The Mississippi Department of Public Safety (MDPS) administers the Law Enforcement Officers and Fire Fighters Death Benefits Trust Fund, pursuant to Mississippi Code Annotated § 45-2-1, as amended, effective August 1, 2006, for establishment and amendment to the fund. MDPS shall make a payment, as provided by the amended statute, in the amount of Sixty-Five Thousand Dollars ($65,000.00) when a “covered individual,” while engaged in the performance of the person’s official duties, is accidentally or intentionally killed or receives accidental or intentional bodily injury that results in the loss of the covered individual’s life, provided that the killing is not the result of suicide and that the bodily injury is not intentionally self-inflicted.
The following instructions and two (2) forms may be accessed, copied and used:
Law Enforcement Officers and Fire Fighters Death Benefits Trust Fund Instructions
The memorandum that specifically explains the Law Enforcement Officers and Fire Fighters Death Benefits Trust Fund, which is administered by the Mississippi Department of Public Safety. The memorandum defines the meaning of the terms: “covered individual;” “employer;” “Fire fighter;” and “Law enforcement officer.” It also provides instruction for completing and using the two distinct forms. (Two pages)
Form “A” Beneficiary Designation Form
To be completed by “Covered Individuals” which are defined by the statute, in order to name a beneficiary or beneficiaries for receiving the benefit. The form should be completed by the covered individual or employee, by being signed, notarized and placed within the public employer’s or agency’s personnel file wherein the person is currently employed. (One page)
Form “B” Death Benefits Trust Claim Application
To be completed by the Chief Law Enforcement Officer or public agency Director, only when needed, as “Employer” for the deceased individual. This form will be used when necessary to notify MDPS when a covered individual is killed while engaged in the performance of the person’s official duties. (Two pages)