| Missouri Department of Labor and Industrial Relations

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.

Unemployment Insurance Application For Review (MOIC-L-6)

An application to have a decision of an Appeals Tribunal of the Division of Employment Security reviewed by the Labor and Industrial Relations Commission

Vivienda Justa - La promoción de vecindarios libres de discriminación (MCHR-41-S)

Guía sobre cómo prevenir la discriminación en la vivienda para propietarios, arrendadores y quienes busquen comprar o alquilar una casa o apartamento.

Workers' Compensation Subpoena (WC-25-AI)

A subpoena for a workers’ compensation case requiring the attendance of an individual at a hearing.

Workers' Compensation Subpoena Duces Tecum (WC-25-A-AI)

A subpoena for a workers’ compensation case requiring the attendance of an individual—along with specified documents or other evidence—at a hearing.

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Frequently Requested Forms

Claim for Compensation (Workers' Comp.)
Quarterly Contribution and Wage Report (Employment Security)
Contribution & Wage Adjustment Report (Employment Security)
Disability Schedule and Benefit Limits (Workers' Comp.)
Certificate to Employ a Child 14 or 15 Years of Age During School Term
Certificate to Employ a Child 14 or 15 Years of Age During Non-School Term
Missouri Minimum Wage Poster
Request for Mediation (Workers' Comp.)
Request for Pre-Hearing (Workers' Comp.)
Information for Workers (Employment Security)
Employers' Rights and Responsibilities (Employment Security)

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