MEETINGS. The office of the Mississippi Workers' Compensation Commission shall be in the City of Jackson. The Commission shall remain in continuous session, but in addition to such continuous session, the Commission shall meet as a body at the call of the Chairman for the purpose of transacting any unusual business that may come before it.
This Rule shall be in force and effect on and after April 17,1956.
AMENDMENTS. The rules of the Commission are subject to amendment at any time, and the Commission
will adopt additional rules whenever in its judgment changes are advisable.
This Rule shall be in force and effect on and after April 17, 1956.
PROOF OF COVERAGE. Every employer within the scope of the Mississippi Workers' Compensation Law
shall file proof of compliance with the insurance provisions of the Law. In cases where insurance is taken
with a carrier registered with the Commission, employer's notice of compliance shall be filed by the carrier
with and through the National Council on Compensation Insurance's Proof of Coverage System. Individual
and group self-insured employers shall file notice of coverage with the Commission in a format specified by
the Commission.
Notice of compliance which is required to be filed hereunder with the National Council on Compensation
Insurance's Proof of Coverage System may be filed electronically if the equipment used to file in this
manner generates or produces a receipt or other tangible document evidencing the filing.
This rule shall be in force and effect on and after September 1, 1993.
ELECTIONS. Where an employer not embraced by the Law elects to come within the provisions
of the Law as provided for in Code Section 71-3-5 (Section 3 of the Act), compensation coverage shall
remain in effect until notice to the contrary is filed with the Commission by said employer or insurance
carrier.
This Rule shall be in force and effect on and after July 1, 1982.
CANCELLATION OF POLICIES. Any insurance carrier having issued a policy to an employer and
desiring to cancel or terminate same before the expiration date stated in the policy, shall be required to give thirty (30) days prior notice thereof in writing to the Commission and the employer.
The employer whose policy has thus been canceled or terminated shall on or before the thirtieth
(30th) day after receipt of notice of cancellation or termination thereof file evidence with the
Commission of having obtained other coverage in accordance with the Act. Failure on the part of the
employer to file such evidence within the thirty (30) days shall be considered by the Commission as
prima facie evidence of violation of Code Section 71-3-9 (Section 5 of Act) and subject the employer
to the penalties prescribed under Code Section 71-3-83 (Section 36 of Act).
This Rule shall be in force and effect on and after July 1, 1982.
ASSIGNED RISKS. This rule has been deleted as of September 1, 1993, to comply with the
provisions of Mississippi Code Annotated Section 71-3-111 (1972), as amended by the legislature in
1992.
(a) SELF-INSURERS. Any employer desiring to qualify as self-insured and carry its own risk
under the provisions of Code Section 71-3-75 (Section 32 of Act) shall make application therefor on
form A-2 (Revised), and shall be required to reply fully to all inquiries made thereon. In each case where
an application is made, an indemnity bond or securities of a class approved by the Commission shall
be posted with the Commission. In no event shall the amount of securities or indemnity bond be less
than $100,000.00 unless otherwise ordered by the Commission. Each application will be considered
upon its merits with strict regard to the hazards involved. No record or any information concerning the
solvency and financial ability of any employer acquired by the Commission shall be subject to
inspection, nor shall any such information be divulged by the Commission unless by order of a court of
competent jurisdiction. So long as the financial status of the employer remains unchanged, and its
liabilities under the compensation law are promptly met, and where there is no accumulation of accrued
benefits sufficient to cause uneasiness on the part of the Commission, there shall be no effort to require
further bond or posted securities. In the event an employer, who is or had been a self-insurer pursuant
to the proper provisions of the Act and the Commission's rules, later ceases to be a self-insurer or
secures coverage through a properly licensed Workers' Compensation Insurance writer, the security
posted or the indemnity bond held by the Commission shall be and is held, and firmly bound, to the
Mississippi Workers' Compensation Commission of the State of Mississippi for any assessment made
against the self-insurer pursuant to Section 71-3-99 (Section 44 of the Act).
All self-insurers are required to furnish the Commission safety reports on an average of once
every ninety (90) days. Such reports are to be made by a safety engineer, or some other experienced
party competent to make safety surveys and reports.
