Montana Petition for Settlement LTDTD, Injury/OD Medical Benefits Reserved (also letter-size) is a document used in Montana courts to request a settlement for a worker who has been injured or developed an occupational disease. It is used to initiate a claim for medical benefits paid by Montana's workers' compensation program. The document includes information about the injured worker, as well as the nature of the injury or occupational disease. Depending on the situation, there are two types of Montana Petition for Settlement LTDTD, Injury/OD Medical Benefits Reserved (also letter-size): one for injuries and one for occupational diseases. Both documents have the same basic information, but the occupational disease petition requires additional information related to the disease diagnosis.
Montana Petition for Settlement - PTD, Injury/OD Medical Benefits Reserved (also letter-size)
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FAQ
Established in 1973, Montana's Subsequent Injury Fund assists persons with disabilities to become employed by offering a financial incentive to employers who hire certified workers. To be considered a "person with a disability," an employee must become certified with the Subsequent Injury Fund.
Montana requires every employer to provide their employees with workers' compensation insurance.
The Employer's First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimant's employment and circumstances surrounding the injury or illness are also requested.
The Form 43 is to be completed by the respondent (employer/workers' compensation insurance carrier) to notify the Administrative Law Judge, the claimant (employee/decedent), and all parties to the claim of its intention to deny the compensability of all or part of the claimant's claim to workers' compensation benefits.
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.
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).