Missouri WC-21-A (01-14) AL: Employer First Report of Injury

What Is the Missouri WC-21-A (01-14) AL?

The WC-21-A (01-14) AL is the Missouri Division of Workers' Compensation form used by employers to report a workplace injury or occupational disease. It is the employer's counterpart to the employee's First Report of Injury (FROI) and starts the formal claims process in Missouri. The "01-14" revision date and "AL" suffix identify this specific version of the form, which the division uses to track employer-reported incidents statewide.

Who Must File and When

Employers with four or more regular employees in Missouri are generally required to carry workers' compensation insurance and must file the WC-21-A promptly after learning of an injury or disease. The employer must provide the injured worker with a copy of the report within seven calendar days of receiving the information. Filing timelines and electronic versus paper submission options can vary depending on whether the employer participates in the division's electronic filing system, so checking the current submission method is a practical first step.

Key Information Captured on the Form

The WC-21-A collects details that establish the baseline of a claim, including the employer's name, address, and federal employer identification number; the date, time, and location of the injury; a description of the injury or disease; the body part affected; and whether the employee missed work or received medical treatment. Accuracy matters because incomplete or inconsistent reports can delay benefit payments and create disputes over compensability.

How the WC-21-A Fits into the Missouri Claims Process

Once the WC-21-A is filed, the division assigns a claim number and forwards the report to the insurer. The insurer then has 30 days to accept or deny the claim, after which benefit payments — medical and, if applicable, temporary disability — begin or are withheld pending investigation. The employer's report also sets the injury date, which can affect waiting periods and the start of benefit calculations. If the employer fails to file, the employee can still file an FROI, but the delay may create complications for timely medical coverage.

Distinguishing WC-21-A from Other Missouri Forms

The WC-21-A is the employer's initial injury report, while the employee files the FROI (Form 110). Subsequent forms include the WC-21 (Employer's Report of Compensation Paid) for ongoing wage replacement and the WC-111 (Employer's Report of Medical Treatment) for reporting medical payments. Each form tracks a different phase of the claim, and using the wrong version — for example, submitting a prior revision of WC-21-A — can delay processing.

Common Filing Errors and How to Avoid Them

• Missing the seven-day copy deadline to the employee.
• Leaving the injury description vague or omitting the body part.
• Using an outdated form revision instead of the current 01-14 AL version.
• Failing to include the federal employer identification number or correct insurance carrier details.
• Not retaining a dated copy of the filed report for the employer's records.

Where to Obtain and Submit the Form

The Missouri Division of Workers' Compensation provides the WC-21-A (01-14) AL on its official website, typically as a fillable PDF. Employers can submit the form electronically through the division's employer portal or mail a completed paper copy. Always verify the latest revision and submission instructions directly with the division, as form versions and electronic filing options are subject to update.