The Montana Petition for Settlement — Injury/OD, Medical Benefits Reserved (also letter-size) is a form used by injured workers in Montana to file a claim for medical benefits associated with an on-the-job injury or occupational disease. This form is used when a worker has been injured and is unable to work, but has not received the medical benefits they are entitled to. The form must be completed in full, signed and notarized, and submitted to the Montana Department of Labor and Industry. It contains detailed information about the injury or illness, the date of injury, medical history, and the medical benefits requested. There are two types of Montana Petition for Settlement — Injury/OD, Medical Benefits Reserved (also letter-size): the standard form and the form for claimants with preexisting conditions. The standard form is used for injuries or illnesses that were not preexisting and the form for claimants with preexisting conditions is used for injuries or illnesses that were preexisting at the time of the injury or illness. Both forms require the claimant to provide evidence to support their claim for medical benefits.
Montana Petition for Settlement - Injury/OD, Medical Benefits Reserved (also letter-size)
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How to fill out Montana Petition For Settlement - Injury/OD, Medical Benefits Reserved (also Letter-size)?
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FAQ
When applying for workers' compensation in Montana, timing is important. First, an injured employee must report an accident to their employer within 30 days. Then, Montana law requires employers to file a First Report of Injury (FROI) form within 6 days of being notified by the injured worker.
We recommend reporting the injury online. If you are unable to report online, call us at 800-332-6102 and a Customer Service Specialist will complete the First Report of Injury form with you over the phone.
Montana Workers Compensation Statute of Limitations If you're hurt at work, you usually have 1 year from the date of the injury to file your claim, or 2 years if you weren't aware of the injury or suffered a latent injury.
Is there a waiting period before I receive benefits? A. Section 39-71-736, MCA. Compensation may not be paid for the first 32 hours or 4 days' loss of wages, whichever is less, that the claimant is totally disabled and unable to work because of an injury.
Form ERD-991 First Report of Injury or Occupational Disease (FROI). (click link above) Employees must submit a written and signed First Report of Injury (FROI) within 12 months from the date of their accident or occupational disease. They can submit this form to you, EMPLOYERS or the Department of Labor and Industry.
You may receive weekly compensation of 66 2/3 percent of your wages at the time of injury ? up to the maximum rate (see chart below).
In Montana, work comp may be obtained in three ways: self-insurance, private company, or from Montana State Fund. Work comp is solely funded by premiums paid by employers based on the amount of payroll they pay in the various job categories or class codes. Each class code has a work comp rate associated with it.
Form ERD-991 First Report of Injury or Occupational Disease (FROI). (click link above) Employees must submit a written and signed First Report of Injury (FROI) within 12 months from the date of their accident or occupational disease. They can submit this form to you, EMPLOYERS or the Department of Labor and Industry.