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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.

Division of Workers' Compensation's 2017 Annual Report

This report, as required by §287.680 RSMo, briefly describes each of the programs and units with the Division of Workers' Compensation and summarizes the transactions and proceedings undertaken for the year 2017.

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.

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