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Missouri Department of Labor and Industrial Relations – Division of Workers’ Compensation, Tort Victims’ Compensation Program fax number
(573) 526-2700
Missouri Department of Labor and Industrial Relations (Division of Workers' Compensation)
Used for: Submit the Application for Tort Victims’ Compensation (WCT-1-AI); provide required affidavits (WCT-2 to WCT-6) as needed; claim is evaluated and an Administrative Determination is issued; possible appeals available.
Fax destination details
- Department
- Missouri Department of Labor and Industrial Relations (Division of Workers' Compensation)
- Purpose
- Submit the Application for Tort Victims’ Compensation (WCT-1-AI); provide required affidavits (WCT-2 to WCT-6) as needed; claim is evaluated and an Administrative Determination is issued; possible appeals available.
- Form
- WCT-1-AI — Application for Tort Victims’ Compensation
- Address
- 421 E Dunklin St, Jefferson City, MO 65102
- Voice phone
- 573-751-4231
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill the WCT-1-AI form clearly in ink, sign the last page and have it notarized; file in person at the Jefferson City office (421 E Dunklin St, Jefferson City, MO 65102) or mail to Tort Victims' Compensation Program, P.O. Box 58, Jefferson City, MO 65102; include affidavits A–E as applicable (WCT-2 to WCT-6).
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