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CLAIMANT\'S AUTHORIZATION TO DISCLOSE WORKERS\' COMPENSATION RECORDS (Pursuant to Workers\' Compensation Law Section 110a) PO Box 5205, Binghamton, NY 139025205lwww.web.NY.claimants ARE PROHIBITED
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The form wwww.cb.ny.gov/content/main/forms/oc110a is needed by individuals who have experienced a work-related injury or illness in the state of New York. It is specifically for filing a claim for workers' compensation benefits with the New York State Workers' Compensation Board. This form is required for employees who want to request compensation for medical expenses, lost wages, and other benefits related to their work-related injury or illness.
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It is a form required to be filed with WCB NY.
Employers in New York State are required to file wwwwcbnygovcontentmainformsoc110a.
The form can be filled out online on the WCB NY website or submitted through mail.
The purpose of the form is to report employee injuries and illnesses.
Information such as employee name, date of injury, nature of injury, and treatment provided must be reported.
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