Workers' Comp Claims Category
The Claims Assistance Bureau provides a variety of information sharing, monitoring and regulatory services for the workers' compensation industry and claimants.
The Claim Assistance Unit ensures compliance with workers' compensation and occupational disease laws relating to benefits and claims. Unit staff provide assistance to claimants and insurers by informing them of applicable laws and assisting them in claims processing procedures.
The Data Management Unit ensures compliance with claims reporting standards, maintains the workers' compensation database system and completes a comprehensive annual report on workers' compensation for the Governor and the legislature. In addition, the unit performs research on the workers' compensation system and related topics.
The Workers' Compensation Mediation Unit provides an alternative method of resolving disputed claims prior to involving the Workers' Compensation Court. This mandatory, non-binding mediation is an informal process to provide a solution to claim disputes.
The Medical Regulations Unit now reports to the Bureau Chief of the Workers’ Compensation Claims Assistance Bureau. Among other tasks, the Unit is responsible for publishing updates to the Montana Non-Facility Fee Schedule and the various Facility Fee Schedule components on the Department’s website. The Unit is also responsible for developing, interpreting and implementing the numerous statutes and administrative rules that provide direction on how the fee schedules are administered. The Medical Regulations Unit is also responsible for the implementation and maintenance of the Montana Utilization and Treatment Guidelines and the web-based delivery system designed for and accessible from the Department’s website. We also serve as administrators for the Subsequent Injury Fund (SIF) which was developed to encourage employers to hire and retain injured workers. In general, The Medical Regulations Unit serves as a liaison between the Department and those who have questions or need assistance with issues relating to the medical regulation of workers’ compensation claims in Montana.
If you wish to view the latest codes, go to the Montana Codes Annotated page. To view the Montana Codes for prior years, go to the Montana Legislature site and then select the year needed. The sections you will need to reference are located in Title 39 Labor. They are Chapter 8 - Professional Employer Organizations, Chapter 9 - Contractor Registration, Chapter 71 - Workers' Compensation, Chapter 72 - Occupational Disease, and Chapter 73 - Silicosis Benefits.
The Department of Labor and Industry Administrative Rules are also available for use on the Secretary of State web site and includes these chapters: Chapter 28 Workers' Compensation Mediation; Chapter 29 Workers' Compensation and Occupational Disease; Chapter 33 Contractor Registration and Chapter 35 Independent Contractors.
FROI/SROI Edit Matrix Change -- Social Security Number (DN0042): Effective July 1, 2013, Montana will begin returning a TR (Transaction Rejected) for FROI and SROI submissions with invalid Social Security Numbers (SSN). SSNs will be validated based on Social Security Administration guidelines. Trading Partners will also be notified to provide the correct SSNs for previously reported claims. This link contains the entire Notice. (Posted 4/8/2013)
EDI Testing Procedures: Montana has revised their EDI FROI and SROI testing requirements for established Value Added Networks (VANs). The new requirements can be found in the FROI Reporting and SROI Reporting links. (Posted 3/20/13)
Electronic Data Interchange (EDI) affords insurers and the Employment Relations Division (ERD) a method of exchanging certain information electronically and thereby avoiding multiple entry of data into computer systems. EDI is fast, accurate, reliable and cost effective. Many insurers nationwide use EDI routinely and ERD has worked hard to make this service available for Montana's workers' compensation system.
Insurers who agree to send documents electronically sign a trading partner agreement with ERD. This agreement includes testing the reporting system to determine if the transmission mechanism is acceptable. Insurers must maintain ninety- five percent completeness in the data transmitted and must re-send any data that is incomplete or invalid.
The International Association of Industrial Accident Boards and Commissions (IAIABC) and the Montana Department of Labor and Industry's Employment Relations Division offer education on reporting workers' compensation data electronically (EDI).
Workers' Compensation Claims Assistance Bureau
Data Management Unit
Welcome to the Employment Relations Division’s Electronic Prior Claims (EPC) page. If you have any questions or concerns, please contact Mona at firstname.lastname@example.org.
The 1997 legislature provided the law and funding to build a prior claim history database for use by insurers at risk on a claim. To be considered "at risk" on a claim in Montana, the Insurer must have a First Report of Injury on file at the Employment Relations Division of the Montana Department of Labor and Industry.
This system provides the claimant's name, claimant's identification number, prior claim number, date of injury, body part involved, and name and address of the insurer and claim adjuster on each claim filed. Further details may be found in 39-71-225 MCA.
Insurers who want access to this site may complete the enclosed Access Agreement and send it to us. This agreement provides an opportunity for the Insurer to designate a Montana adjuster or third party administrator to access the site on their behalf. Each time the Insurer changes administrators they will need to notify us so we may provide access to their new administrator.
Workers' Compensation Claims Assistance Bureau
Data Management Unit
The Mediation Unit provides an alternative method of resolving workers' compensation benefit disputes before the dispute goes to the Workers' Compensation Court. This is a mandatory, non-binding process.
What is mediation?
Mediation is used to assist an injured worker and the insurer/employer in resolving a dispute concerning benefits under the Workers' Compensation Act. The mediator is a neutral third person who listens to the concerns of both parties and assists them in resolving the dispute. The conferences are informal; confidential; with no verbatim record kept.
Mediation conferences are held by telephone.
The purpose of mediation is to prevent, when possible, the filing in the workers' compensation court of disputes by injured workers or insurers if a fair and reasonable resolution can be reached at an earlier stage.
What issues qualify for mediation?
In general, any dispute between a claimant and the insurance company concerning benefits under the Workers' Compensation Act qualifies for mediation. However, there are some exceptions to this. If you are in doubt as to whether or not your dispute falls under the jurisdiction of the mediation unit please call the examiner handling your claim or the mediation unit at (406) 444-6534.
Do I need legal representation?
The general purpose of the Workers' Compensation Act is to allow injured workers who wish to proceed without an attorney to do so. The mediation process was created with the intent to avoid a situation where legal counsel is necessary to resolve disputes. However, this is not intended to discourage injured workers from seeking legal counsel if they so choose.
How do I prepare for a mediation conference?
At least one week prior to the mediation conference you should submit copies of any documentation you feel may support your position or assist the mediator in making a recommendation.
During the conference, you and the insurer will be asked to present your positions. Prior to the conference, it may be helpful to write down your concerns and note any information you wish to present during the conference. This will ensure nothing is forgotten.
The conference will be held at the date and time indicated in the NOTICE OF MEDIATION CONFERENCE. You are expected to be available at the phone number listed on the REQUEST FOR MEDIATION CONFERENCE you completed. If your phone number changes or you are unavailable at the time scheduled, it is your responsibility to call the Mediation Unit as soon as possible so other arrangements can be made.
Every effort will be made by the Mediator to help the parties resolve the issue during the conference. If this does not happen, the mediator will issue a written recommendation to all parties within ten working days. Once you receive the recommendation, you have 25 days to advise the Mediator as to whether you agree with the recommendation or not. If the parties cannot resolve the dispute once the recommendation is issued, either party may proceed to the Workers' Compensation Court.
Workers Compensation Claims Assistance Bureau
P.O. Box 1728
Helena, MT 59624-1728
The information in these pamphlets is a summary of the most commonly requested information on workers' compensation wage loss and medical benefits available to covered employees injured on the job. It is not all-inclusive. Select the link for the appropriate year of injury for more information.