Publications and Forms
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.
A form, when properly executed, that allows the Division to release or disclose certain information regarding an individual’s workers’ compensation records.
Un folleto delineando hechos para los trabajadores lesionados en materia de indemnización de los trabajadores en Missouri.
A visual chart showing the number of weeks of compensation payable for permanent partial disabilities.
A form outlining eligibility guidelines for the Second Injury Fund.
A brochure outlining facts for injured workers regarding workers’ compensation in Missouri.
A form used to report a group trust members name and/or address change.
A sample indemnity agreement that may be used as a reference when forming a new group trust.
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)