If your workers’ comp claim has been denied, or you have a dispute with the insurance company about your benefits, you can challenge the insurance company’s decision. Below is an explanation of how the process works and what you need to do to initiate your appeal. (For an overview of eligibility and benefits, see our article on filing a workers’ comp claim in Montana.)
Before you can request a hearing about your case, you must try to resolve the dispute with the insurance company. This is a two-step process. You must first send a letter to the insurance company explaining why you disagree with its decision and what you believe you are entitled to. If the insurance company denies your request, or fails to respond within 15 days, you must move on to the next step: a mediation conference.
Mediation conferences are mandatory in most Montana workers’ compensation cases. To request mediation, you must file a Petition for Mediation Conference with the Mediation Unit of the Montana Department of Labor & Industry. At mediation, a neutral third party (called a “mediator”) will have a conference call with you and the insurance company to try to facilitate a settlement agreement. The mediator does not make a decision in your case, but he or she will issue a recommended solution. You or the insurance company are free to reject the recommendation and proceed to a workers’ comp hearing.
If mediation is not successful, you may request a hearing before a workers’ compensation judge. You must file a Petition for Hearing with the Montana Workers’ Compensation Court within two years after your benefits were denied. Once the court receives your petition, it will schedule your case for a hearing and notify you of the date, time, and location.
Before your hearing, you will have a pretrial conference. This is an opportunity for the judge to review your case, identify the issues in dispute, and go over the evidence to be presented at the hearing. At the hearing, each side will have an opportunity to present witnesses, submit documents, and make legal arguments. The workers’ comp judge will review all of the evidence and make a written decision in your case.
If you disagree with the judge’s opinion, you can appeal to the Montana Supreme Court. The judge’s order will explain the deadline and how to file your appeal. The Supreme Court will review the judge’s order and decide whether to uphold it.
While you are permitted to represent yourself in the appeals process, you should consider hiring a workers’ compensation attorney. The appeals process requires detailed knowledge of workers’ compensation law and procedural rules, especially when it comes to workers' compensation hearings and court appeals. For help finding a workers’ compensation lawyer, check out our lawyer directory.