Noncompliance Referral Form {WC-258}

WC-258 - FRAUD AND NONCOMPLIANCE REFERRAL FORM. This form is used by the Missouri Division of Workers’ Compensation to report employers who may be violating state workers' compensation laws. The form allows individuals to provide details about businesses that fail to carry required workers’ compensation insurance, commit fraud, or engage in other noncompliant activities. It collects information about the employer, the nature of the alleged violation, and any related work injuries or deaths. The form also provides an option for the person reporting the violation to remain anonymous, though contact information is encouraged for follow-up. Once submitted, the Fraud and Noncompliance Unit investigates the claim, and if violations are found, the case may be referred to the Missouri Attorney General’s Office for prosecution. www.FormsWorkflow.com