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Publications and Forms

Application for Review to the Labor and Industrial Relations Commission (MOIC-2567)

An application to have an award, decision or order reviewed by the LIRC.

Claim for Compensation (WC-21)

A form to be completed by the injured worker or by his or her attorney when making a claim for workers' compensation for injuries occurring prior to January 1, 2014.

Claim for Compensation (WC-21-A)

A form to be completed by the injured worker or by his or her attorney when making a claim for workers' compensation for injuries occurring on or after January 1, 2014, based upon the revisions to the Workers’ Compensation Law made by Senate Bill 1.

Claim for Compensation for Line of Duty Compensation Benefits (WCLoD-1)

A claim to be filed regarding a payment to the estate of an Air Ambulance Pilot, an Air Ambulance Registered Professional Nurse, an Emergency Medical Technician, a Firefighter, or a Law Enforcement Officer who was killed in the line of duty.

Datos para Trabajadores Lesionados (WC-101-S)

Un folleto delineando hechos para los trabajadores lesionados en materia de indemnización de los trabajadores en Missouri.

Disability Schedule and Benefit Limits (WC-110)

A visual chart showing the number of weeks of compensation payable for permanent partial disabilities.

Docket Locations Directory (WC-266)

Directory of Missouri Docket locations and addresses.

Eligibility Guidelines for Physical Rehabilitation (WCR-7)

A form outlining eligibility guidelines for the Second Injury Fund.

Facts For Injured Workers (WC-101)

A brochure outlining facts for injured workers regarding workers’ compensation in Missouri.

Missouri's Second Injury Fund (WC-120)

Information regarding the Missouri Second Injury Fund.

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