Fill and Sign the Mississippi Wc Law Anderson Crawley Ampamp Burke Pllc Form

BEFORE THE MISSISSIPPI WORKERS' COMPENSATION COMMISSION V MWCC NO. NOTICE OF CONTROVERSION COMES NOW, the Employer, a Self Insured, in the above styled and numbered claim by and through its attorney and gives notice that it is controverting the Claimant's right to benefits and in support thereof would show unto the Commission the following:1. Claimant is alleging an injury to her chest, hand, spine and other parts of her body which arose out of and in the course and scope of her employment with her Employer herein on , . Employer denies liability for any injury related to multiple and any conditions, complaints, or treatment related thereto.2. The Employer has voluntarily provided Claimant temporary total disability benefits and medical benefits for the alleged rib injuries. 3. The Employer avers that Claimant is suffering from a pre-existing condition, multiple , which is the cause of her disability at this time. 4.The Employer denies liability for payment of any benefits, compensation, medical or otherwise, not medically related to the alleged accidental injury of , .5. Attached hereto as required by Mississippi Workers' Compensation Commission Procedural Rule 2 is a copy of the Employer's First Renort of ~~I any, including the issues raised herein and which may be raised herein in subsequent pleadings and/or proceedings. Respectfully submitted,**BY: ** CERTIFICATE OF SERVICE I, **, attorney for **, a Self -Insured, do hereby certify that I have this day mailed, by United States mail, postage prepaid, a true and correct copy of the above and foregoing Employer's Notice of Controversion to: This the 13th day of February, 1991.