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How Montana's Workers' Compensation Benefits Work and What They Mean for You




The Montana Department of Labor & Industry publishes a Workers’ Compensation Benefits Summary[1].  Here is a table containing DLI’s July 1, 2023, through June 30, 2024, summary:

Topic

Information

What is Workers' Compensation?

Workers' Compensation in Montana is designed to provide wage loss benefits and medical benefits to workers suffering from a work-related injury or occupational disease, return the worker to the workforce as soon as possible, and provide coverage at reasonably constant rates to employers. Montana has specific laws about limits of liability.

Who is covered?

Workers' compensation insurance is required for most types of employment. If you are injured on the job, you may be eligible for workers' compensation benefits provided you submit notice and the proper claim form on time.

Reporting Requirements

Report all on-the-job injuries to your supervisor, insurer, or employer as soon as possible, regardless of if you receive medical treatment. You must give notice within 30 days after the occurrence of the accident. The notice must include the time and place where the accident occurred and the nature of the injury. This 30-day notice requirement does not apply to occupational diseases.

First Report of Injury (FROI)

You must submit a signed First Report of Injury (FROI) within 12 months from the date of the accident. You can submit this form to your employer, the workers' compensation insurer, or the Montana Department of Labor & Industry (DLI), Employment Standards Division (ESD). FROI forms are available from your employer, insurer, or the DLI website erd.dli.mt.gov.

Occupational Disease

To claim an occupational disease, you must submit a signed FROI in writing to your employer, insurer, or DLI within one year from the date you knew or should have known your condition resulted from an occupational disease. An occupational disease is a condition caused by events occurring on more than a single day or work shift.

Acceptance or Denial of Claim

Upon receipt of your signed FROI, the insurer has 30 days to either accept or deny your claim.

Medical Benefits

Once the insurer accepts your injury or occupational disease claim, you are entitled to reasonable medical costs, including doctor, hospital, and prescription payments. You do not have to pay the balance between what the medical provider charges and the insurance company pays.

Choosing a Treating Physician

You may choose the treating physician for initial treatment. However, any time after acceptance of liability by an insurer, the insurer may designate a different treating physician, or approve your choice of the treating physician. The treating physician is responsible for the management and coordination of your medical care and must treat you within the recommendations of the Montana Utilization and Treatment Guidelines adopted by DLI including prescribing medications pursuant to the Montana Workers' Compensation Drug Formulary.

Termination of Medical Benefits

Medical benefits terminate 60 months from the date of injury or diagnosis of an occupational disease. A worker may request reopening of terminated medical benefits within five years of the termination by filing a petition with DLI. Repair or replacement of a prosthesis or permanently disabled workers are exempt from the closure of medical benefits.

Emergency Room Charges

After your first visit to an emergency room, you are responsible for $25 of the cost of each subsequent visit to an emergency room.

Generic Drugs

An insurer will only pay for the purchase of generic name drugs if the generic product is a therapeutic equivalent unless the generic product is unavailable. You may be required to pay the difference between name-brand drugs and the generic if you choose to use the name brand product.

Travel for Treatment

The insurer is required to pay reasonable travel expense. Your first 100 miles of travel per month are excluded. Workers will not receive payment for travel outside their community if equal treatment is available within the community unless the insurer requests you attend a medical appointment. You will not receive a payment if you are incurring travel to unauthorized or disallowed treatment or procedures. Travel claim forms are provided by the insurer.

Reimbursement for Travel Expenses

You must submit the travel claim to the insurer within 90 days of the travel.

Wage Loss

If your medical provider does not permit you to return to work because of your injury or occupational disease, and your claim has been accepted by the insurer, you may be eligible for wage loss benefits. If you are eligible for compensation benefits, no compensation may be paid for the first 32 hours or four days of wage loss, whichever is less. You are eligible for compensation starting with the 33rd hour or fifth day of wage loss. If you are totally disabled and unable to work for 21 days or longer, compensation may be paid retroactively to the first day of total wage loss.

Temporary Total Disability (TTD)

If you suffer a total loss of wages due to your injury or occupational disease, you may be eligible for Temporary Total Disability (TTD) benefits until your medical provider determines you have reached maximum medical improvement (MMI) or you are released to return to the employment in which you were injured or a job with similar physical requirements. You may receive weekly compensation of 66 2/3% of your gross wages at the time of injury - up to the maximum rate of $1,034 a week.

Temporary Partial Disability (TPD)

If prior to reaching maximum medical improvement, you have a physical restriction, suffer an actual wage loss and are approved to return to modified or alternative employment, you may be eligible for Temporary Partial Disability benefits (TPD). The benefits may not exceed your temporary total disability rate of $1,034 a week and are the difference between your average weekly wage at the time of injury, subject to the maximum of 40 hours a week, and the actual wages you earn in the modified or alternative employment.

Permanent Partial Disability (PPD)

If your medical provider determines you have reached MMI, you may be eligible for Permanent Partial Disability (PPD) benefits if you meet certain requirements.

Permanent Total Disability (PTD)

If your medical provider determines you have reached MMI and you cannot return to any regular employment, you may be eligible for Permanent Total Disability (PTD) benefits. Regular employment means recurring work performed for remuneration in a trade, business, profession, or other occupation in the state. The benefit rate is the same as for Temporary Total Disability (TTD). Benefits are available until you are eligible to receive Social Security retirement benefits or retirement benefits from a system that is an alternative to Social Security retirement.

Stay at Work/Return to Work

DLI and workers' compensation insurers assist Montana workers in efforts to stay at work or return to work quickly after a work-related injury. To request stay at work or return to work assistance, contact your workers' compensation insurer or DLI by visiting erd.dli.mt.gov or by phone (406) 444-6543.

Death Benefits

If an on-the-job injury or occupational disease is the cause of death, contact the workers' compensation insurance provider or ESD for information.

Rehabilitation Benefits

You may be eligible for rehabilitation benefits if you have a permanent medical impairment resulting from your injury or occupational disease and cannot return to your time of injury job or a job with similar physical requirements, you suffer an actual wage loss, or you have a permanent medical impairment rating 15% or greater and have no actual wage loss.

Accurate & Truthful Information

When you sign your FROI, you are confirming the information on the claim is true. If you obtain benefits to which you are not entitled, you may be guilty of theft, and criminal proceedings can be initiated. Helping someone else to fraudulently obtain benefits is also a crime.

Reporting Suspected Fraud

You can report suspected fraud by calling the Montana State Fund Fraud Hotline at (888) 682-7463 (if the employer is insured by Montana State Fund) or the DLI at (406) 444-6543.

Coverage for Claim

Ask your employer for the name of the company providing coverage for the employer, or you may contact ESD at (406) 444-6543.

Rights & Remedies

If you disagree with a decision made by your insurer regarding benefits, you may request mediation through the ESD at (406) 444-6534. Within two years of the insurer's denial of benefits and upon satisfying the mediation requirements, you may petition the workers' compensation judge for a determination of the dispute.

Additional Benefits

Kids' Chance of Montana provides scholarships to children affected by a workplace injury by helping them pursue and achieve their educational goals. Visit kidschanceofmontana.org for details.

 

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