Mo claim compensation 2026

1. Click ‘Get Form’ to open the mo claim compensation form in the editor.
2. Begin by filling out the Employee Information section. Enter the injured employee’s name, mailing address, and social security number in the designated fields.
3. In Box 4, provide the date of accident or occupational disease. Ensure you follow the guidelines for repetitive motion claims as specified.
4. Complete Box 5 with the average weekly wage earned by the employee. This should reflect gross wages, not net.
5. For Box 7, include the ZIP code where the accident occurred. This is crucial for accurate processing.
6. If applicable, fill out Box 15 with dependent information only if the employee has died. Ensure all details are accurate and legible.
7. Finally, sign Box 16 as the injured employee or claimant unless represented by an attorney. Review all entries for completeness before submission.

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