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Medicare Authorization Form (Form CMS-10106)

Jed Dietrich, Esq. Is Regarded to be a Best Lawyer of America, and With Over Twenty Years of Experience is Prepared to Represent Individuals in Personal Injury Claims in Buffalo, New York, and the Greater New York Area.


Fillable form and pen The Medicare Authorization Form (Form CMS-10106) informs Medicare that an individual has granted permission to another individual or entity to access their personal health information. If Medicare does not receive official permission of release, they cannot legally grant any other individual access to an individual’s healthcare information. Often, a Medicare Authorization Form is required in order to disclose personal health information in the event of a personal injury claim. In these situations, the last things you need to concern yourself with are questions regarding what paperwork you need to fill out and how to fill the forms out properly. At the Dietrich Law Firm P.C., our team of highly experienced Buffalo, New York personal injury attorneys is more than capable of assisting you every step of the way. Allow us to represent you in your case – you do not have to fight alone. Call today at 716-839-3939 or visit us online to begin the process.

What Is Medicare Authorization Form?

In 1966, the Social Security Administration launched Medicare, a nation-based health insurance program. Although it is one of hundreds of health insurance programs, Medicare’s main goal is to administer health insurance to individuals over the age of 65, individuals with disabilities, and individuals suffering from certain diseases. As with many health insurances, Medicare is responsible for covering some of the costs associated with medical care and maintains medical records of the individuals participating in the program. A Medicare Authorization Form is used to release personal medical information, such as your Medicare health insurance claims. Often this form is used to acquire medical records before insurance settlement talks begin. Your records help determine the amount of monetary compensation you may be able to receive.

Jed Dietrich, Esq. has spent the past 20 years working as a personal injury attorney, tackling countless personal injury cases across the Western New York area. Today, he and his team of elite Buffalo injury attorneys are more than prepared to assist you in your personal injury claim. Call us today at 716-839-3939 or visit us online for your free consultation. You will not be charged until we achieve a win!

Frequently Asked Questions

Nurse speaking to elder man There are many questions that might arise in the event of a personal injury claim. Some of the most frequently asked questions regarding Medicare Authorization Forms are:

  1. What information will I need to fill out this form? You will need your Medicare number and the name and address of the individual or entity to whom you want Medicare to release your information. In the event of a personal injury claim, you will also add the date of your accident. That way, only your medical records relating to your accident will be accessible.
  2. Can I cancel this form if I change my mind? Yes, you can withdraw your permission to release your Medicare information. However, depending on how long you wait, there is always a chance that Medicare might have already distributed your information.
  3. Can I choose someone to act on my behalf? If you require any assistance in filling out this and other legal forms, you can select an authorized representative. An authorized representative is an individual chosen by you to speak on your behalf, often in legal matters.
  4. Who can become an authorized representative? Anyone can act as your authorized representative. On some occasions, Medicare will elect someone to act in this capacity, but personal injury attorneys are capable of standing as your authorized representative as well.
  5. Can I call Medicare on behalf of someone else? Yes, as long as the individual in question has given their permission to Medicare that you are acting as their representative.
  6. Why do I need to disclose my medical records? In the event of a personal injury claim, it is your responsibility to prove that you sustained the injuries alleged. Your medical records, in addition to other documentation, provide invaluable support of your claim and help to build your personal injury case.
  7. Where can I view a sample form? You can find a link to the form here.
  8. Is there someone who can help me fill out this form? Yes! Often a Medicare Authorization Form is used in a personal injury lawsuit and is accompanied by multiple legal documents. It can be challenging to know what forms to fill out and who should be given access to your personal information. Our team of top rated lawyers at the Dietrich Law Firm P.C. is fully capable of providing any assistance you might require in your personal injury case.

DID YOU, OR A LOVED ONE, SUFFER INJURIES IN BUFFALO, NEW YORK?

CALL JED DIETRICH, ESQ. AND HIS TEAM OF QUALIFIED BUFFALO, NEW YORK PERSONAL INJURY ATTORNEYS AT 716-839-3939 NOW TO OBTAIN THE HELP THAT YOU NEED!

Over the past 20 years, Jed Dietrich, Esq. has worked tirelessly on behalf of individuals who sustained injuries in Buffalo, New York, and the Greater New York area. He and his team of top rated personal injury attorneys are prepared to answer any questions you might have about your personal injury case. Call today at 716-839-3939 or contact us online to receive your free consultation. Remember, our clients are never charged until we have obtained a win on their behalf.


Call the Dietrich Law Firm P.C. immediately at 716-839-3939 so that our aggressive, tenacious and hardworking personal injury lawyers can fight to obtain the best result for your personal injury claim in Buffalo, New York. We are available 24 hours a day, 7 days a week, and there is never a fee until we WIN for you!

Client Reviews
★★★★★
I am a medical doctor and have worked with many of the best lawyers in Buffalo and I can say without question that Jed Dietrich is the only lawyer I would trust with my injury case in Buffalo New York. B.O.
★★★★★
Dogged, Determined, and Dead-set on getting you the Maximum settlement for your injuries! T.F.
★★★★★
No one will work harder, smarter or better; I have retained Jed and he obtained the best result for my case. D.P.
★★★★★
The definition of an "A" type personality-exactly who I would want to represent me in a serious personal injury case. E.S.
★★★★★
Jed is a Master in the courtroom without an equal. S.C.
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