A form for use by a health care provider requesting the dismissal of an application for payment of additional reimbursement of medical fees in a workers’ compensation “reasonableness” medical fee dispute.
Request to DWC for a final award hearing regarding workers compensation claim.
Request to DWC for a hardship hearing regarding workers compensation claim.
A form requesting services from a workers' compensation program or the Missouri workers' safety program. Fill out an online version of this form by clicking here.
An annual report of an individually self-insured employer’s audited financial statements.
An annual report of an individually self-insured employer’s Missouri payroll by class code and employee count by Missouri location.
An annual report of an individually self-insured employer’s Missouri compensation payments for the prior calendar year.
An annual report of an individually self-insured employer’s outstanding losses.
A form submitted to an Administration Law Judge for approval of the settlement of a workers' compensation case.