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.