Claims Kit

Posting Requirements MCA 71-3-81, General Rule 8

Every employer who has secured compensation must keep notices posted in a conspicuous place or places in and about his place or places of business, in accordance with a form prescribed by the commission, stating that the employer has secured the payment of compensation in accordance with the law. The notice will contain the name and address of the carrier, if any, with whom the employer has secured payment of the compensation 

Notice of Coverage

Notice of Coverage (SPANISH)

Reporting of Claim by Employer 71-3-67

Employers should complete and file a first report of injury (FROI) with their carrier or third party administrator immediately upon receiving notice of an injury, if the injury requires a loss of more than the shift on which the injury occurs. If the injury causes lost time in excess of five days, or if the injury results in permanent impairment, the carrier or third party administrator must file the form with the Mississippi Workers' Compensation Commission. The Commission will return a file number to be used for any future filings related to the claim. The statute contemplates such filing within ten days of the employer's notice of the injury or notice that the injury has resulted in lost time in excess of the waiting period or permanent impairment.    .

B-3 (IAIABC IA-1) Employer's First Report of Injury or Occupational Disease

The failure to file a First Report of Injury has resulted in court decisions refusing to apply the two year statute of limitation on a claim and has served as the basis for an employer to become a defendant in bad faith litigation

March 31, 2021
The Mississippi Workers' Compensation Commission implemented several policies and proceduresin response to the State of Emergency declared by Governor Reeves on March 16, 2020. Inaccordance with the Governor's declaration and with his subsequent orders, the following policiesand procedures will remain in place until April 15,2021 unless otherwise noted

Settlement Procedure:
All settlements must be mailed in or filed electronically through ATOS, and must have all requiredsignatures. If filing through ATOS, use the "unrepresented claimant, proposed" tab. After approval,mail in settlements will be returned to each attorney by mail and settlements filed though A TOS willbe returned by email. The parties can also check the Commission's website to determine whethera settlement was approved and to print a copy of the signed order.

Pro se claimants may appear in person for settlement interviews by appointment, or may participate
in settlement interviews telephonically. However, a Commissioner, at his or her discretion, may
require an in person interview.

Miss. Work. Compo Comm. Rule 2.9: December 22, 2020
Under the "MEDICAL RECORDS AND AFFIDAVITS" portion of this Rule, the attorney's swornstatement when offering medical records/reports need not be notarized. Further, attorneys mayelectronically sign their sworn statement with an "s/" signature and include his or her MS Barnumber. This emergency Rule change extends through March 24, 2021.

Notarization of Claimant's Signature: December 22,2020
Unless signed using Docusign, Claimants' signatures must either a) be notarized or b) include a copyof the claimant's driver's license or ID AND a statement by the claimant and his or her attorney (oremployer and carrier's attorney if the claimant is unrepresented) certifying that the claimant signedthe petition.

Settlement Procedures December 22, 2020

All settlements must be mailed in or filed electronically through ATOS, and must have all requiredsignatures. If filing through ATOS, use the "unrepresented claimant, proposed" tab. After approval,mail in settlements will be returned to each attorney bymail and settlements filed though ATOS will be returned by email. The parties can also check the Commission's website to determine whethera settlement was approved and to print a copy of the signed order.

Pro se claimants may appear in person for settlement interviews by appointment, or may participatein settlement interviews telephonically. However, a Commissioner, at his or her discretion, mayrequire an in person interview.

August 25, 2020

Unlessotherwise noted, the following policies an procedures will remain in place until October 2, 2020.

Miss. Work. Compo Comm. Rule 2.9:

Under the "MEDICAL RECORDS AND AFFIDAVITS" portion ofthis Rule, the attorney's swornstatement when offering medical records/reports need not be notarized. Further, attorneys mayelectronically sign their sworn statement with an "s/" signature and include his or her MS Barnumber. This emergency Rule change extends through December 24,2020.

Auigust 25, 2020

The following policies an procedures will remain in place until October 2, 2020.

