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 locations listed on the Board's website: www.wcb.ny.gov , mailed to the Board or faxed. If the form is submitted in person and signed by a WC Law Judge, 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). Check ONE Box Only:So ordered.OC-110AORD (4-18)decisions (not intended for insurer attorneys)*.JUDICIAL ORDER full and complete access to the case file(s) mentioned above, with no automatic notices of hearings and/or decisions, only until (date): full and complete access to the case file(s) mentioned above, with no automatic notices of hearings and/or decisions. full and complete access to the case file(s) mentioned above, with automatic receipt of all notices of hearings and Requester's Name: Requester's Address: Claimant's Name (Last, First, MI): WCB Case No(s).: Reason for this request (attach additional sheet, if necessary): Board-assigned ID# (W, T or R): Date: Requester's Signature: I do hereby grant (Name of Requester): Date Signature of WC Law Judge REQUEST FOR JUDICIAL ORDER - ACCESS TO CASE FILES *Grantee must send a copy of this Order to all Parties of Interest in order to receive documents from them.PO Box 5205, Binghamton, NY 13902-5205 Customer Service: (866) 750-5157 l Statewide Fax: (877) 533-0337 American LegalNet, Inc. www.FormsWorkFlow.com