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MISSISSIPPI WORKERS COMPENSATION COMMISSION MWC File No.: Injury Date / / Carrier File No.: Disability Date / / Type of NOTICE: NOTICE OF FIRST PAYMENT OF T.T.D. BENEFITS SUPPLEMENTAL AGREEMENT AS
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How to fill out mississippi workers compensation commission

01
Obtain the necessary forms from the Mississippi Workers Compensation Commission (MWCC) website or by contacting their office.
02
Fill in your personal information, including your name, address, and contact details.
03
Provide details about your employer, such as their name, address, and contact information.
04
Specify the date and time of your work-related injury or illness.
05
Describe the nature of your injury or illness, including the body parts affected and the circumstances surrounding the incident.
06
Provide information about any medical treatment you have received or are currently receiving for your injury or illness.
07
Attach any relevant medical documents, such as doctor's reports, X-rays, or test results.
08
Include details about your employment status, such as your job title, salary, and date of hire.
09
Sign and date the form.
10
Submit the completed form to the MWCC either electronically or by mail.
11
Keep a copy of the filled-out form for your records.

Who needs mississippi workers compensation commission?

01
Employees who have suffered a work-related injury or illness in Mississippi.
02
Employers who need to report an employee's work-related injury or illness to the MWCC.
03
Medical professionals who are treating individuals with work-related injuries or illnesses.
04
Attorneys or legal representatives involved in workers' compensation cases in Mississippi.
05
Insurance companies or adjusters handling workers' compensation claims in Mississippi.
06
Individuals or organizations interested in understanding the workers' compensation process in Mississippi.
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The Mississippi Workers' Compensation Commission is a state agency responsible for overseeing and regulating workers' compensation claims in Mississippi.
Employers in Mississippi are required to file with the Workers' Compensation Commission.
To fill out the Mississippi Workers' Compensation Commission forms, employers must provide information about their business and their employees.
The purpose of the Mississippi Workers' Compensation Commission is to ensure that injured workers receive proper compensation and that employers fulfill their obligations under workers' compensation laws.
Employers must report information such as employee wages, injury details, and any benefits paid to the injured worker.
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Relevant keywords

MISSISSIPPI FEIN MWCC statutorily SSN III Itemize therefor Dependents applicable certify SUPPLEMENTAL statutory II decrease furnished Revised commencing IV Beneficiary

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