Petition To Controvert {B-5-11} | Pdf Fpdf Doc Docx | Mississippi

 Mississippi   Workers Compensation 
Petition To Controvert {B-5-11} | Pdf Fpdf Doc Docx | Mississippi

Last updated: 10/25/2024

Petition To Controvert {B-5-11}

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Description

Form B-5,11 - PETITION TO CONTROVERT. The Mississippi Workers' Compensation Commission form is used by employees to dispute a workers' compensation claim and request a hearing. It includes information on the claimant, employer, injury details, notification, medical treatment, compensation history, and any dependents if death was involved. It also allows the claimant to request penalties for non-payment or delays. Medical records may be required to support the claim if no benefits have been paid. This form starts the process for a legal review of the disputed workers' compensation claim. www.FormsWorkflow.com

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