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Publications and Forms

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.

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).

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