Joining the MSBA Workers' Compensation Trust gives school districts and community/junior colleges several distinct advantages:

• participation in a group whose members have similar risks
• control by a Board of Trustees representing participants
• Loss Control / Safety Seminars designed for school districts
• FREE step-by-step Loss Control Manual which shows specifically how to handle various school situations
• professional claims management
• sound Investment of premium dollars
• commitment to participants for lower premiums as loss experience permits

The governing body for the WCT is made up of trustees elected by MSBA Workers' Compensation Trust members in the state. This board decides policy issues and sets the direction for the self-insured group.

For general information, call Anissa Young at MSBA toll free, 1-888-367-6722. Email Anissa at ayoung@msbaonline.org .

Workers' Compensation Claims Reporting Forms

These forms are to be completed and filed on all claims.

• First Notice of Loss
  This form is required by the Mississippi Workers' Compensation Commission and must be filed on all claims. It is often referred to as the B-3 form.
• MSBA First Report of Injury or illness
  This form collects all of the required information for the B-3 but gives more room to write and is more user friendly. Either this form or the First Notice of Loss form above can be completed and submitted directly into the CorVel CareMC claims system.
• Witness Statement*
  This form may be used if there is a witness(es) to the incident. Information on the form helps the adjuster in investigating the claim.
• HIPAA Authorization*
  This form must be signed so that the adjuster can get copies of the medical records and pay any bills MSBA is responsible for paying.
• Notice of Physician Choice*
  The form gives notification of the doctor chosen by the employee to render treatment.
• WC Exam and Work Status*
  This form goes with the employee to the doctor. It has a section to be completed by the doctor regarding work status.
• Pharmacy First Fill Form
  This form allows an employee to receive a 14 day supply of medications with no out of pocket expense or co-pays. Injured employees should take this form with them to the pharmacy when filling their first prescription.

For additional information about these forms, please contact Anissa Young, ayoung@msbaonline.org or 888-367-6722.

*These forms must be completed and faxed to CorVel at 1-866-434-4720.