Claimants' signatures must either a) be notarized or b) include a copy of the claimant's driver'slicense or ID AND a statement by the claimant and his or her attorney (or employer and carrier'sattorney if the claimant is unrepresented) certifying that the claimant signed the petition.

August 25, 2020

The following procedure will remain in place until October 2, 2020

All settlements must be mailed in or filed electronically through ATOS, and must have all requiredsignatures. If filing through ATOS, use the "unrepresented claimant, proposed" tab. After approval,mail in settlements will be returned to each attorney by mail and settlements filed though A TOS willbe returned by email. The parties can also check the Commission's website to determine whethera settlement was approved and to print a copy of the signed order.

Pro se claimants may appear in person for settlement interviews by appointment, or may participate
in settlement interviews telephonically. However, a Commissioner, at his or her discretion, may
require an in person interview.

The Mississippi Workers' Compensation Commission implemented several policies and proceduresin response to the State of Emergency declared by Governor Reeves on March 16, 2020. Unlessotherwise noted, the following policies and procedures will remain in place until August 31, 2020.

Notarization of Claimant's Signature:

Claimants' signatures must either a) be notarized or b) include a copy of the claimant's driver'slicense or ID AND a statement by the claimant and his or her attorney ( or employer and carrier'sattorney if the claimant is unrepresented) certifying that the claimant signed the petition.

Miss. Work. Comp. Comm. Rule 2.9:

Under the "MEDICAL RECORDS AND AFFIDAVITS" portion of this Rule, the attorney's swornstatement when offering medical records/reports need not be notarized. Further, attorneys mayelectronically sign their sworn statement with an "s/" signature and include his or her MS Barnumber. This emergency Rule change extends through September 28, 2020.

The Mississippi Workers' Compensation Commission implemented several policies and proceduresin response to the State of Emergency declared by Governor Reeves on March 16, 2020. Unless otherwise noted, the following policies and procedures will remain in place until August 31, 2020.

Settlement Procedure:

All settlements must be mailed in or filed electronically through ATOS, and must have all requiredsignatures. If filing through ATOS, use the "unrepresented claimant, proposed" tab. After approval,mail in settlements will be returned to each attorney by mail and settlements filed though ATOS will

be returned by email. The parties can also check the Commission's website to determine whethera settlement was approved and to print a copy of the signed order.

Prose claimants may appear in person for settlement interviews by appointment, or may participatein settlement interviews telephonically. However, a Commissioner, at his or her discretion, mayrequire an in person interview.

Physician Selection MCA 71-3-15

An employer's obligation in the event of an injury is to tender medical treatment to the claimant. The claimant's option is to either accept that tender or to choose his own. Acceptance of the employer's tender of a physician must be made in writing in order to be enforceable. MWCC Rule 1.9. In addition, a part of the 2012 amendments provides that a physician shall be deemed to be claimant’s choice whether or not the claimant had previously “chosen” that physician in writing, if (1) the claimant had treated with that physician for six months or (2) had undergone surgery by that physician. Once the choice is made, the claimant's choice is limited to the chosen physician and referrals by that physician to one physician in other areas of specialty. In other words, a general practitioner chosen by the claimant can make a referral to one orthopedic surgeon, one neurosurgeon, one neurologist, one psychiatrist, etc., but could not make a referral to two different orthopedic surgeons. A chiropractor may be chosen as a treating physician, but the Mississippi Workers' Compensation Medical Fee Schedule limits chiropractic treatment to fifteen visits or treatment for thirty days, whichever occurs first, unless additional treatment is authorized by the employer/carrier. Claimant's choice of physician is limited to an area reasonably convenient to the injury or the residence of the claimant.

Penalties for Late Reporting MCA 71-3-67 (4)

Whenever an employer or carrier fails or refuses to file any report required within the time prescribed, the commission may levy a penalty against the employer or carrier not to exceed One Hundred Dollars ($100.00). 

In addition to the above civil penalty, a sum not to exceed One Hundred Dollars ($ 100.00) may, in the discretion of an administrative judge or the commission, be added to any award which may be made as a result of any injury not timely reported