All applications for the right of self-insurance are granted upon the express condition that said
self-insurers file promptly and complete all reports required of them by the Commission.
Any applicant for self-insurance not approved by the commission shall be given fifteen (15) days
from the date of notice of rejection, to procure insurance with a carrier, or to request that he be covered
under the assigned risk plan.
(b) GROUP SELF-INSURERS.
Section 1 - Authority to Act as a Workers' Compensation Self-Insurance Group.
No person, association or other entity shall act as a workers' compensation self-insurance group
unless it has been issued an annual certificate of authority by the Mississippi Workers' Compensation
Commission. Such certificate of authority must be renewed annually on or before the anniversary date
of the original award of group self-insurance.
Section 2 - Qualifications for Initial Approval and Continued Authority to Act as a Workers'
Compensation Group.
A. A proposed self-insurance group shall file with the commission its application for a
certificate of approval accompanied by a non-refundable filing fee in the amount of $200.00. The
application shall include but not be limited to the group's name, location of its principal office, date of
organization, name and address of each member, together with the following:
(1) A copy of the articles of association, if any.
(2) A copy of the bylaws of the proposed group.
(3) A copy of agreements with the administrator and with any service company.
(4) A copy of the agreement between the group and each member securing the payment
of workers' compensation benefits, which shall include provisions for payment of assessments as
provided by law.
(5) Designation of the initial board of trustees and administrator.
(6) The address in this state where the books and records of the group will be maintained.
(7) A pro-forma financial statement and any other documents required by the commission
on forms acceptable to the commission showing the financial ability of the group to pay workers'
compensation obligations of its members.
(8) Proof of payment to the group by each member of not less than 25% of that member's
first year of estimated annual premium as defined by the commission on a date prescribed.
(9) Public groups must submit authorization from the governing authorities of each proposed
member allowing participation in such a group self-insurance program with other political subdivision
or state agencies, boards, commissions or other public entities.
B. To obtain and maintain its certificate of approval for group self-insurance the group must
comply with the following provision:
(1) A combined net worth of all members of at least $1,000,000.00.
(2) Security against unpaid claims in case of insolvency as prescribed by the commission
which shall be provided by either a surety bond, financial security endorsement, payment into the self-
insurance guaranty fund in an amount specified by the commission, or any combination thereof. The
commission may adjust from time to time the requirements for the amount of security based on
differences among groups in their size, types of employment, years in existence, financial status or
other relevant factors.
(3) Specific and/or aggregate excess insurance in a form, and in an amount, by an insurance
company acceptable to the commission.
(4) An indemnity agreement jointly and severally binding the group and each member thereof to meet the workers' compensation obligations of each member. The indemnity agreement shall
be in a form prescribed by the commission.
(5) A fidelity bond for the administrator in a form and amount prescribed by the commission.
Section 3 - Examinations
The commission may examine the affairs, transactions, accounts, records, assets and liabilities
of each group as often as the commission deems advisable. The expenses of such examinations shall
be assessed against the group.
Section 4 - Board of Trustees: Membership, Powers, Duties, Prohibition.
Each group shall be operated by a board of trustees which shall consist of not less than five
persons whom the members of a group elect for stated terms of office. At least two-thirds of the
trustees shall be employees, officers, or directors of members of the group. The group's administrator,
service company or any owner, officer, employee of, or any person affiliated with such administration
or service company shall not serve on the board of trustees of the group. All trustees shall be residents
of the state of Mississippi or officers of corporations authorized to do business in the state of
Mississippi. The board of trustees of each group shall ensure that all claims are paid promptly and take
all necessary precautions to safeguard the assets of the group.
A. The board of trustees shall:
(1) Maintain responsibility for all monies collected or disbursed from the group and
segregate all monies into a claims fund account and an administrative fund account. At least 70% of
the premium as determined by the commission shall be placed into a designated depository for the sole
purpose of paying claims, allocated claims expenses, reinsurance or excess insurance, and special fund
contributions, including second injury and other loss related funds. This shall be called the claims fund
account. The remaining net premium shall be placed into a designated depository for the payment of
taxes, general regulatory fees, and assessments, and administrative costs. This shall be called the
administrative fund account. The commission may approve an administrative fund account of more
than 30% and a claims fund account of less than 70% only if the group shows to the commission's
satisfaction that (a) more than 30% is needed for an effective safety and loss control program or (b)
the group's aggregate excess insurance attaches at less than 70%.
