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 July 1, 2016, for establishment and amendment to the fund. MDPS shall make a payment, as provided by the amended statute, in the amount of One Hundred Thousand Dollars ($100,000.00) when a “covered individual,” while engaged in the performance of the person’s official duties, dies 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.
To apply, please refer to the instructions and required forms below:
Law Enforcement Officers and Fire Fighters Death Benefits Trust Fund Instructions Memorandum
This is 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. (Three page memorandum)
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 signed and notarized by the covered individual or employee and placed within the public employer’s or agency’s personnel file wherein the person is currently employed. (One page form)
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 page form)
Form "A" must be attached to Form "B" before it is sent to MDPS in order to submit a Death Benefits Trust claim.
