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Publications and Forms

2013 Trust Self-Insurance Annual Report (WC-135)

A report to be completed annually by a self-insured group trust.

Affidavit of Zero Reporting - Commercial Insurers Only (WC-240)

An affidavit of zero reporting may be completed by insurance carriers authorized to write workers’ compensation policies in Missouri but not writing workers’ compensation policies for the calendar year.

Annual Certification Renewal - Safety Consultant/Safety Engineer (WSP-11)

An annual renewal for certification for a safety consultant or safety engineer.

Answer to Claim For Compensation (WC-22)

A form to be completed by the employer, attorney for employer/insurer/Third-Party Administrator, or Missouri Attorney General’s Office when filing an Answer to a claim for workers’ compensation. This Answer form is to be used for injuries occurring prior to January 1, 2014.

Answer to Claim for Compensation (WC-22-A)

Answer to Claim for Compensation form to be completed by the employer, attorney for employer/insurer/Third-Party Administrator, or Missouri Attorney General’s Office when filing an Answer to a claim for workers’ compensation.  This Answer form is to be used for injuries occurring on or after January 1, 2014, based upon the revisions to the Workers’ Compensation Law. 

Appeals Rights and Procedures (WC-116)

Appeals rights and procedures in workers' compensation cases.

Application for Certification (WSP-45)

An application for certification by an insurance carrier writing workers' compensation in the state of Missouri.

Application for Membership (WC-81B)

Form to be used by employers applying for membership in a group trust.

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.

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