(2) Maintain minutes and make such minutes available to the commission.
(3) Designate an administrator to carry out the policies established by the board of trustees,
provide day to day management of the group, and delineate in the written minutes of its meetings the
areas of authority it delegates to the administrator.
(4) Retain an independent certified public accountant to prepare the statement of financial
condition as required by the commission.
B. The board of trustees shall not:
(1) Extend credit to individual members for payment of a premium, except pursuant to
payment plans approved by the commission.
(2) Borrow any monies from the group or in the name of the group except in the ordinary
course of business, without first advising the commission of the nature and purpose of the loan and
obtaining prior approval from the commission.
Section 5 - Group Membership; Termination and Liability.
(A) An employer joining a workers' compensation self-insurance group after the group has
been issued a certificate of approval shall (1) submit an application for membership to the board of
trustees or its administrator and (2) enter into the indemnity agreement required by subsection 2B(4).
Membership takes effect no earlier than each members' date of approval. The application for
membership and its approval shall be maintained as permanent records of the board of trustees.
(B) Individual members of a group shall be subject to cancellation by the group pursuant to
the bylaws of the group. In addition, individual members may elect to terminate their participation in
the group. The group shall notify the commission of the termination or cancellation of a member within
ten (10) days and shall maintain coverage of each canceled or terminated member for thirty (30) days
after such notice, at the terminating member's expense, unless the group is notified sooner than the
canceled or terminated member has procured workers' compensation insurance, has become an
approved individual self-insurer, or has become a member of another group. The commission may
terminate any member of a group.
(C) The group shall pay all workers' compensation benefits for which each member incurs
liability during its period of membership. A member who wishes to terminate its membership or is
canceled by a group remains jointly and severally liable for workers' compensation obligations of the
group and its members which were incurred during the canceled or terminated member's period of
membership.
(D) A group member is not relieved of its workers' compensation liabilities incurred during
its period of membership except through payment by the group or the member of required workers'
compensation benefits.
(E) The insolvency or bankruptcy of a member does not relieve the group or any other
member of liability for the payment of any workers' compensation benefits incurred during the insolvent
or bankrupt member's period of membership.
Section 6 - Service Companies
(A) No service company or its employees, officers or directors shall be an employee, officer,
or director of, or have either a direct or indirect financial interest in, an administrator. No administrator
or its employees, officers or directors shall be an employee, officer or director of, or have either a direct
or indirect financial interest in, a service company.
(B) The service contract shall state that unless the commission approves otherwise the
service company shall handle, to their conclusion, all claims and their obligations incurred during the
contract period.
Section 7 - Financial Statements and Other Reports.
(A) Each group shall submit to the commission a statement of financial condition audited
by an independent certified public accountant on or before the last day of the sixth month following the
end of the group's fiscal year. The financial statement shall include, but not be limited to, actuarially
appropriated reserves for (1) known claims and expenses associated therewith, (2) claims incurred but
not reported and associated there with, (3) unearned premiums and (4) bad debt, which reserves shall
be shown as liabilities. An actuarial opinion regarding reserves for (1) claims and expenses associated
therewith and (2) claims incurred but not reported and expense associated therewith shall be included
in the audited financial statement. The actuarial opinion shall be given by a member of the American
Academy of Actuaries or other qualified loss reserve specialist as defined in the annual statement
adopted by the National Association of Insurance Commissioners, or any other qualified entity approved by the commission.
(B) The commission may prescribe the formed and frequency of other reports which may
include, but shall not be limited to, payroll audit reports, summary loss reports, and quarterly financial
statements.
Section 8 - Rates and Reporting of Rates
(A) Subject to the approval of the commission, the premium contributions may be reduced
by an advance premium discount reflecting the group's expense levels and loss experience.
