Application For Review {MOIC-2567}

MOIC-2567 - APPLICATION FOR REVIEW. This form is used to appeal an award, decision, or order issued by an Administrative Law Judge (ALJ) of the Missouri Division of Workers’ Compensation. It is submitted to the Missouri Labor and Industrial Relations Commission when a party—such as an employee, employer, insurer, healthcare provider, or the Second Injury Fund—believes the ALJ’s decision is legally or factually incorrect. The form includes identifying information about the case, such as the injury number, date of injury, and the names of involved parties. Applicants must provide specific reasons why they believe the ALJ’s decision was erroneous and may request additional options such as a transcript, filing a brief, or an oral argument. To be considered, the application must be filed within 20 days of the ALJ’s decision, in accordance with Missouri law. www.FormsWorkflow.com