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Fill and Sign the Notice of Controversion Mississippi Form

Fill and Sign the Notice of Controversion Mississippi Form

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BEFORE THE MISSISSIPPI WORKERS' COMPENSATION COMMISSION       CLAIMANT V. NO.             EMPLOYER AND       CARRIER NOTICE OF CONTROVERSION Comes now the employer/carrier, by and through counsel, and fle this their Notice of Controversion in support thereof would show unto the Commission as follows, to wit: 1. That the claimant sustained a work related injury on             , 20       ; 2. That the claimant has been treated by Dr.       and has also seen Dr.       ; 3. That upon information and belief, the employer/carrier believes that Dr.       has recommended back surgery for the claimant, however, Dr.       has indicated that he does not fnd any defect which would warrant surgery; 4. That employer/carrier controvert the claimant's treatment by Dr.       and would submit to this Commission that the claimant should be evaluated by a physician designated by the Mississippi Workers' Compensation Commission for a determination as to whether surgery is warranted; 5. That attached hereto and marked "Exhibit A" is the form B - 3 fled with the Commission; 6. That attached hereto and marked "Exhibit B" this Order designating an orthopaedic surgeon or a neurosurgeon to evaluate the claimant for determination of whether surgery is necessary. Respectfully submitted,      

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