(B) Each group shall be audited at least annually by an auditor acceptable to the commission
to verify proper
classification, experience rating, payroll and rates. A report of the audit shall be filed with the
commission. A group or any member thereof may request a hearing on any objections to the
classifications. If the commission determines that as a result of an improper classification, a member's
premium is insufficient, the commission may order the group to assess that member an amount equal
to the deficiency. If the commission determines that as a result of an improper classification a member's
premium is excessive the commission may order the group to refund to the member the excess
collected. The audit shall be at the expense of the group.
Section 9 - Refunds
(A) Any monies for a fund year in excess of the amount necessary to fund all obligations
for that fund year may be declared to be refundable by the board of trustees with the approval of the
commission and be payable not less than twelve (12) months after the end of the fund year.
(B) Each member shall be given a written description of the refund plan at the time of
application for membership. A refund for any year shall be paid only to those employers who remain
participants in the group for the entire fund year. Payments of a refund based on a premium fund year
shall not be contingent on continued membership in the group after that fund year.
Section 10 - Payment of Premium Reserves
(A) Each group shall establish to the satisfaction of the commission a premium payment plan
which shall include (1) an annual payment by each member of at least 25% of that member's annual
premium before the start of the group's fund year and (2) payment of the balance of each member's
annual premium in monthly or quarterly installments.
(B) Each group shall establish and maintain actuarially appropriate loss reserves which shall
include reserves for
(1) known claims and expenses associated therewith and (2) claims incurred but not reported and
expenses associated therewith.
(C) Each group shall establish and maintain bad debt reserves based on the historical
experience of the group or other groups.
Section 11 -Deficits and Insolvencies
(A) If the assets of a group are at any time insufficient to enable the group to discharge its
legal liabilities and other obligations and to maintain the reserves required of it under the Mississippi
Workers' Compensation Act and the provisions herein, it shall forthwith make up the deficiency or levy
an assessment upon its members for the amount needed to make up the deficiency.
(B) In the event of a deficiency in any fund year, such deficiency shall be made up
immediately, either from (a) surplus from a fund year other than the current fund year, (b) administrative
funds, (c) assessments of the membership, if ordered by the group or, (d) such alternate method as the
commission may approve or direct. The commission shall be notified prior to any transfer of surplus
funds from one year to another.
(C) The Commission may deem a group insolvent if:
(1) it fails to make and collect the assessments to overcome recognized deficiencies;
(2) it is unable to pay its outstanding lawful obligations as they mature in the regular course
of business, as may be shown either by an excess of its required reserves and other liabilities over its
assets or by its not having sufficient assets to reinsure all of its outstanding liabilities after paying all
accrued claims owed by it.
The commission shall levy an assessment upon the members of an insolvent group sufficient
to discharge all liabilities of the group, including the reasonable cost of liquidation.
Section 12 - Revocation of Certificate of Approval
(A) After notice and opportunity for a hearing, the commission may revoke a group's
certificate of approval if it (1) is found to be insolvent, (2) fails to pay assessments, fines, or other
payments imposed upon it, or (3) fails to comply with any of the provisions of the Mississippi Workers'
Compensation Act or rules promulgated thereunder. In addition the commission may revoke a group's
certificate of approval if, after notice and opportunity for hearing, the commission finds that (a) any
certificate of approval that was issued to the group was obtained by fraud; (b) there was a material
misrepresentation in the application for the certificate of approval; or (c) the group or its administrator
has misappropriated, converted, illegally withheld, or refused to pay over upon proper demand any
monies that belong to a member, or employee of a member, or a person otherwise entitled thereto and
that may have been entrusted to the group or its administrator in its fiduciary capacities.
(B) Non-renewal of the annual certificate of authority shall be at the discretion of the
commission and shall not require a hearing.
(A) "Administrator" means an individual, partnership or corporation engaged by a workers'
compensation self-insurance group's board of trustees to carry out the policies established by the group's
board of trustees and to provide day to day management of the group.
(B) "Commission" means the Mississippi Workers' Compensation Commission.
(C) "Service Company" means a person or entity which provides services not provided by the
administrator, including but not limited to, (a) claims adjustment, (b) safety engineering, (c) compilation
of statistics and the preparation of premium, loss and tax reports, (d) preparation of other required self-insurance reports, (e) development of members' assessments and fees, and (f) administration of a claim
fund.
