Risk Management

Workers' Compensation (CARO) State Agencies' Resources

Time Lost for Workers' Compensation Injuries (MO 630-0651)

Time Lost Report for Workers' Compensation Injuries[OneForm Version]
Time Lost Report for Workers' Compensation Injuries [PDF Version]
Completed example of Time Lost Report [PDF Version]

State agencies are responsible for reporting the following workers' compensation related leave events/dates to CARO:

• Days the employee is totally or partially off work;
• Days the employee is in a modified duty status;
• Date the employee returns to full duty.

CARO recommends the following codes when completing the Time Lost Report:

• WC: if the employee is on leave without pay or annual leave
• MD: if the employee is working modified duty

If the employee was directed by the physician to work partial days, temporary partial disability benefits may be due. Please indicate the number of hours worked and the number of hours off work for each day. For example, if the employee worked four hours and was of on work comp for four hours indicate it on the report as follows: 4 work/4 wc

Do not send a time lost report to CARO if the employee is working and takes time to attend medical appointments only.