We help business owners navigate Mississippi workers' comp rules.

Workers' Compensation Shop.com offers free access to all state of Mississippi workers' compensation forms, applications and guides. We strive to keep these forms up to date.

As with all information we provide please verify the accuracy of this information with the Mississippi Workers' Compensation Commission.

If you have questions about any Mississippi forms, feel free to contact a specialist at 888-611-7467.

Mississippi Workers' Compensation Insurance Forms

MS Acord 130 Workers' Compensation Application.

The standard Acord 130 application form for workers' comp coverage in Mississippi.

Mississippi Workers' Compensation Facts

MS First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.

Mississippi First Report of Injury Form

MS First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs.

Mississippi Officer Exclusion Form

Complete this form to exclude officers and shareholder from workers' compensation coverage.

Mississippi Workers' Compensation Coverage Election/Rejection Form

Complete this form to select elect or reject workers' compensation coverage for the state of Mississippi.

Mississippi Drug Free Workplace Guidelines

This document contains the guidelines for the Mississippi Drug Free Workplace Program.

Mississippi Drug Free Workplace Application

This document contains the application for the Mississippi Drug Free Workplace Program.

Workers' Comp Exemption

Each state has its own laws and requirements regarding when and how employers are allowed to opt-out of coverage under their workers' compensation policy. Some states make it easier than others because they don't require anything to be filed. Other states require special inclusion or exclusion affidavit documentation. Failure to comply often causes employers to have to pay premium on themselves even when they wanted to be excluded form coverage.

Waiver of Subrogation

A waiver of subrogation means that a business and their insurance company is foregoing all rights to file suit, or seek damages, from another business. This is common in the construction industry as builders attempt to protect their company from negligence. A workers' comp waiver of subrogation does not prevent an injured employee from filing a lawsuit for damages. This coverage typically add about $100 to the cost of a work comp policy.

Certificate of Insurance

A Certificate of Insurance is a document that serves as evidence of insurance or proof of coverage. Certificates indicate your current coverages and policy limits. Insurance Agencies issue on an insured's behalf and they often list a third party as a certificate holder. This means they should be notified if a policy cancels prior to expiration. Requests for any special wording should be carefully checked against the policy language before being added to a certificate as they can create legal issues with coverage.

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Pay As You Go Work Comp

Improve your business cash flow with our Agency Pay As You Go Workers' Comp plans. Available through most of our insurance companies.

Pay ASs You Go

State Resources for Mississippi

Mississippi Workers' Compensation Commission

PO Box 5300
1428 Lakeland Drive
aJackson, MS 39296-5300

Mississippi Insurance Department

P.O. Box 79
1001 Woolfolk State Office Building
501 N. West St.
Jackson, MS 39205

Workers' compensation insurance is required by law for Mississippi employers.

Mississippi forms and applications such as owners inclusion or exclusion forms are sometimes updated by the state. Contact us if you need help or can't find the workers' compensation form your need for Mississippi.

Why Quote Workers' Comp Insurance with Us?

Find the best workers' comp insurance company.


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Easy payment plans for work comp insurance.

We offer Pay As You Go Workers' comp plans and easy monthly payment options for your business.

Get Pay As You Go workers' compensation insurance.

We've developed Target Programs with key insurance companies that provide bigger discounts and more credits.

Visit NCCI for more resources and information about workers' compensation class codes. Visit United States Department of Labor for more information about government agencies managing workers compensation insurance rates.

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