Get Mt Erd-991 2022-2025

The MT ERD-991 form is essential for documenting workplace injuries and initiating workers' compensation claims. This guide provides a clear, step-by-step process to help users confidently complete this important document online.

Follow the steps to complete the MT ERD-991 online.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Fill in the worker's details, including last name, first name, middle initial, mailing address, phone number, date of birth, social security number, city, education level, and postal code. Provide the worker's gender and marital status, along with the number of dependents.
3. Next, detail the worker's wages. Include the date hired, gross earnings for the four pay periods preceding the injury, and employment status. Specify the number of days worked per week and any additional earnings such as room and board, overtime, or bonuses.
4. Describe the accident by including the job title, the nature of the injury, cause of injury, part of the body affected, and the accident location. Fill in the date of the injury, date disability began, and any witnesses present.
5. Provide medical information, including the attending physician's name, address, and phone number, as well as the hospital name and treatment received.
6. Sign the form, indicating that this is a claim for workers' compensation benefits and authorize the release of relevant medical information.
7. Complete the employer section with the employer's name, mailing address, business structure, and details on the worker’s employment classification.
8. Finally, review the entire form for accuracy. Once satisfied, save your changes, download, print, or share the completed form as needed.

Complete your MT ERD-991 form online today to ensure a smooth claims process.