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Workers’ Compensation Authorization Form (Form OC-110A)

Jed Dietrich, Esq., a Distinguished Member of the Million Dollar Advocates Forum, and His Top Rated Injury Attorneys at the Dietrich Law Firm P.C. of Buffalo, New York, are ready to Assist Individuals Seeking Legal Representation for their Personal Injury Claims in Buffalo, Niagara Falls, Rochester, or other parts of New York State.


Work injury claim form The Workers’ Compensation Authorization Form (Form OC-110A) grants a specific individual or entity permission to access the Workers’ Compensation records of an injured individual. The form is in accordance with section 110-a of the Workers’ Compensation Law, which states that the personal records of an individual cannot be released without the express consent of that individual. Without this form, it is illegal to release anyone’s personal Workers’ Compensation records, except in certain circumstances such as a court order.

The Dietrich Law Firm P.C., recognized as a Best Law Firm of America, has been helping accident victims throughout Buffalo, New York, for over a decade. In that time, it has championed countless personal injury claims. If you are looking for a team of dedicated, hardworking, and skilled injury lawyers to represent you, the Dietrich Law Firm, P.C., is your top choice. Our team of highly experienced personal injury attorneys works on a contingency-fee-basis, meaning our legal fees depend on the compensation we obtain for you. We only seek a fee for our services after your case is successfully settled or tried. For more information on how we might best represent you, call us today for your free consultation at 716-839-3939 or contact us online.

What Is A Workers’ Compensation Authorization Form?

Workers’ Compensation is an insurance program under the United States’ Department of Labor. The purpose of the program is to cover costs in the event of a workplace-related injury. These can be costs associated with medical treatment, including the treatment itself or the rehabilitation following an injury. The program also provides monetary compensation for any wages lost on account of an accident, and, in the event that an accident forces an individual to take a lower-paying job, it can sometimes be used to make up the difference of that lower salary. To date, in New York State alone, there have been over 14,000 Workers’ Compensation claims filed and $500,000,000 paid out in worker compensation and medical bills.

The circumstances that require an individual to submit a Workers’ Compensation Authorization Form are often a result of a personal injury accident. The uncertainty regarding what steps to take and how to begin the process of filing a personal injury claim can be frustrating, but there is help available. Jed Dietrich, Esq. is recognized as a New York Super Lawyer and is adept at tackling personal injury cases on behalf of his clients. If you, or a loved one, are seeking top rated legal representation for a personal injury accident in Buffalo, Niagara Falls, Rochester, or other parts of New York State, contact the Dietrich Law Firm P.C. now at 716-839-3939 or contact us online for your free consultation.

Frequently Asked Questions

Person with broken hand typing The Workers’ Compensation Authorization Form is not an uncommon form, but even so, it is very common to have questions regarding the circumstances in which this form is necessary. The following are a few of the most frequently asked questions regarding the Workers’ Compensation Authorization Form:

  1. What will I need to fill out the Workers’ Compensation Authorization Form? You will need your Social Security Number, or Tax Identification Number, the case number or date of the accident, and the name and address of the individual or entity you want the information released to.
  2. In what circumstances would I need a Workers’ Compensation Authorization Form? There are certain legal circumstances that require the release of information from an individual’s Workers’ Compensation file. When you file a personal injury claim, for example, the defense will try to disprove your injury claim by asserting that you are not really injured. The defense attorney can access your Workers’ Compensation records and use them to claim that you were already injured before the accident in question. This is why it is essential that you are always honest with your personal injury lawyer. In ensuring that your attorney has knowledge of and access to documentation of your past injuries or accidents, you are doing your part to help strengthen your case. If your personal injury attorney has this knowledge from the outset, they can modify your case to include your past medical history while focusing on your current injuries. If you fail to provide your attorney with this important history, the defense attorney could attempt to use it against you, and it could be harmful to your case and severely hinder your chance of getting compensation for your injuries. For more information on your rights and responsibilities as a personal injury plaintiff, visit our webpage.
  3. Are there any exceptions regarding who this information can be released to? Yes, information on an individual’s Workers’ Compensation records cannot be released to prospective employers in order to determine an individual’s capacity to work.
  4. Where can I access a sample Workers’ Compensation Authorization Form? You can view a sample form by clicking this link.
  5. Can someone help me to understand the Workers’ Compensation Authorization Form? Yes! The top rated personal injury lawyers at the Dietrich Law Firm P.C. are more than capable of answering any questions you might have about this form and your personal injury claim.

WERE YOU, OR A LOVED ONE, SERIOUSLY INJURED IN AN ACCIDENT CAUSED BY ANOTHER’S NEGLIGENCE IN BUFFALO, NIAGARA FALLS, ROCHESTER, OR OTHER PARTS OF NEW YORK STATE?

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

As a resident of Western New York, Jed Dietrich, Esq. has represented countless clients in their personal injury claims. He is well acquainted with the challenges that individuals face in the aftermath of an accident, and that is why his clients are always his top priority. With over $175,000,000 secured in settlements and verdicts for our clients, the Dietrich Law Firm, P.C. is experienced in personal injury law and knows how to assist you in your personal injury case best. Call us today at 716-839-3939 or visit us online to schedule your free consultation.


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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