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Publications and Forms

Request for Award on Undisputed Facts in Regard to Application for Payment of Additional Reimbursement of Medical Fees (WC-297)

A request by an employer or insurer for an award on undisputed facts in regard to application for payment of additional reimbursement of medical fees on the ground that the Application was not filed within the limitation period set forth in §287.140.4, RSMo, or that the charges were paid in full or any ground that negates liability for payment.

Request for Pre-Hearing (WC-183)

Request to DWC for a pre-hearing regarding workers compensation claim.

Self-Insuring Workers' Compensation Liability Through Trusts (WC-124)

This brochure is to inform employers who are or want to be self-insured for workers' compensation liability through trusts (a way employers that are usually within the same industry or members of the same association can pool their liabilities with other employers).

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.

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