In Montana, the state workers’ compensation system covers medical treatment and pays benefits to employees who are injured at work. Employees typically need to go through workers’ comp to get compensation, rather than suing their employers in court. (Although there are a few exceptions. To learn more, see Workplace Injury: When You Can Sue Outside of Workers’ Compensation.) This article explains the workers’ comp process in Montana and how to start a claim if you were injured at work.
Montana law requires all private employers to have workers’ compensation coverage for their employees. Many employers meet this obligation by purchasing a policy from a private insurance company. The insurance company is responsible for reviewing claims and deciding whether to pay benefits. (Larger employers can also get the state’s approval to be self-insured, which means that they reviews claims and pay their employees directly.) The Montana Department of Labor & Industry oversees the workers’ compensation system and resolves disputes between employees and insurance companies.
Workers’ compensation covers injuries that happen in the course and scope of employment. For example, if you work at a computer all day and develop carpal tunnel, your injury will likely be covered by workers’ comp. Similarly, if you aggravate an old back injury while carrying heavy boxes for work, you will likely be covered. On the other hand, if you are injured during an off-site lunch break or during your commute to or from work, you will probably not be covered. (For more information, see Workers’ Compensation: Is Your Injury or Illness Work-Related?)
The first step to making a workers’ comp claim is to report your injury to your employer. You have 30 days to provide notice, but it is best to notify your employer as soon as possible. If you wait more than a few days to report it, your employer or its insurance company might question the legitimacy of your claim.
You must also complete a First Report of Injury and give it to your employer within one year of your injury. Your employer should provide you with the form, or you can download a copy of the form at the DLI’s website. This is the official start to your workers’ compensation claim.
Once you give notice of your injury, your employer should notify its insurance company and complete its portion of the First Report of Injury. The insurance company will then evaluate your claim, usually by talking to you, your employer, and your doctors. The insurance company has 30 days to decide whether to accept or deny your claim.
You should also get medical treatment right away. If you need emergency treatment, you should go to the nearest emergency room or urgent care. You can also select your own doctor for your initial treatment. However, once the insurance company accepts your claim, it can send you to a different doctor for further treatment.
Workers’ compensation should pay for all necessary medical treatment related to your work injury. This includes the cost of doctors’ visits, hospital stays, prescriptions, and medical equipment. You can also receive disability benefits if you need time off work or if your injury causes permanent impairment.
If the insurance company denies your claim, you can challenge its decision with the Montana Department of Labor and Industry (DLI). (For common grounds for a denial, see Denied Workers’ Compensation Claims.) You must first participate in a mediation, where a neutral representative of the Mediation Unit will try to help you resolve the dispute. If mediation is unsuccessful, you may request a hearing with the Montana Workers’ Compensation Court within two years of the claim denial.
Many workers can handle the initial workers’ comp claim process on their own. However, if the insurance company denies your claim or disputes the amount of benefits you are entitled to, you should consider hiring a lawyer. This is especially true if you need to attend a workers’ comp hearing, which follow complex procedural rules. For more information, see Should I Hire a Workers’ Comp Attorney or Can I Handle My Own Case?