The Mississippi Premiering Statement of Claimant/Employer-Carrier: (Revised 03/15/08) is a document used to provide information regarding a workers' compensation claim prior to a hearing. This document is required by the Mississippi Workers' Compensation Commission and must be submitted within 21 days of an employer receiving notice of a claim. The document includes information such as the claimant's name, address, and phone number, the employer's name, address, and phone number, and the date and time of the incident that led to the claim. It also includes a description of the incident, the injuries sustained, and the medical treatment provided. Additionally, the form requires the employer to provide information about any benefits or payments they have made to the claimant, any disputed facts about the claim, and any defenses they have to the claim. There are two types of Pre-Hearing Statements: one for the claimant and one for the employer/carrier.
Mississippi Pre-Hearing Statement of Claimant/Employer-Carrier: (Revised 03/15/08)
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How to fill out Mississippi Pre-Hearing Statement Of Claimant/Employer-Carrier: (Revised 03/15/08)?
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FAQ
The insurance carrier can contest, or controvert, the claim for a variety of reasons (e.g., the injury was not work-related or the employee is not injured to the extent claimed.) An employer can also request that the insurance carrier contest the claim.
WHO IS COVERED? Most working Mississippians are protected by the Workers' Compensation Law, but there are exceptions. All employers with five (5) employees regularly employed are required to provide workers' compensation insurance coverage.
Controverted claim means there has been a contested hearing before the Commission over whether there has been a compensable injury or whether the employee is entitled to temporary total disability, temporary partial disability, permanent partial disability, permanent total disability, or death compensation.
CONTROVERT Definition & Legal Meaning To dispute; to deny; to oppose or contest; to take issue on.