Get Mo Dwc Wc-21 2015-2025
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How to fill out the MO DWC WC-21 online
Completing the Missouri Department of Labor and Industrial Relations’ Claim for Compensation, known as the MO DWC WC-21, is a vital step in seeking workers' compensation. This guide provides detailed, step-by-step instructions for filling out the form online, ensuring you can submit your claim accurately.
Follow the steps to complete the form with ease.
- Press the ‘Get Form’ button to access the form and open it in your preferred editing platform.
- Begin with the employee information section. Fill in the injured employee’s name, including last, first, and middle initial. Ensure accuracy in the mailing address and add the ZIP code in Box 1D.
- Provide the last four digits of the social security number in Box 2, along with the date of birth in Box 3 and the date of injury in Box 4.
- In Box 5, enter the gross wages earned by the employee. Be sure to use the correct figure to avoid discrepancies.
- Outline the time and place of the accident in Boxes 6 and 7, making sure to include the city, county, and state.
- Detail the parts of the body injured in Box 8. In Box 9, provide a clear description of how the injury occurred.
- For employer information, list the employer(s) against whom the claim is filed in Box 10. Include their mailing addresses as necessary.
- If filing against the Second Injury Fund, complete Section 12 and provide any necessary history of pre-existing disabilities.
- If applicable, include details regarding dependents in Box 15, as this is particularly important if the injury resulted in death.
- Have the employee or claimant sign in Box 16. If there is an attorney representing the claimant, the attorney should sign and fill in their details in the designated boxes.
- Upon completion, review all information for accuracy. Then, save your changes, download the completed form, print it, and prepare it for submission.
Complete your MO DWC WC-21 form online today and submit your claim for workers' compensation with confidence.
Yes, workers' compensation benefits may include a tax form that you will receive depending on the nature of the payments. These forms report the benefits you received, which can help with your tax filings. It's crucial to keep these documents for accurate reporting. If you have questions about your tax obligations concerning workers' comp, consult a tax advisor.
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