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Publications and Forms

Report Unemployment Insurance (UI) Fraud (MODES-4631)

A form used to report unemployment insurance fraud.

Request by a Health Care Provider for Case Status Information to file a Medical Fee Dispute Application (WC-194)

A form for use by health care provider to determine case status information to file a medical fee dispute application.

Request for Conference (WC-182)

Request to DWC for conference regarding workers’ compensation case.

Request for Award on Undisputed Facts in Regard to Application for Direct Payment (WC-201)

A request by an employer or insurer for an award on undisputed facts in regard to application for a direct payment medical fee dispute.

Request for Certification of Rehabilitation Providers (WCR-8)

A form to be completed by a health care provider requesting certification as a rehabilitation facility.

Request for Dismissal of Application for Direct Payment (WC-MD-10)

A form for use by a health care provider requesting the dismissal of an application for direct payment in a workers’ compensation medical fee dispute.

Request for Dismissal of Application for Payment of Additional Reimbursement of Medical Fees (WC-MD-05)

A form for use by a health care provider requesting the dismissal of an application for payment of additional reimbursement of medical fees in a workers’ compensation “reasonableness” medical fee dispute.

Request for Hearing-Final Award (WC-186)

Request to DWC for a final award hearing regarding workers compensation claim.

Request for Hearing-Hardship or Section 287.203 RSMo Hardship Hearing (WC-185)

Request to DWC for a hardship hearing regarding workers compensation claim.

Request for Mediation (WC-184)

Request to DWC for a mediation regarding workers compensation claim.

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