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Publications and Forms

Request for Services from the Missouri Workers' Safety Program (WSP-6)

A form requesting services from a workers' compensation program or the Missouri workers' safety program.

Self-Insurer’s Annual Financial Statement (WC-85)

An annual report of an individually self-insured employer’s audited financial statements.

Self-Insurer’s Payroll Report (WC-84)

An annual report of an individually self-insured employer’s Missouri payroll by class code and employee count by Missouri location.

Self-Insurer’s Report of Compensation Payments (WC-86)

An annual report of an individually self-insured employer’s Missouri compensation payments for the prior calendar year.

Self-Insurer’s Statement of Outstanding Losses (WC-83)

An annual report of an individually self-insured employer’s outstanding losses.

Stipulation for Compromise Settlement (WC-G-11)

A form submitted to an Administration Law Judge for approval of the settlement of a workers' compensation case.

Substitution of Counsel (WC-237)

A request for substitution of counsel in a workers' compensation case.

Surety Bond (MODES-4252)

Some employers ("lessors") lease employees to clients. Unless the lessor provides a financial guarantee, such as a surety bond, to ensure prompt payment of unemployment liabilities: (1) the lessor must file a separate Quarterly Contribution and Wage Report for the employees leased to each client; and (2) the client is jointly liable for the contributions otherwise due on the workers it leases from the lessor. MODES-4252 must be used for the posting of a surety bond.

Surplus Distribution Request (WC-265)

A form requesting authority to distribute surplus monies of a self-insured group trust.

Trust Quick Reference Due Dates (WC-193)

A quick reference for group trust reporting requirements.

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