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Annual Report

of

Occupational Injuries and Illnesses

General Information



Prepared by the



Mississippi Workers' Compensation Commission

P. O. Box 5300

Jackson, Mississippi 39296-5300

(601) 987-4200


ANNUAL REPORT GENERAL INFORMATION



BACKGROUND

In 1948 the Mississippi Legislature enacted the Mississippi Workers' Compensation Law. At the time, there was no standard, equitable system prescribing the rights and liabilities of employers, employees and third parties in respect to industrial injuries. The only course of action available to an injured employee was to either negotiate a settlement with the employer or resort to a common law tort action. In a great majority of cases, this proved to be neither equitable nor economically feasible for the interested parties.

The workers' compensation system was created to provide a measured level of benefits to employees injured in the course of employment, without regard to negligence or fault, and, at the same time, to limit the liability of employers for these injuries. An employer's assumption of the cost of occupational injury, without regard to fault, is considered a cost of doing business which may ultimately be spread to the consuming public. In exchange for this assumption, the employee is precluded from seeking traditional remedies.

THE COMMISSION



In order to further the basic objectives of the Mississippi Workers' Compensation Law, the Legislature created the Mississippi Workers' Compensation Commission to enforce and administer the Law. The Commission performs all necessary administrative and judicial functions, and promulgates all rules and regulations relating to the processing of claims.

The Commission is comprised of three members appointed for 6-year terms by the Governor, with the advice and consent of the State Senate. The Governor designates the chairman of the Commission. The Commission may appoint such officers and employees as are necessary to adequately administer the Act, including up to eight (8) Administrative Judges, with the consent of the Governor. These Judges conduct hearings, make investigations, determine disputed issues, and review settlements. Their decisions may be reviewed by the Full Commission, and from there appeal may be taken through the state court system.

The Commission receives notices of injury. On receipt of any such notice, a determination is made whether to establish a claim file. Each case is then processed through prescribed procedures until it is finally closed. The severity of the injury or the complexity of the claim determines the length of time a claim remains open.

In the vast majority of cases, a claimant need not retain an attorney and wait for an administrative proceeding or an adjudication of his claim in order to receive benefits under the Workers' Compensation Law. Most claims are not controverted, and compensation is paid voluntarily without a formal hearing or award. Employers and insurers are obligated to notify the Commission and the claimant if the right to compensation is being denied. Either party may request a hearing to resolve any disputed issues.

In administering the Law, the Commission has the authority to hear and determine all claims, make awards, conduct necessary investigations, require medical services for injured employees, approve and fix attorneys' fees and assess penalties. The Commission also has the responsibility of approving settlement agreements and requests for lump sum awards.



COVERAGE



The Law is applicable to all employers who have in service five (5) or more workers regularly employed in the same business or in or about the same establishment under any contract of hire, express or implied. An employer may be a person, firm or private corporations, but all non-profit charitable, fraternal, cultural or religious corporations or associations are excluded. Several categories of workers are specifically exempted from the Mississippi Workers' Compensation Law as well: domestic servants, farmers and farm labor, transportation and maritime employees covered under federal compensation laws, independent contractors and vendors.



BENEFITS



If an employee sustains a disabling work-related injury, illness or disease, or is killed, medical and/or funeral benefits are due. Fatal injuries excepted, no benefits, other than medical, are payable during the first five (5) days of disability. Only if an injury causes disability in excess of five (5) days, or likely will result in permanent disability or disfigurement, are disability benefits payable. Claims which require the payment of disability benefits in addition to medical benefits are referred to as "LOST TIME" claims.

If the injury results in disability continuing fourteen (14) days or more, disability or compensation benefits are payable from the first day of disability. TABLE A reflects the number of "lost time" claims by year, and also how many claims have been controverted.

The Law limits the weekly recovery to 66 2/3% of the average weekly wage for the State, and in certain instances provides a minimum weekly benefit of $25.00. The Law also sets a maximum overall limit on compensation for disability. For further rate information, see the Rates Table.

Compensation benefits payable for permanent total disability equal 66 2/3% of the employee's average weekly wage at the time of the injury (subject to the maximum and minimum limitations), and are payable for a period not to exceed 450 weeks from the date of the injury. If the disability is total, but not permanent, benefits are paid at a rate and for a period determined by the nature of the injury and disability. In no case will benefits exceed either the weekly or overall maximum benefits allowed.

In case of temporary partial disability and permanent partial disability to the body as a whole, the compensation rate equals 66 2/3% of the difference between the employee's pre-injury wage and post-injury wage earning capacity, subject to the maximum weekly limitations of the Law. Benefits for each may not exceed 450 weeks.

The loss of or loss-of-use of certain members is treated as permanent partial disability. Scheduled members are the arms, legs, hands, feet, eyes, thumbs, fingers, toes, testicles and female breasts. Loss or impairment of hearing and binocular vision are also included in the schedules, and hernias are compensated per a schedule. Compensation for loss of a scheduled member is payable for a fixed number of weeks specified in the schedules.

