Updated December 18, 2018
The workers’ comp 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.
All employers in Montana must carry workers’ compensation insurance, and workers’ comp covers all injuries or illnesses that occur in the course of employment. Injuries that happen while you are performing your work duties or running work errands are covered by workers’ comp, while injuries that occur while you are off duty (during your lunch break or during your commute to and from work) are generally not compensated through 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).
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 (FROI) 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.
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.
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.
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, 2018, the maximum weekly benefit is $793. 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.
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. As of July 1, 2018, the maximum benefit it $396.50 per week.
If you have a lasting impairment, you may want to reach a settlement with the insurance company for a lump sum payment of future permanent disability benefits.
If your workers’ comp claim has been denied, or you have a dispute with the insurance company about settling 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.
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.