Form B-18 - Notice Of First Payment Of T.t.d. Benefits / Notice Of Suspension Of Payment - Mississippi Workers' Compensation Commission Page 2

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Reverse Side to Form B-18

This Form (B-18) combines former MWCC forms B-15, B-16, and B-17.

This Form has been developed by the Commission pursuant to Mississippi Code Annotated Sections 71-3-37(3)

and 71-3-85 (3), (6) (1972), as amended, and may be used in lieu of forms B-15, B-16, and B-17. PRIOR APPROVAL

OF THIS OR ANY OTHER FORM USED FOR SUCH PURPOSES IS NOT REQUIRED IN ORDER FOR

PAYMENT OF BENEFITS TO BEGIN OR CONTINUE. THE EMPLOYER/CARRIER'S OBLIGATION TO

BEGIN OR CONTINUE PAYING BENEFITS IS NOT SUSPENDED PENDING COMMISSION REVIEW OF

THIS OR ANY OTHER FORM USED FOR THE SAME PURPOSE. THE COMMISSION WILL NOTIFY

THE EMPLOYER/CARRIER IF THERE IS A MISTAKE, DEFICIENCY OR OTHER PROBLEM SO THAT

CORRECTIVE ACTION CAN BE TAKEN BY THE EMPLOYER/CARRIER.

Part I of this Form (General Information) should be completed in full in all cases.

Part II of this Form (Notice of First Payment) should be used when making the first payment for temporary total

disability benefits. Mississippi Code Annotated Section 71-3-37 (3) (1972), as amended.

Part III of this Form (Supplemental Agreement) should be used when making the first payment of temporary partial

disability benefits, permanent disability benefits (partial or total), death benefits, head or facial disfigurement,

maintenance payments in connection with vocational rehabilitation, accelerated permanent disability benefits, and upon

the resumption of temporary disability benefits for an additional period. Mississippi Code Annotated Sections 71-3-19, -

37(3) (1972), as amended; General Rule 13.

Part IV of this Form (Notice of Suspension) should be used and filed immediately with the Commission upon

suspension of payment of compensation benefits. Mississippi Code Annotated Section 71-3-37(3) (1972), as amended.

THE ORIGINAL OF THIS FORM ONLY MUST BE FILED WITH THE COMMISSION, AND A COPY

MUST ALSO BE MAILED TO OR FURNISHED TO THE EMPLOYEE, BENEFICIARY, OR

REPRESENTATIVE BY THE EMPLOYER/CARRIER.

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