If permanent disability is shown, and there is evidence of a pre-existing occupational disability which is a material contributing factor to the current disability, compensation benefits will be reduced by the proportion which the pre-existing disability contributed to the results following the compensable injury. There is no apportionment of medical benefits by reason of the co-existence of a disease or infirmity unrelated to the compensable injury or disease.

If death results from the injury, the Law provides for payment of funeral expenses, not to exceed $2,000.00, and an immediate lump sum of $250.00 payable to the surviving spouse. The Law also provides for the payment of additional weekly benefits to the surviving spouse and any surviving dependents. The total weekly amount of death benefits payable in any case shall not exceed 66 2/3% of the deceased's weekly wage, or the maximum weekly amount set by the Law, whichever is less, and the cumulative total shall not exceed the maximum overall limitation of the Law.

Finally, the Commission, in its discretion, is authorized to award compensation for serious facial or head disfigurement not to exceed $2,000.00. No such award shall be made until a lapse of one (1) year from the date of the injury resulting in such disfigurement.



STATISTICAL DATA



Information used to compile statistical reports is obtained primarily from the Employer's First Report of Injury and updated from subsequent reports if necessary. All ''LOST TIME'' cases reported to the Commission are coded into a statistical data base. The Commission's computer system allows it to use this information to measure employer and carrier reporting performance, measure payment performance and to retrieve injury summaries by various sorting criteria.



Once a claim becomes controverted, the system tracks and reports statistics related to the time taken to reach each level of controversy, summarizes administrative judge activity, and provides management statistics on the status of each case as it travels through the system.



TOTAL COMPENSATION and MEDICAL



Payments made through the end of the calendar year and reported by insurance companies and self-insurers are listed in each year's report. Not included in these amounts are any reserves which carriers must maintain in order to meet future payments on claims extending over long periods of time. Such severe cases frequently take years for full payment and filing of final settlement reports.



MEDICAL SELECTION and PAYMENTS



Although the choice of physician lies first with the employee, a 1992 amendment to the Law has narrowed that choice. An injured worker may accept the services offered by the employer or may choose one physician or provider to administer treatment. The chosen provider is limited to making one referral. Any additional selection or referral must be approved in advance by the employer/ carrier, or the Commission. In order for the services offered by the employer to count as the employee's selection, the employee must agree thereto in writing. Also, the Commission implemented a utilization review system and medical fee schedule effective August 1, 1993.



SELF-INSURANCE



The Mississippi Workers' Compensation Law provides that an employer may be granted an exemption from insuring liability for workers' compensation through the commercial insurance market. An employer may insure its own liability by application to and Order of the Commission. The principal requirement is that the application demonstrate the financial ability to pay its claims. Commission approval of the applicant may be conditioned on the applicant's provision of sufficient security to insure payment of all medical and indemnity claims.



By legislative act, effective July 1, 1988, group self-insurance was authorized in Mississippi. Each group acts as a "risk pool," where employers with common interests pay "premium" to the pool in return for workers' compensation coverage.



REHABILITATION



The Law provides for rehabilitation services for injured employees in order that they may return to gainful employment. An injured employee engaged in a rehabilitation program is entitled to receive additional compensation necessary for his maintenance; however such additional compensation shall not exceed $10.00 per week for more than 52 weeks.

The Commission has established within the agency a rehabilitation unit which works conjunction with rehabilitation providers to insure the availability of sufficient rehabilitation services to workers' compensation recipients who can potentially benefit from such services.



SECOND INJURY FUND



The Commission is also responsible for maintaining a second injury fund. If an employee who has previously lost, or lost the use of an arm, hand, leg, foot or eye, becomes totally incapacitated through the loss, or loss of use of, another member or organ while working for an employer covered by the Law, such employer is liable only for the compensation payable for disability related to the second injury. The employee is paid the remainder of compensation that would be due for permanent total incapacity out of the second injury fund. The second injury fund is maintained through payments made to the Commission in cases of compensable death. Such payments are deposited with the State Treasurer for the benefit of the second injury fund. If an employee's death is compensable, the injury causing death occurred prior to July 1, 1984, and there are surviving dependents, an amount of $150. 00 is payable to the second injury fund. If an employee's death is compensable and the injury causing death occurred July 1, 1984 or thereafter and there are surviving dependents, an amount of $300.00 is payable to the second injury fund. If there are no dependents, then there shall be paid to the Commission the sum of $500.00.



ADMINISTRATIVE EXPENSES



The Commission receives no funds from the State General Fund. Costs of the Commission's administrative expenses are borne entirely by the insurance carriers and self-insuring employers whose claim operations are supervised by the Commission. Each carrier and self-insured employer pays a pro-rata share of the annual expenses of the Commission based on its own total compensation and medical payments made during the previous year. By statute, the Commission is required to estimate annually in advance the amounts necessary for the administration of the Workers' Compensation Law. This amount is used by the Commission as the basis for determining the amount to be assessed annually against each carrier and self-insured employer. Regulations of the Commission provide for the collection of the assessments to be paid into the Administrative Expense Fund.
















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