Form Oc-110aord - Request For Judicial Order - Access To Case Files - State Of New York - Workers' Compensation Board
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STATE OF NEW YORK - WORKERS' COMPENSATION BOARD
REQUEST FOR JUDICIAL ORDER - ACCESS TO CASE FILES
INSTRUCTIONS: Form OC-110AORD is used to request a Judicial Order from a Workers' Compensation Law Judge
granting access to cases to which the requester is not a party in interest. This form may be submitted in person at one of
the Board's District Offices or Customer Service Center locations, mailed to the Board (see addresses above) or faxed
(877-533-0337). If the form is submitted in person and signed by a WC Law Judge at one of the Customer Service Center
locations, the requester is responsible for returning this form to a Board Customer Service Representative for processing.
Bring the original or a copy with you to the Workers' Compensation Board when accessing case file information at Board
offices. If this form is submitted by mail or fax, you will receive a notice from the Board when you have been granted access
to the case file(s).
Requester's Name:_____________________________________ Board-assigned ID#(W,T or R):_____________________
Requester's Address:_________________________________________________________________________________
Claimant's Name:____________________________________________________________________________________
WCB Case No(s).:___________________________________________________________________________________
Reason for this request:_______________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
(attach additional sheet if necessary)
Requester's Signature:______________________________________________ Date:_____________________________
JUDICIAL ORDER
I do hereby grant__________________________________________________________________:
(Name of Requester)
(Check ONE box only.)
full and complete access to the case file(s) mentioned above, with no automatic notices of hearings
and/or decisions, only until (date)____________________.
OR
full and complete access to the case file(s) mentioned above, with no automatic notices of hearings
and/or decisions.
OR
full and complete access to the case file(s) mentioned above, with automatic receipt of all notices
of hearings and decisions (not intended for carrier attorneys)*.
So ordered.
________________________________________________ ________________________________
Signature of WC Law Judge
Date
*Grantee must send a copy of this Order to all Parties of Interest in order to receive documents from them.
OC-110AORD (7-10)
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