Individual Self Insured Employer Information {WC-131}

WC-131 - INDIVIDUAL SELF-INSURED EMPLOYER INFORMATION. This form is used by the Missouri Department of Labor and Industrial Relations to collect detailed information about an individual self-insured employer. The form requires the employer to provide data such as the legal entity holding Missouri self-insurance authority, contact information for various responsible individuals within the organization (including those handling self-insurance, financial matters, annual reports, safety, corporate legal counsel, claims administration, and administrative tax), and any significant changes in operations over the last year. www.FormsWorkflow.com