This Rule shall be in force and effect on and after July 1, 1988,
POSTING NOTICE OF COVERAGE. Every employer operating under the provisions of the Mississippi Workers' Compensation Law shall keep in a conspicuous place in and about its place of
business a "Notice of Coverage" (Form A-16 revised) as follows:
As required by Code Section 71-3-81 (Section 35 of Act), notice is hereby given that the
undersigned employer has secured the payment of compensation under the provisions of the Mississippi
Workers' Compensation Law. The name and address of the Self-insurer/Carrier is:
NAME:___________________________________________________
ADDRESS:________________________________________________
The date of the expiration of the policy is: ____ day of ____________, 19___. Notice is hereby
given, in accordance with Code Section 71-3-35(1) (Section 12 of Act), that your employer has been
designated to receive notices of injury, _______________________, being the __________________________
of the employer. In all cases of injury such person should be notified immediately as provided by Code
Section 71-3-35 (Section 12 of Act).
Dated and posted on the _______ day of _______________, 19___
________________________________________
(Name of Employer)
________________________________________
(Signature of Authorized Representative)
This notice is required to be posted in a conspicuous place or places in or about the employer's
place of business
This Rule shall be in force and effect on and after July 1, 1982.
SELECTION OF MEDICAL. The employer shall select competent physicians, hospitals, and other
attendance or treatment and immediately furnish such services, including all emergency services, to the
injured employee. The injured employee shall have the right to accept the services furnished by the
employer or, in his discretion, to select one (1) competent physician of his choosing and such other
specialists to whom he is referred by his chosen physician to administer medical treatment according
to the guidelines set forth in Mississippi Code Annotated Section 71-3-15(1) (1972), as amended. Such
physician(s) selected by the employer or the employee, including any authorized referral, shall be located
in an area reasonably convenient to the place of the injury or the residence of the injured employee, and
the medical services shall be reasonably suited to the nature of the injury.
The employer may have the injured employee examined by a physician of its choice for the
purpose of evaluating temporary or permanent disability or medical treatment being rendered. If such
an examination is desired by the employer, the employer must make an appointment with the physician
for the injured employee at a time reasonably convenient to the injured employee, prepay mileage at the
prevailing statutory rate, pay all reasonable expenses for the attendance of the injured employee as well
as the charges by the physician. The Commission must be notified in writing of such appointment for
the examination, and copies of all reports must be promptly furnished to the Commission and the injured
employee. If at any time the injured employee unreasonably refuses or fails to submit to such medical
examination, the Commission may, by order, suspend the payment of future compensation during such
time as such refusal continues, and no compensation shall be paid at any time during the period of such
suspension.
Upon proper showing by any party of interest that the injured employee is suffering from
improper medical attention or lack of medical treatment, further medical treatment may be ordered by
the Commission at the employer's expense. If at any time during such period the injured employee
unreasonably refuses to submit to medical or surgical treatment, the Commission shall, by order,
suspend the payment of further compensation during such time as such refusal continues and no
compensation shall be paid at any time during the period of such suspension.
Any hearing required by the Commission under this Rule may be held upon five (5) days notice
to determine (1) if compensation payments should be suspended for refusal or failure to submit to a
medical examination or to proper medical treatment or (2) that the injured employee is suffering from
improper medical attention or lack of medical treatment.
Medical reports must be furnished by all treating or examining physicians to the Commission
and the employer or carrier within twenty (20) days of the first treatment and periodically thereafter on
a form prescribed by the Commission to which there may be attached office notes or narrative reports.
(The HCFA 1500 form will be accepted in lieu of the Commission Forms B-9 and B-27, provided
appropriate office/progress notes are attached.) The failure to furnish such reports may result in the
claim for medical and surgical treatment being unenforceable against the employer unless excused by
the Commission.
In the event an injured employee should be eligible for and desirous of treatment at any Veterans
Hospital, or at the expense of the Medical Commission or Vocational Rehabilitation Division of the
Department of Education as a result of a disability under the Workers' Compensation Act, the employer
or his carrier shall not be liable for such medical treatment as in other cases, unless the officials of the
Veterans Hospital, the Medicaid Commission or Vocational Rehabilitation Division of the Department
of Education to whom the injured employee is referred complies fully with Code Section 71-3-15
(Section 7 of the 1948 Act), and the Commission Rules.
