MWCC Form B-19 Application for Lump Sum Payment - Mississippi

MWCC Form B-19 Application for Lump Sum Payment - Mississippi

What Is MWCC Form B-19?

This is a legal form that was released by the Mississippi Workers' Compensation Commission - a government authority operating within Mississippi. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form B-19?A: Form B-19 is an application for a lump sum payment in the state of Mississippi.

Q: Who can use Form B-19?A: Any individual who is eligible for workers' compensation benefits in Mississippi and wishes to receive a lump sum payment instead of weekly payments can use Form B-19.

Q: What is a lump sum payment?A: A lump sum payment is a one-time payment of all or a portion of the workers' compensation benefits that an individual is entitled to.

Q: How do I fill out Form B-19?A: You should provide your personal information, details of your employment, information about your injury, medical treatment, and any other relevant information requested in the form.

Q: What happens after I submit Form B-19?A: The Mississippi Workers' Compensation Commission will review your application and determine whether to approve or deny your request for a lump sum payment.

Q: Is there a deadline for submitting Form B-19?A: Yes, you must submit Form B-19 within one year from the date of your injury or the date of your last receipt of compensation benefits, whichever is later.

Q: Can I change my mind after submitting Form B-19?A: No, once you submit Form B-19 and receive a lump sum payment, you cannot change your mind or request additional benefits for the same injury.

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Form Details:

  • Released on January 1, 2003;
  • The latest edition provided by the Mississippi Workers' Compensation Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of MWCC Form B-19 by clicking the link below or browse more documents and templates provided by the Mississippi Workers' Compensation Commission.

Download MWCC Form B-19 Application for Lump Sum Payment - Mississippi

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