A is the Claimant's Authorization to Disclose Workers' Compensation Records in New York.

Q: What is the purpose of Form OC-110A?
A: The purpose of Form OC-110A is to authorize the release of your workers' compensation records.

Q: When is Form OC-110A used?
A: Form OC-110A is used when you want to allow someone access to your workers' compensation records.

Q: Who can use Form OC-110A?
A: Any claimant in New York who wants to disclose their workers' compensation records can use Form OC-110A.

Q: Is Form OC-110A mandatory?
A: No, Form OC-110A is not mandatory. It is optional, and you can choose to sign and authorize the release of your workers' compensation records.

Q: What information is required on Form OC-110A?
A: On Form OC-110A, you will need to provide your personal information and the specific individuals or organizations you are authorizing to access your workers' compensation records.

Q: How do I submit Form OC-110A?
A: Once you have completed and signed Form OC-110A, you can submit it to the appropriate party, such as your employer, insurance company, or attorney.

Q: Can I revoke the authorization on Form OC-110A?
A: Yes, you can revoke the authorization on Form OC-110A at any time by providing written notice to the party you initially authorized.

Q: Is there a fee for filing Form OC-110A?
A: No, there is no fee for filing Form OC-110A. It is a free form provided by the New York Workers' Compensation Board.

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Form Details:

  • Released on December 1, 2017;
  • The latest edition provided by the New York State Workers' Compensation Board;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form OC-110A by clicking the link below or browse more documents and templates provided by the New York State Workers' Compensation Board.

Download Form OC-110A Claimant's Authorization to Disclose Workers' Compensation Records - New York

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