Montana Workers' Comp Claims: Eligibility, Filing, and Appeals
Know your rights under the workers' compensation system in Montana
All employers in Montana must carry workers’ compensation insurance. As in other states, the workers’ compensation system in Montana is a no-fault system that compensates injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must follow certain procedures required by Montana law.
Who Is Eligible for Workers’ Comp Benefits?
Workers’ compensation covers all injuries or illnesses that happen in the course of employment. In general, injuries that happen while you are performing your work duties or running work errands are covered by workers’ comp. On the other hand, injuries that occur while you are off duty are generally not compensated through workers’ comp. For example, if you were injured during your lunch break or during your commute to and from work, you will typically not be covered by workers’ comp. (For more information, see our article on what types of injuries are not covered by workers' comp.)
Workers’ comp covers both traumatic injuries and occupational illnesses. Traumatic injuries result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).
What Should I Do if I’m Injured at Work?
To start your claim for benefits, you should report your injury to your employer right away, but no later than 30 days from the date of your accident. You must also fill out a First Report of Injury and give it to your employer, its insurance company, or the Montana Department of Labor and Industry (the state agency responsible for overseeing workers’ compensation). You have one year from your accident to file the report. Otherwise, your benefits may be denied.
How Do I Get Medical Treatment?
In Montana, injured workers have the right to choose their initial treating doctor. However, once the insurance company accepts your claim, it can select a different doctor to treat your injuries. All reasonable and necessary medical treatment related to your work injury will be covered through workers’ comp, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You will also be reimbursed for certain travel expenses related to attending medical appointments.
What Other Benefits Can I Receive?
In addition to medical benefits, you will also be eligible to receive disability benefits. The amount and duration of these benefits depends on the severity of your injury and its impact on your ability to work.
Temporary Disability Benefits
Montana provides temporary total disability (TTD) benefits to workers who are unable to work while recovering from their injuries. These benefits are two-thirds of your gross wages at the time of your accident, up to a maximum set by law each year. As of July 1, 2016, the maximum weekly benefit is $756. TTD benefits are available until you return to work or until a doctor finds that your condition has improved as much as it is going to (called “maximum medical improvement”).
If you are able to work during this time, but you are earning less due to your injuries, you can receive temporary partial disability (TPD) benefits. TPD benefits are the difference between your actual earnings and your average weekly wage at the time of your accident, subject to the same weekly maximum described above.
Permanent Disability Benefits
If you are completely unable to work after reaching maximum medical improvement, you can receive permanent total disability (PTD) benefits. These benefits are paid at the same rate as temporary total disability benefits and end once you become eligible for Social Security retirement benefits.
If you are able to work after reaching MMI, but you still have a permanent impairment, you may be eligible for permanent partial disability (PPD) benefits. You can receive a PPD award if you have more than a minor impairment or if you have suffered an actual wage loss due to your impairment. The amount of your award depends on the impairment rating assigned by your doctor and the extent of your wage loss. For 2016, the maximum benefit it $378 per week.
What If My Claim Is Denied?
If the insurance company denies your claim, you can file a petition to have a workers’ compensation hearing before a judge. If you disagree with the judge’s decision, you can appeal to the Supreme Court of Montana. For more information on the appeals process, see our article on appealing a denial of your Montana workers’ comp claim.