The Montana Petition for Settlement — Injury/OD, Medical Closed on an Accepted Claim (also letter-size) is a form used by individuals who have sustained an injury or occupational disease that has been accepted for workers’ compensation in the state of Montana. The form is used to petition for payment of medical bills or other expenses that have been incurred as a result of the injury or occupational disease. The form asks for information such as the name and address of the petitioner, the date of injury, the type of injury, details of the medical treatment, and any other expenses that the petitioner has incurred as a result of the injury. The form must be signed by the petitioner and mailed or hand-delivered to the Montana State Fund. There are two types of Montana Petition for Settlement — Injury/OD, Medical Closed on an Accepted Claim (also letter-size): the Original Petition and the Supplemental Petition. The Original Petition is used when filing the initial claim or when making changes to the original claim, such as adding additional medical bills or expenses. The Supplemental Petition is used when additional medical bills or expenses have been incurred after the initial claim has been accepted.
Montana Petition for Settlement - Injury/OD, Medical Closed on an Accepted Claim (also letter-size)
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FAQ
Permanent Total Disability Benefits (PTD) Generally, total disability benefits pay two-thirds of the average weekly wages you earned before your accident. Partial disability benefits cover two-thirds of the difference between the wages you earned before your injury and what you earn after your 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.
How much are Montana death benefits? In Montana, death benefits are paid based on a percentage of the deceased worker's average weekly wage, and not exceeding 66.67% (66 and ?%)of the worker's average weekly wage (this is the total amount, which is then divided between dependents).
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.
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.
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).
Exempt Employments The most common employments that are exempt are: Sole proprietors, working members of a partnership, working members of a limited liability partnership and working members of a member-managed limited liability.