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Publications and Forms

Irrevocable Letter of Credit (WC-249)

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)

Ley sobre Indemnización al Trabajador (WC-106-S Letter size)

Información de los trabajadores acerca de la indemnización de los trabajadores; requerida en el lugar de trabajo.

Ley sobre Indemnización al Trabajador (WC-106-S Tabloid Size)

Información de los trabajadores acerca de la indemnización de los trabajadores; requerida en el lugar de trabajo.

Medical Treatment Form (WC-9)

A form to be completed by a physician when treating a worker involved in a workers' compensation claim.

Mesothelioma Liability Election of Self-Insured Employer or Group Trust Member Pursuant to 287.200.4(3), RSMo (WC-304-I)

A form used by Division authorized self-insured employers and group trust members to notify the Department of their mesothelioma liability election

Missouri Workers' Safety Program (WSP-50)

The Missouri Workers' Safety Program helps businesses improve workplace safety and reduce workers' compensation insurance costs.  The brochure is a brief overview of the program and what they offer.  

Missouri's Second Injury Fund (WC-120)

Information regarding the Missouri Second Injury Fund.

Notice of Commencement/Termination of Compensation (WC-2)

A notice of commencement/termination of compensation to be filled out by a self-insured/self-administered employer, insurance company, or third party administrator.

Notice of Commencement/Termination of Compensation Spreadsheet (WC-2)

A notice of commencement/termination of compensation to be filled out by a self-insured/self-administered employer, insurance company, or third party administrator.

Notice of Employers Election to Become a Member of a Group Insurance Pool* Pursuant to 287.200.4(3)(a), RSMo (WC-304-G)

A form used by employers to notify the Department of their election to become a member of a group insurance pool pursuant to 287.200.4(3)(a), RSMo

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