20 MAC Pt. 1, R. 1.8
Posting Notice of Coverage
Cite as 20 Miss. Admin. Code Pt. 1, R. 1.8
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 which
measures at least 8 1/2 inches by 11 inches and which contains the
following information:
I. The name, address and telephone number of the workers’
compensation insurance carrier for the employer, or a statement that
the employer is self-insured, if applicable;
II. The name, address and telephone number of the third party
administrator, if any, or other office responsible for processing and
paying the workers’ compensation claims on behalf of the carrier or
self-insured employer;
III. The effective dates of the workers’ compensation insurance
coverage or the self-insurance certificate of authority which the
employer maintains;
IV. The name of the person or representative affiliated with the
employer to whom employees should provide notice of their injuries
or illnesses; and
V. A statement that any person who willfully makes any false or
misleading statement or representation for the purpose of obtaining
or wrongfully withholding any benefits or payment under the
Mississippi Workers’ Compensation Law may be charged with
violation of Miss. Code Ann. Section 71-3-69 and upon conviction be
subjected to the penalties therein provided.
This Rule shall be in force and effect on and after January 18,
2018.