Montana Sample Letter for Legal Representation - Worker's Compensation

State:
Multi-State
Control #:
US-0952LTR
Format:
Word; 
Rich Text
Instant download

Description

This form is a sample letter in Word format covering the subject matter of the title of the form.

How to fill out Sample Letter For Legal Representation - Worker's Compensation?

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FAQ

What should you include in an incident report? When & where did it happen? Your report should contain the date, time and location where the accident took place. ... Who were involved? ... What did they do? ... Why did it happen? ... Were there any witnesses? ... What is the extent of damage to a person or property?

Dear [Supervisor Name]: I am respectfully presenting this letter as written notice that I was involved in a work-related accident on [date of incident] at approximately [time of incident]. [I was injured / I became ill] when [give clear details involving the accident, including what led up to it].

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.

Keep in mind that these three considerations are not to be confused with the three requirements for writing an incident report: The report must be factual and without assumption. An incident report must be accurate and without bias. The incident report must be complete.

When & How to Document Workplace Injury Get to the site as quickly as possible. Ensure the area is safe to enter. Make sure the injured/ill person is receiving first-aid or medical attention. Identify any witnesses. Record the scene with photos (ideally with date and time stamp) or sketches. Safeguard any evidence.

A claim for workers' compensation benefits may be submitted by the employee, or by a personal representative if the employee is unable to submit the claim. Accident or injury claims must be submitted to the insurer within 12 months from the date of the accident.

Wage loss benefits under Montana workers' compensation Temporary total disability (TTD). You have a temporary total disability if you're unable to return to the same or similar job for a specific period of time. You'll receive exactly two-thirds (66%) of your gross wages at the time of injury, up to the cap.

Dear [Supervisor Name]: I am respectfully presenting this letter as written notice that I was involved in a work-related accident on [date of incident] at approximately [time of incident]. [I was injured / I became ill] when [give clear details involving the accident, including what led up to it].

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Montana Sample Letter for Legal Representation - Worker's Compensation