Montana's system of workers' compensation is compulsory, meaning that employers are required to provide workers' compensation insurance to their employees. Workers' compensation insurance may be provided through private insurance carriers, a competitive state fund, or self-insurance. Waivers are not permitted.
Exemptions from coverage may apply to certain employees, including agricultural employees, domestic employees, casual workers and professional athletes.
Medical Benefits are provided to employees entitled to workers' compensation benefits, including coverage for necessary medical care, with restrictions on palliative care. After an initial emergency room visit, injured workers must pay a copayment for additional visits unless requested by the insurer. Medical benefits terminate if not used over a period of sixty consecutive months.
The employee can choose an initial treating physician, but once the insurer accepts liability for the claim the insurer may transfer care to a designated physician. The employee may change doctors with the consent of the employer or workers' compensation insurer.
Indemnity benefits are payable to injured workers to help make up for lost income. There is a waiting period of the lesser of thirty-two work hours or four days before a worker is eligible for indemnity benefits, but if the worker's disability lasts more than 21 days indemnity benefits become retroactive to the date of the injury.
Benefits available to injured workers include the following:
Temporary Total Disability (TTD)
Temporary total disability (TTD) benefits are paid to workers who are unable to work due to injury, but who are expected to make full or partial recovery such that they may return to work. Benefits are based upon 2/3 of the injured worker's pre-injury wages, subject to a cap, and may continue for the duration of the temporary disability. Offsets may apply for Social Security disability benefits.
Permanent Total Disability (PTD)
When a worker is not expected to recover from a total disability caused by a work-related injury, and as a result suffers a total loss of earning capacity, the worker becomes eligible for permanent total disability (PTD) benefits. In Montana PTD benefits are calculated based upon 2/3 of the injured worker's pre-injury wage, subject to a cap, and may continue until retirement. After two years, benefits are periodically adjusted for inflation. Offsets may apply for Social Security disability benefits.
Permanent Partial Disability (PPD)
Once an injured worker has recovered to the maximum possible extent, the worker may be able to return to employment but nonetheless remain partially disabled, and may potentially qualify for permanent partial disability (PPD) benefits. In Montana PPD benefits are available to workers who have suffered a whole person impairment rating greater than zero, who have experienced a wage loss, and to injured workers who have a Class 2 or greater impairment rating converted to a whole person rating without regard to wage loss. Benefits are calculated based upon 2/3 of worker's pre-injury wage, and are payable for a maximum of 400 weeks.
Temporary Partial Disability (TPD)
When a worker suffers an injury that limits his ability to return to work, resulting in a reduction of income as a result of reduced hours or wages, the injured worker may be eligible to receive a benefit based on the difference between the worker's pre-injury earnings and their reduced, post-injury earnings. In Montana, TPD benefits are paid based upon the difference between the injured worker's pre-injury and post-injury wage, based upon a maximum 40 hour work week, subject to a cap.
Coverage may be available for cumulative trauma, disfigurement, and occupational hearing loss.
When a worker dies as the result of a work-related injury, workers' compensation pays additional benefits, including a burial allowance, and benefits for a surviving spouse and dependents. Survivor benefits are calculated based on 2/3 of the worker's average weekly wage, subject to a cap in amount and duration. Benefits may continue for minors until the age of 18, the age of 22 if the dependent is a student, or indefinitely in the event of disability. Spousal benefits end upon remarriage.
If a deceased worker has no dependents, a lump sum benefit is paid to the worker's parents.
Attorney fees are limited to 20% of any recovery obtained through the lawyer's efforts, or 25% of a recovery obtained through litigation. Attorney fees are subject to review by the Employment Relations Division.
This article provides a quick overview of the benefits available to injured workers, but the full formulas used for assessment of benefits, coordination of different types of benefits, and assessment of injuries and disability ratings can quickly complicate the determination of benefits. Also, states frequently revise their workers' compensation laws. Most workers who suffer a significant injury or wage loss as the result of a workplace injury will benefit from consulting a workers' compensation lawyer.
The state agency responsible for workers' compensation is:
Montana Department of Labor and Industry
Employment Relations Division
Workers' Compensation Claims Assistance Bureau
1805 Prospect Avenue
P. O. Box 8011
Helena, MT 59604-8011