Claims Kit

Penalties for Late Reporting 39-71-307 (3)

An employer or insurer who refuses or neglects to submit the reports necessary for the proper filing and review of a claim, will be assessed a penalty between $200 and $500 dollars for each offense.

Effective April 14, 2021, the Department’s Legacy Claim Guidance issued March 30, 2020 due to the COVID-19 crisis is no longer in effect.

History - On March 30, 2020 the Department issued a guidance requesting all TPAs and insurers delay adherence to the Drug Formulary requirements for Legacy Claims (ARM 24.29.1607) due to COVID-19 crisis and concerns of healthcare capacity.

Notice of Public Hearing Related to Signatures on Electronically Transmitted Documents

On February 17, 2021, at 10:00 a.m., the Department of Labor and Industry will hold a public hearing via remote conferencing to consider the proposed amendment to ARM 24.29.221. Because there currently exists a state of emergency in Montana due to the public health crisis caused by the novel coronavirus, there will be no in-person hearing. Interested parties may access the remote conferencing platform in the following ways:

Drug Formulary & Legacy Claims-REQUEST

With the COVID-19 emergency, the Department is requesting new guidance be followed in respect to the Drug Formulary requirements for Legacy Claims.Click hereto view the formal request.

Physician Selection 39-71-1101 

Prior to the insurer's designation or approval of a treating physician or a referral to a managed care organization or preferred provider organization,  a worker may choose a person who is listed in 39-71-116(42) for initial treatment. 

Any time after acceptance of liability by an insurer, the insurer may designate or approve a treating physician who agrees to assume the responsibilities of the treating physician. The designated or approved treating physician:

(a) is responsible for coordinating the worker's receipt of medical services as provided in 39-71-704;

(b) will provide timely determinations required under this chapter, including but not limited to maximum medical healing, physical restrictions, return to work, and approval of job analyses, and will provide documentation;

(c) will provide or arrange for treatment within the utilization and treatment guidelines or obtain prior approval for other treatment; and

(d) will conduct or arrange for timely impairment ratings.

The treating physician may refer the worker to other health care providers for medical services, as provided in 39-71-704, for the treatment of a worker's compensable injury or occupational disease. A health care provider to whom the worker is referred by the designated treating physician is not responsible for coordinating care or providing determinations as required of the treating physician.

Reporting of Claim by Employer 39-71-307, Rule 24.29.801

Montana law requires employers to complete this form within six days after notice of every on-the-job accident, injury and/or occupational disease (OD) by a worker. 

An employer must submit to the workers' compensation insurer or, if self-insured, to the department, the First Report of  Injury or Occupational Disease DLI-ERD_WCC040/ERD-991 within 6 days after notice of an accident, injury or occupational disease.

Posting Requirements 39-71-401  (6)

Each employer must post a sign in the workplace at the locations where notices to employees are normally posted, informing employees about the employer's current provision of workers' compensation insurance. A workplace is any location where an employee performs any work-related act in the course of employment, regardless of whether the location is temporary or permanent, and includes the place of business or property of a third person while the employer has access to or control over the place of business or property. The sign must be provided by the department, distributed through insurers or directly by the department, and posted by employers in accordance with rules adopted by the department. An employer who purposely or knowingly fails to post a sign as provided in this subsection is subject to a $50 fine for each citation.