The University of Mississippi provides workers’ compensation benefits to all faculty, staff, and student workers who are injured performing work while in the course of University employment.
AmFed is contracted to provide administrative services and is responsible for reviewing claims, determining benefits, and processing payments for expenses incurred and loss of work wages.
Employees and student workers injured on the job shall notify their direct supervisor or department head when an injury occurs. The department has 48 hours from date of injury to complete the employer and employee packets and submit to the Department of Human Resources. Forms will be accepted via the following methods.
- email to email@example.com (Please leave the social security field blank to ensure the security of personal, sensitive information. The benefits team can add this information before faxing to AmFed for processing.)
- fax to 662-915-5836
- campus mail/drop off at the Human Resources office at the Jackson Avenue Center – Central
- MWCC – Workers’ Compensation – First Report of Injury of Illness: The injured employee or student worker’s department shall complete this form beginning with the EMPLOYEE/WAGE section.The form must be signed by the department head/chair or their assigned delegate (as approved by the Department of Human Resources) under Preparer’s Name and Title at the bottom of the form.
- Caution: the injured employee or student worker cannot sign this form. Forms must be signed be signed by an authorized representative and forms signed by the injured employee or student will be returned to the department and may delay processing.
- Untitled Form: The Job Duties Form defines the physical requirements of the injured employee or student worker’s position and shall be completed and signed by their supervisor or an administrative member of the department (i.e. department head/chair, assistant/associate director, etc.)
Employee ‘Claimant’ Packet – The packet includes the following forms.
- Statement of Claimant: This form shall be completed and signed by the injured employee or student worker. The purpose is for the injured employee or student worker to describe how the injury occurred, what part of the body was affected, and to share information on medical treatment.
- Medicare Eligibility: Information about your eligibility/participation in Medicare
- Authorization for Release of Health Information: This form authorizes the release of medical information to AmFed and shall be completed and signed by the injured employee or student worker.
- Notice of Physician Choice: Acknowledgement of service with a medical care provider.
Where Should the Employee Receive Medical Treatment?
The University authorizes initial treatment for workers’ compensation injuries at 2 locations in Oxford. For minor injuries, the employee or student worker shall be escorted to Employee Health on the 2nd floor of the V.B. Harrison Health Center to seek medical services. Care for serious injuries shall be provided by medical personnel at the Baptist Memorial Hospital-North Mississippi emergency room. Those who seek services at the emergency room are subject to drug and alcohol testing. Should the injured employee or student worker voluntary elect to receive initial medical treatment from an unauthorized medical care provider or facility, they must complete the Choice of Physician form which is available in the Human Resources office.
Mississippi Workers’ Compensation Notice of Coverage
Questions about filing a workers’ compensation claim should be directed the Department of Human Resources benefits team at 662-915-7431 / firstname.lastname@example.org. The form may be faxed to 662-915-5836 or dropped off/mailed to Jackson Avenue Center – Central.