This page provides answers to the following questions:
- I had an accident at work. How do I file a workers compensation claim in my state?
- Should my employer have workers compensation insurance? How do I know I am covered?
- What are the conditions that enable me or prevent me from claiming benefits under my state's law?
- What benefits might I be eligible to receive?
- How much time do I have to file my claim? What are the stages of the claim process? What should I expect?
- If I'm not happy with the determination, how do I appeal?
1. I had an accident at work. How do I file a workers compensation claim in my state?
You should report any on-the-job injuries or illnesses to your insurer or employer as soon as possible. You have thirty (30) days to give notice of your accident, or one year from the date you would have learned about any conditions or illnesses resulting from your work. Don't hesitate to report your injury; the Department recommends you report any injury, regardless of the scope or severity.
In addition to providing notice of your work-related injury or illness, you must provide a written and signed First Report of Injury form to either your employer, the workers' compensation insurance provider at your place of employment, or the Department. This form must be submitted within twelve (12) months from the date of the accident or diagnosis of the occupational disease. Take note that establishing a work-related injury is different from establishing an occupational disease. An occupational disease or condition requires a finding based on objective medical evaluation, where your employment is the major contributing cause of the condition.
2. Should my employer have workers compensation insurance? How do I know if I am covered?
In Montana, workers' compensation insurance is required for most types of employment. Your employer may purchase insurance coverage through an insurer authorized to provide workers' compensation coverage plans in Montana, or may be granted the authority to become self-insured.
In the event you are injured or you are diagnosed with an occupational illness or disease, you or your employer will submit your First Report of Injury form to your employer's insurance provider. The insurance provider will evaluate your claim and will make a determination to accept or deny liability for your claim within thirty days.
If your employer is uninsured, you may eligible to receive benefits from the state uninsured employers' fund. You should contact the Department to determine your eligibility.
3. What are the conditions that enable me or prevent me from claiming benefits under my state's law?
In Montana, workers' compensation is a no fault system. This means the employee is entitled to workers' compensation as an exclusive remedy. Complying with the procedures and requirements for submitting a claim with the Department is the best way to ensure your eligibility for benefits.
However, the circumstances specific to your claim may challenge or change the amount of benefits you may be entitled to. For example, your ability to return to work; whether you currently receive state or federal benefits such as social security; the severity and scope of your injury or illness.
4. What benefits might I be eligible to receive?
Depending on the extent of your injuries, you may be entitled to one or more of the following types of benefits:
- Medical Benefits: You may be entitled to receive compensation for medical expenses related to the reasonable care and treatment of your injury or illness. The allowable charges and expenses are established by a state medical fee schedule. Your employer's insurance provider will designate a medical professional you may seek treatment from or approve your choice of medical professional. All medical professionals working in compliance with a workers compensation benefits scheme are expected to adhere to Montana's Utilization and Treatment Guidelines. Requesting or consenting to procedures or treatments outside of these guidelines may place you in a position of ineligibility for benefits. You are also only entitled to medical benefits for a period of sixty months either post-date of injury or post-diagnosis of occupational illness.
- Wage Loss: Upon the determination or recommendation of a physician, an inability to return to work may cause you to be eligible for wage-loss benefits. You will not be eligible for wage-loss benefits for the first 32 hours or first 4 days of a loss of wages. Thus, you wage-benefits are payable once your injury has caused you to lose thirty-three (33) hours or five (5) days worth of lost wages. To regain the first few days of wages lost, you must be unable to work for a period of at least twenty-one (21) days.
- Wage loss benefits may be further categorized based on the scope and severity of your disability, whether as a result of illness or injury.
- Temporary Total Disability benefits are paid when a total loss of wages has occurred. You will be eligible for these wages, calculated as roughly two-thirds (66.67%) of your gross wages at the time of your injury, until your physician determines that you have either reached maximum medical improvement or you are considered capable of returning back to work. These benefits may be increased or reduced subject to circumstances specific to your case (i.e. receipt of other state or federal benefits).
- Permanent Partial Disability benefits are awarded if you have an actual wage loss resulting from your injury or your injury or illness has caused permanent impairment. These are two allocations of benefits; therefore, for example, if you have a permanent impairment but have not suffered wage loss, you may only receive compensation for the impairment.
- Permanent Total Disability: At the discretion of your physician that you have reached maximum medical improvement and you are incapable of returning to regular employment, you may be eligible for Permanent Total Disability benefits. These are benefits calculated as two-thirds (66.67%) of your gross wages at the time of your injury. You will be entitled to receive these benefits until you are capable of receiving social security benefits.
- Stay at Work/ Return to Work is a benefits program that helps to provide opportunity for individuals dealing with a work related injury or illness to get back to normal employment.
- Death benefits are paid to your survivors or dependents in the event that a work-related injury or illness results in your death.
5. How much time do I have to file my claim? What are the stages of the claims process? What should I expect?
If you are unsatisfied with your insurer's decision regarding your claim and benefits, you may request a meditation through the Department's Employment Relations Division.
The mediation process is an opportunity for you, the injury employee, and your employer and/or employer's insurance provider to resolve any disputes that may have arisen during the course of your claim. The mediator works to facilitate the potential dispute resolution. These mediation conferences are informal and confidential, but not necessarily binding. They are an opportunity to come to a settlement without the need for formal litigation.
If a mediation does not result in a settlement or resolution of the issues of your claim, the mediator will provide a written recommendation to both parties within 10 working days specifying what the mediator understands to be the best solution to the issue. Once you receive the recommendation, you have twenty-five (25) days to respond as to whether you agree or not. If you remain unsettled with the recommendation, you or your employer or your employer's insurance provider may file your claim to be heard at the Workers' Compensation Court.
To move your claim to the Workers' Compensation Court, you will be required to submit a petition to the court outlining the circumstances and facts of your case, including the claims you bring forward and the relevant evidence and medical information related to your injury or illness. You may also request an emergency trial in this petition by providing a basis for why the claim constitutes an emergency situation. The opposing party is expected to respond to the petition within twenty (20) days of receiving notice of the initial filing of the petition with the court. A proceeding within the Workers' Compensation Court is conducted similarly to a trial in any other court. It is highly recommended that you seek the guidance and counsel of an attorney to help you in this process. A decision of the court is certified as a final decision and determination. These decisions may be appealed within the Department of Labor and Industry.
6. If I am not happy with the determination, how do I appeal?
If after exhausting all of the administrative proceedings available through the Workers' Compensation Court, you remain unhappy with the determination of your claim, you may appeal to the state Supreme Court in regards to issues of law that may have been applied or considered in error against your claim.