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.

 

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

 

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

 

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

 

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

 

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

 

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

 

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. 

 

A form to be completed by physician examining a workers compensation eye injury.

 

Instructions for completing the application, affidavit and waiver of workers compensation benefits.