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Publications and Forms

Electronic Fund Transfer Enrollment Form (WC-132)

This form must be used by the Workers' Compensation Insurance Carriers, the Self-Insured Employers and the Self-Insured Groups or trusts who would like to make Second Injury Fund surcharge payments to the Missouri Division of Workers' Compensation through an Electronic Fund Transfer.

Employee's Application for Religious Exception (WC-138)

The form to be completed by an employee request to be exempt from workers' compensation due to religious reasons.

Employee's Religious Exception Affidavit and Waiver (WC-138-3)

The affidavit to be completed by an employee request to be exempt from workers' compensation due to religious reasons.

Employer's Affidavit for Religious Exception (WC-138-5)

The affidavit to be completed by an employer when requesting for an employee to be exempt from workers' compensation due to religious reasons.

Escrow Agreement (WC-82E)

An Escrow Agreement; one of three options available to meet the self-insurance security requirement.

Group Insurance Checklist (WC-239)

The checklist of required items and information that must accompany the Application for Self-Insurance Trust (WC-81A).

Guaranty to Satisfy Compensation Claims Under Workers’ Compensation Law of Missouri (WC-82A)

A guaranty of a third party to satisfy an individually self-insured employer’s workers’ compensation obligations under Missouri law.

Information for Appeals Tribunal Hearings (MODES-INF-166)

Information for Appeals Tribunal hearings, including what they are, instructions, and other important facts to know.

Joint Motion for Change of Venue (WC-281)

This form allows attorneys that are parties to a case to jointly submit a motion for change of venue.  All parties must agree to the change of venue. 

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