Other Safety Officials Death Benefits Trust Fund Application Process

Other Safety Officials Death Benefits Trust Fund Application Process 1. Death Benefits Trust Claim Application (Form OS-020) must be completed by the Employer when a covered individual is killed while engaged in the performance of the individual's official duties and sent by the Employer to the Mississippi Department of Public Safety along with the original copy of Form OS-010. 2. The following documents must be included with Form OS-020 at the time of submission: a. A certified copy of the original certificate of death; b. If one was completed, the original of the Beneficiary Designation Form (Form OS- 010); c. An attested copy of the incident report documenting how death occurred; and d. An attested copy of the covered employer’s record showing deceased’s date of hire. 3. The submission of Form OS-010 and Form OS-020 does not guarantee payment under MCA §45-2-31. The Mississippi Department of Public Safety makes the final determination of payment under the statute. 4. Submission of the Death Benefits Trust Claim Application should be made by the Employer and filed with the Legal Division of the Mississippi Department of Public Safety at Post Office Box 958 in Jackson, Mississippi 39205. Questions or concerns should be directed to DeathBenefitsTrust@dps.ms.gov. 5. All completed applications for death benefits claims will be presented by the Legal Division and evaluated by the Commissioner and the Executive Committee during the Department’s Executive Staff Meeting.