Form WC-276 Electronic Partnering / Confidentiality Agreement (Second Injury Fund Surcharge) - Missouri

What Is Form WC-276?

This is a legal form that was released by the Missouri Department of Labor and Industrial Relations - a government authority operating within Missouri. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form WC-276?A: Form WC-276 is an Electronic Partnering/Confidentiality Agreement specific to the Second Injury Fund Surcharge in Missouri.

Q: What is the purpose of Form WC-276?A: The purpose of Form WC-276 is to establish an electronic partnership and confidentiality agreement related to the Second Injury Fund Surcharge.

Q: What is the Second Injury Fund Surcharge?A: The Second Injury Fund Surcharge in Missouri is a fee assessed on workers' compensation insurance policies to fund benefits for workers with pre-existing disabilities.

Q: Who needs to complete Form WC-276?A: Both the insurer and the endorsing insurance producer must complete and sign Form WC-276.

Q: Are there any fees associated with Form WC-276?A: No, there are no fees associated with completing Form WC-276.

Q: Is Form WC-276 mandatory?A: Yes, Form WC-276 is mandatory for insurers and endorsing insurance producers participating in the Second Injury Fund Surcharge program in Missouri.

Q: Is there a deadline for submitting Form WC-276?A: Yes, Form WC-276 should be completed and submitted to the Division of Workers' Compensation within 30 days of endorsement or termination of the insurance producer.

Q: What happens if Form WC-276 is not submitted?A: Failure to submit Form WC-276 may result in penalties, suspension, or termination of authorization to transact business with the Second Injury Fund Surcharge program.