This Rule shall be in force and effect on and after September 1, 1993.
SEVEN-DAY WORK WEEK. All compensation for loss of time shall be based upon a seven-day
work-week, which shall be computed as consisting of consecutive calendar days.
This Rule shall be in force and effect on and after April 17, 1956.
COMPUTATION OF LOST TIME. If the injured employee is paid in full for the date of the accident, lost-time should be computed as beginning with that day next following the date of accident.
If the injured employee is not paid in full for the date of accident, lost-time should be computed as
beginning as of the date of the accident.
This Rule shall be in force and effect on and after April 17, 1956.
MEDICAL FEES: FEE DISPUTE RESOLUTION. The fees of physicians, hospitals, and other
attendant parties must be reasonable and measured according to the employee's need and must be
within the guidelines established by the Commission in its medical fee schedule(s) pursuant to
Mississippi Code Annotated Section 71-3-15(3) (1972), as amended. Copies of the Commission's
medical fee schedule(s) are on public record at the offices of the Commission at 1428 Lakeland Drive,
Jackson, Mississippi, and at the office of the Secretary of State of Mississippi. Copies of the medical
fee schedule(s) may be purchased at a nominal cost from a source officially designated by the
Commission; order forms are available at the reception desk of the Commission.
The procedure for resolving disputes over the fees charged for services is as follows:
A. Requests for dispute resolution will be reviewed by a designated Commission
representative within thirty (30) days of receipt of the request. The payer and/or provider may be
contacted by phone for additional information if necessary.
B. Every effort will be made to resolve disputes by telephone or in writing. The payer and
provider may be requested to attend an informal hearing conducted by a Commission representative.
Failure to appear at an informal hearing may result in dismissal of the request for dispute resolution.
C. Following review of all documentation submitted for resolution review and/or following
contact with the payer and/or provider for additional information and/or negotiation, the Commission
representative shall render a decision on all requests for dispute resolution.
D. If the submitted dispute involves medical care determination, the case records will be
reviewed by a peer review consultant only upon request of the Commission. The peer review
consultant will render an opinion, and a written report will be submitted to the Commission
representative within thirty (30) days following receipt of request for resolution of a dispute. The
Commission representative will notify the parties in dispute of the peer consultant's determination.
E. Any party aggrieved by the decision of the Commission representative shall have twenty
(20) days from the date of the decision to request an administrative hearing with an administrative
judge. The request for administrative hearing shall be filed with the Secretary of the Mississippi
Workers' Compensation Commission. Any appeal shall be in writing and state the grounds on which
the appellant relies.
F. Any party aggrieved by the decision of the administrative judge shall have twenty (20)
days from the date of the judge's order to file an appeal with the Full Commission.
This Rule shall be in force and effect on and after September 1, 1993.
ACCELERATION OF PAYMENTS. In any case in which compensation is to be paid to a claimant
for permanent partial disability for a period not to exceed 450 weeks and at a weekly rate less than that computed for temporary total disability, whether voluntary or by order, such compensation may, as an
alternate method of payment, be accelerated by paying the same weekly rate established for temporary
total disability until the full amount has been paid.
Should the parties elect to pay and receive such compensation at the accelerated rate provided
herein, such election may be reported to the Commission on Form B-17 by setting out said election
thereon or by statement attached thereto.
Any time subsequent to such election, should the claimant request, and the Commission
approve, payment of future compensation benefits in a partial or full lump sum, the discount to which
the employer-carrier shall be entitled shall be computed as if there had been no such election and as if
the claimant were to receive all future benefits at the original lesser weekly rate; i.e., the amount
previously paid shall be subtracted from the total compensation benefits to which the claimant is
entitled, and the resulting amount thus obtained shall be divided by the original lesser weekly benefit
rate, thereby producing the number of weeks to be used in computing the discount.
In the event a partial lump sum payment is made, as aforementioned, following the payment
of benefits at the accelerated rate, the remaining weekly benefits shall continue to be paid at the
accelerated rate and shall begin immediately following the last payment of compensation received prior
to the lump sum, so as not to interrupt the continuity of benefits.
This Rule shall be in force and effect on and after May 23, 1972.