Montana work comp laws are set forth in the Workers’ Compensation Act (often called “The Act”). The Act is considered the grand bargain, or “quid pro quo,” between Montana employers and workers. Under Montana work comp, qualifying injured workers are afforded benefits regardless of fault, and employers are free from direct liability but must provide workers’ compensation insurance. Injured workers give up their right to a jury trial and full damages, in exchange for no-fault, albeit limited, coverage. What follows is a general Montana work comp overview.
#1 – Montana Work Comp Laws
The Montana’s Work Comp Act is found in the Montana Code Annotated, Title 39, Chapter 71. The Act is statutory, meaning written into the Montana statutes, and then interpreted by the Workers’ Compensation Court. The Act is authored by the Legislature and is under constant legislative scrutiny. Employers and insurance companies have substantial lobbying influence, and with few exceptions, nearly all proposed or enacted new legislation is employer-friendly, taking benefits aways from injured workers. Injured workers, though numerous, do not have the resources or cohesion to influence legislation and are typically trampled over at the legislative level. Oftentimes the only way to fight back for injured workers is through the claims process and the Workers’ Compensation Court.
#2 – Montana Work Comp Claim Filing
If you are injured, the first step is to file a claim by completing a form called First Report of Injury (FROI). To file a Montana Work Comp claim, the FROI must then be sent to the Employer’s insurance company, or the Department of Labor and Industry. Employer’s insurer can be found online, or contact the Department of Labor directly for more accurate information. You can also provide the FROI to the employer, who is required to file it, but in our experience this is not a good method of filing. Employer’s often fail to timely file the claim and there is little to no enforcement of the employer’s legal obligation to file.
#3 – Montana Work Comp Medical Benefits
The Montana work comp medical benefit structure is far too complex to discuss in detail, but generally, injured workers receive reasonable primary medical services. Medical benefits are set forth in MCA 39-71-704. Reasonable primary medical services are defined as “treatment prescribed by the treating physician, for conditions resulting from the injury or occupational disease, necessary for achieving medical stability.” MCA 39-71-116. Medical expenses must be reasonable and sometimes require pre-authorization from the insurer. Once you reach medical stability, the rules change and you may run into difficulty getting some treatment approved. The Act also provides for impairment benefits, vocational benefits, and domiciliary benefits, but they are all limited, with many loopholes.
There are many recent pro-insurer changes to the medical benefit structure too numerous to discuss. A few recent changes include:
- Limiting medical benefits to 5 years from the date of the injury, for most claims;
- Denying “Class 1” impairment, without wage loss;
- Allowing insurance companies to hand-pick the doctor.
Contact us if you run into an issue with your medical benefits.
#4 – Montana Work Comp Wage Loss Benefits
If you miss work because of a work injury, you are entitled to wage loss benefits. Montana work comp wage loss benefits are limited to 2/3 of your average weekly wages, and there is a cap for higher wage earners.
There are categories of wage loss benefits depending on the degree of disability, and the stage of your disability. Initially, an injured worker who cannot work during the treatment and recovery phase is entitled to temporary total disability benefits (TTD). TTD benefits are paid at 2/3 of your average weekly wages, and capped at the state’s average weekly wage. TTD benefit law is found at MCA 39-71-701. A recovering worker who is working through recovery, but part-time, may be entitled to temporary partial disability (TPD). MCA 39-71-712.
Once an injured worker recovers to a point of medical stability – in common terms, “as good as you’re going to get” – a determination is made. Either a worker can: 1) go back to work without a wage loss; 2) go back to work but with a permanent wage loss; or, 3) is totally unable to work.
1 – A worker who can return to work without wage loss is not entitled to permanent wage loss benefits, but may receive an impairment award depending on the extent of impairment. MCA 39-71-703(2).
2 – A worker who can return to work but suffers a permanent decrease in wages is entitled to permanent partial disability benefits (PPD). PPD is capped at half the state’s average weekly wage, and paid based on a percentage formula of 400 weeks. PPD benefits are set forth in MCA 39-71-703.
3 – A worker who is totally unable to work receive permanent total disability benefits (PTD). PTD benefits are paid at a rate of 2/3 of your average weekly wages, capped at the state’s average weekly wage. PTD benefits are paid until a worker is considered retired, defined as receipt or eligibility to receive social security retirement benefits. PTD benefits are set forth in MCA 39-71-702.
There are many more specific aspects of each wage loss benefits. Wage loss benefits are the source of countless disputes and if you have any issue with wage loss benefits you should contact a lawyer immediately.
#5 – Montana Work Comp Settlement
One of the most common questions I get is regarding Montana work comp settlements. When to settle, and the amount of settlement, are critical determinations. You should strongly consider contacting a lawyer before deciding to settle a workers’ compensation claim. I rarely review settlement offers from unrepresented claimants, without seeing a way that I could increase the amount. You should also be very careful about deciding to settle, because it may have unforeseen consequences.
Settlements require approval from either the Employment Relations Division, or the Montana Workers’ Compensation Court. Settlements can take many forms, including reserving medical benefits, settling all benefits, and some in between. Montana work comp settlements are far too complex and case specific to discuss here, but PLEASE contact a lawyer before agreeing to any settlement. We can likely get you more money, or advise against making a costly decision.
At Duckworth Law we fight back against insurance companies, and fight daily for the injured workers we represent. The Montana work comp Act is complex, and an experienced attorney is essential to make sure you receive the benefits you deserve. Insurers and employers will discourage injured workers from hiring lawyers, which only makes it easier for them to perpetuate the ongoing efforts to reduce benefits.
Fight back. Every case and claim is different, and if you have any questions about your claim, contact our firm.