Google Translate

Search by form number, title, or keyword

Publications and Forms

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

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

Application for Direct Payment (WC-MD-01)

A form for use by a health care provider to apply for direct payment in regards to a workers' compensation medical fee dispute—if the health care provider believes that it can show that it was authorized to treat the employee but no payment has been made.

Application for Evidentiary Hearing (WC-MD-03)

A form for use by a health care provider, an employer or an insurer to request an evidentiary hearing in regards to a workers’ compensation medical fee dispute.

Application for Payment of Additional Reimbursement of Medical Fees (WC-MD-02)

A form for use by health care provider applying for payment of additional reimbursement of medical fees in a workers’ compensation medical fee dispute —if a partial payment has been made. (These are called “reasonableness” cases.)

Application for Tort Victims' Compensation (WCT-1)

An application for tort victims compensation.

Authorization to Inspect and/or Copy Medical Records (WC-43-AI)

An authorization form to inspect and/or copy medical records pertaining to a workers’ compensation case.

Authorization to Release Information (WC-126) and Instructions

This form allows a job applicant to grant a prospective employer access to the job applicant’s workers’ compensation record in Missouri.

Dispute Management Process (WC-107)

A brochure outlining the voluntary dispute management process.

Docket Location Map (WC-266-3)

Map of Missouri Docket locations that show which County belongs to which Area office.

EDI File Matrix (WC-EDI-262)

EDI File Matrix, IAIBC release first report of injury.