Montana Workers Compensation Claims: Eligibility, Filing and Appeals

Workers' Compensation insurance is compulsory in Montana, and all employers with few exceptions are required to provide coverage for their employees. Employers may provide insurance through the Montana State Fund, a private carrier, or they may choose to self insure. In Montana, the regulatory agency for the workers' compensation system is the Department of Labor and Industry. There were 30,970 reported Workers' Compensation claims in Montana in 2007, and 42% of those claims were made due to sprains and rupture injuries.

Common Covered Work Related Injuries

Common on the job accidents and injuries are covered under Montana Workers' Compensation law. Sprains, fractures, burns, cuts, head injuries, amputations, and other general injuries are covered. Occupational diseases are also covered. Occupational diseases are diseases caused by workplace conditions or workplace activity, such as lung diseases caused by inhaling chemicals used at work. Workers are not covered while traveling to and from work, but are usually covered when driving for work related reasons.

How to File a Montana Workers Compensation Claim

Employees must report on the job injuries to their insurer or employer within 30 days. The employer must also file an injury report with their insurer or the Department of Labor and Industry within six days of notification. For an employee to make a claim, they must submit a claim form or First Report of Injury (FROI) form within 12 months. This form may be submitted to the employer or filed directly with the insurer or the Department of Labor and Industry. In addition to an emergency room visit, an employee has the right to choose their first treating physician, but the insurer must approve any further physician changes.

Workers Compensation Claim Denials

The most common reason given for Workers' Compensation claim denials is “no objective medical findings to substantiate injury.” Insufficient information, late claim filing, and failure to follow proper procedure may also result in denial. Claims that do not meet the definition of injury or occupational disease or claims that are found to be insufficiently caused by work related activity may also be denied.

Appealing a Montana Workers Compensation Denial

The Employment Relations Division of the Montana Department of Labor and Industry offers mandatory informal mediation services which resolve disputes approximately 79% of the time. This should be the first step. The next step is to appeal by requesting a contested case hearing with the Department of Labor and Industry Hearings Bureau. Claimants may also file a petition with the Workers' Compensation Court for a formal hearing. A lawyer is recommended when making an appeal due to the complex nature of Workers' Compensation law.

Collecting Montana Workers Compensation Benefits

Montana Workers' Compensation insurance pays medical benefits as well as wage loss benefits. Employees are not eligible for wage loss compensation until they have missed five days of work. Benefits are generally paid weekly, unless an alternative settlement has been reached. The amount of benefits is determined by the type of injury as well as the employees’ average weekly wage. Benefits for total disability, either temporary or permanent, equal 66% of an employee's weekly wage. Partial disability benefits are lower than this percentage, depending on the severity of the injury. Benefits may not exceed the maximum level of $626 a week.

Hiring a Montana Workers Compensation Lawyer

A Workers' Compensation attorney should be consulted if a worker is not getting the benefits he or she feels are rightly deserved. Workers' Compensation lawyers may assist in negotiating settlements, and may also represent workers in formal hearings. Due to the complex nature of the legal issues surrounding Workers' Compensation law, consulting a lawyer is recommended if a worker has any questions or difficulties obtaining their benefits.

Montana Workers Compensation Office Locations

Montana Workers Compensation Claims Assistance Bureau
Street Address:
1805 Prospect Avenue
Helena, Montana 59624
Mailing Address:
Post Office Box 8011
Helena, Montana 59624-8011
(406) 444-6543

Montana Workers Compensation Regulation Bureau
Street Address:
1805 Prospect Avenue
Helena, Montana 59624
Mailing Address:
Post Office Box 8011
Helena, Montana 59624-8011
(406) 444-6541, Fax: (406) 444-3465

Montana Workers Compensation Court
Street Address:
1625 11th Avenue
Helena, Montana
Mailing Address:
Post Office Box 537
Helena, Montana 59624-0537
(406) 444-7794

Montana Department of Labor and Industry
Post Office Box 1728
Helena, Montana 59624-1728
(406) 444-2840