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Publications and Forms

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.

Claimant Authorization to Disclose Worker's Compensation Records (WC-303)

A form, when properly executed, that allows the Division to release or disclose certain information regarding an individual’s workers’ compensation records. 

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.

Group Trust Member Information Update (WC-270)

A form used to report a group trust members name and/or address change.

Indemnity (Trust) Agreement (WC-267)

A sample indemnity agreement that may be used as a reference when forming a new group trust.

Irrevocable Letter of Credit (WC-249)

An Irrevocable Letter of Credit; one of three options available to meet the self-insurance security requirement.  Must be accompanied by the Authorization for Release of Confidential Information (WC-249-3)