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Publications and Forms

Statement of Specific and Aggregate Excess Insurance Coverage (WC-121)

Proof of initial, renewal, or changes to specific and aggregate Missouri only excess insurance coverage.

Survivors' Benefits: For Family Members of Missouri's Fallen Workforce (WCLoD-15)

A brochure outlining the benefits provided by the Missouri Workers’ Compensation Law in the event of a compensable fatal accident or fatal occupational disease.

Workers' Compensation (WC-106 Letter)

Roles and responsibilities for Employers and Employees; required in workplace.

Workers' Compensation (WC-106 Tabloid)

Roles and responsibilities for Employers and Employees; required in workplace.

Workers' Compensation Requirements For the Missouri Construction Industry (WC-259)

A guide as to when construction industry employers are required to purchase workers’ compensation insurance in Missouri.

Workers' Compensation: Fraud and Noncompliance (FN-09)

A brochure containing information about workers' compensation fraud and noncompliance.

Answer to Application for Direct Payment (WC-199)

A form to be completed by the employer or insurer responding to the application for direct payment.

Answer to Application for Payment of Additional Reimbursement of Medical Fees (WC-198)

A form to be completed by the employer or insurer responding to the application for payment of additional reimbursement of medical fees (a “reasonableness” case).

Application for Administrative Ruling (WC-214)

A form which may be completed by a health care provider, an employer or insurer in a “reasonableness” medical fee dispute where the amount in dispute does not exceed $1,000.

Application for Certification - Safety Consultant/Safety Engineer (WSP-10)

A form application for certification for a safety consultant or safety engineer.

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