Learn how to file a workers' compensation claim and appeal an unfavorable decision
An occupational injury or illness is an injury or illness that results from a job site. Occupational injuries and illnesses include everything from broken bones to traumatic brain injuries and even death.
In Mississippi, injured workers can receive financial benefits by filing a workers' compensation claim. Almost all Missippians are eligible, but workers' compensation claim denials do happen.
Here's a look at Mississippi's workers' compensation system, including how to file a claim and the steps you need to take to appeal a denied claim.
What is the Mississippi workers' compensation system?
Workers' compensation insurance is a form of insurance that provides benefits to employees who are injured on the job.
The Mississippi workers' compensation system is mandated by state law, supervised by the Workers' Compensation Commission, and paid for by employers.
Before we go any further, there are two important things you should know about the Mississippi workers' compensation system:
• The Mississippi workers' compensation system is a no-fault insurance system, which means injured workers can receive benefits regardless of who's at fault for their injuries.
• Workers' compensation is an exclusive remedy, which means that injured workers must typically file a workers' compensation claim in lieu of a personal injury lawsuit. There is an exception to this general rule. If a third party (someone other than your employer or colleague) causes your injury, you may be able to file a workers' compensation claim and a personal injury lawsuit against the third party.
Who's covered by workers' compensation insurance?
Mississippi law requires all employers with at least five employees to carry workers' compensation coverage. If the employer has fewer than five employees, workers' compensation coverage isn't required, but the employer may nevertheless choose to carry it.
The following types of employees are exempt from the workers' compensation coverage law:
• Domestic laborers (housekeepers, babysitters, etc.)
• Farm laborers
• Charitable, religious, and cultural organizations
• Federal employees and certain transportation and maritime employees
You can verify that your employer carries workers' compensation insurance by using the free online workers' compensation verification tool or by contacting your local workers' compensation agency.
What injuries are covered by workers' compensation insurance?
The vast majority of injuries and illnesses are covered by workers' compensation insurance.
The only injuries and illnesses that are not covered are those that did not “arise out of” and “in the course of” your employment. This may sound confusing, but it basically means that your injury or illness must have some relationship to your job, and it must have occurred while you were on the clock.
For example, a construction worker who falls off scaffolding and injures their back will likely be covered. On the other hand, a secretary who has a heart attack at work due to inherited heart disease will probably not be covered.
Generally, an injury that occurs while the employee is traveling to and from work is NOT compensable. There are, however, a couple of exceptions, including situations in which the employer furnishes the means of transportation.
Are mental health injuries covered by workers' compensation in Mississippi?
Mental disorders are on the rise across the United States. According to the National Alliance on Mental Illness (NAMI), one in five adults experiences mental illness each year.
In Mississippi, employees can file a workers' compensation claim for a mental health injury if:
• The mental health injury is the result of a physical work injury that occurred at work (for example, you develop depression as a result of breaking your leg at work); or
• You can demonstrate the conditions in your workplace were unusual and caused your mental health injury (for example, you witnessed an explosion at work that killed a colleague).
How do I file a workers' compensation claim in Mississippi?
As an injured employee, your primary responsibility is to notify your supervisor of your injury. Notice must be provided to your employer within 30 days of your injury or you risk having your workers' compensation claim denied.
Once you provide notice, your employer is responsible for filing a First Report of Injury or Illness form with its insurance company and the Workers' Compensation Commission. This form must be completed within 10 days of receiving notice of a work-related injury. Fatalities must be reported within 24 hours.
If the First Report of Injury or Illness form is not filed with the Workers' Compensation Commission within two years of the injury, your claim will be forever barred.
To avoid any confusion about when you notified your employer of your injury, send a copy of your notice to your employer via certified mail with a return receipt requested.
If your employer refuses to file the First Report of Injury or Illness form, contact an experienced Mississippi workers' compensation attorney or the Mississippi Workers' Compensation Commission at 601-987-4200.
Workers' compensation benefits in Mississippi
As an injured worker in Mississippi, you're entitled to the following workers' compensation benefits:
• Medical expenses. You're entitled to all reasonable and necessary medical expenses. These expenses include doctor visits, medication, surgeries, physical therapy, and even mileage reimbursement.
• Wage loss benefits. You can receive wage loss benefits if you're unable to return to work or you're unable to return to the same type of work. The wage loss benefits you receive can be as much as two-thirds of your average weekly wage prior to your injury, subject to a maximum weekly amount and to certain time limits.
• It's not always clear what wage loss benefits you should receive and for how long. DO NOT assume that your employer or the insurance carrier correctly calculated your wage loss benefits. A Mississippi workers' compensation attorney can help make sure you receive the benefits you deserve.
• Death benefits. In the case of a fatal work injury, Mississippi law provides payments to any surviving spouse and certain surviving dependents. These benefits are payable every 14 days and may continue up to 450 weeks after the worker's death. Additionally, Mississippi workers' compensation law guarantees up to $5,000 in funeral expenses.
There's more good news: There is no deductible or copay to be paid by the injured worker for any of the benefits received. All workers' compensation benefits in Mississippi are provided at no cost to the employee.
What if my claim is denied?
If you don't receive the benefits you think you deserve, your first step is to contact your employer or the insurance company representative handling your claim. Sometimes, honest mistakes are made and can be resolved with a respectful telephone call.
If the problem cannot be resolved with a telephone call, you may have to take one or more of the following steps:
- File a petition with the Mississippi Workers' Compensation Commission. The first step in the appeals process is to file a Petition to Controvert (Form B-5,11) with the Mississippi Workers' Compensation Commission. You must file this Petition within two years of your injury.
Depending on the nature of the dispute, it may be resolved through informal negotiations, or you may have a hearing before an administrative law judge. - Appeal to the Full Commission. If you're not satisfied with the workers' compensation judge's decision, you can appeal to the Full Commission. This must be done within 20 days of receiving the judge's order. The Full Commission will consider the appeal based on the record made before the administrative law judge. The Full Commission review is not a new trial.
- Appeal to the Mississippi Supreme Court. If you're not satisfied with the Full Commission's decision, you can file an appeal with the Mississippi Supreme Court. It's highly recommended that you hire an attorney to help you with this process.
Hiring a Mississippi workers' compensation attorney
You're allowed to hire an attorney at any point in the workers' compensation claims process. An attorney can help you file your claim and handle an appeal if your claim is denied.
Most workers' compensation attorneys accept cases on a contingency fee basis, which means your lawyer won't be owed a penny unless you receive benefits.
Did you know that workers' compensation law varies by state?
Need a lawyer?
The basis for personal injury law is fairly straightforward:
If you're injured because of someone's negligence, then you're entitled to recover for your financial losses related to the injury.
The premise for the workers' compensation system is similar:
Your employer is required to have specific insurance that provides benefits if you're injured at work.