Insurer/Medical Provider Resources



Annual Rate Change Rate ChangeAdoption of the Average Rate for the U.S. 10-Year Treasury Bills, Annual Rate Change
Electronic Prior Claim (EPC) History System Prior Claim (EPC) History SystemThe 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
Historic WC Medical Reimbursement Conversion Factors WC Medical Reimbursement Conversion Factors
Historical Fee Schedule Conversion Factors for 2003-2007 Fee Schedule Conversion Factors for 2003-2007Pursuant to section 39-71-704 (4), MCA, and an administrative rules change to 24.29.1572, and 1582, ARM, on July 1, 2002, the Department adopted the following conversion factors, effective July 1, 2002, for use with the unit
Meals, Lodging and Mileage, Lodging and MileageSection 39-71-704(1) (d), MCA, directs WC Insurers to reimburse workers for reasonable travel expenses pursuant to rates allowed for state employees. When determining the reimbursement, please refer to 39-71-704(1), MCA and ARM 24.29.1409
Third Party Administrator Notification Party Administrator NotificationMontana statute requires insurers to notify the Department of Labor & Industry of any changes of third party administrators with respect to the handling of Montana workers’ compensation claims. The insurer must notify the department in writing 14 days, Third Party Administrator Notification
Workers' Compensation Benefits Summary' Compensation Benefits SummaryThe 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
Workers' Compensation Claim Reporting by Insurers' Compensation Claim Reporting by InsurersAll insurers are to file a complete report of every injury or occupational disease to the department, either on a paper claim form or by electronic means within specified timelines. Electronic reporting is required



Claim Reporting ReportingUsed by an injured worker, empoyer or insurer/adjuster to report an injury or occupational disease, Claim Reporting Forms
Electronic Data Interchange (EDI) Data Interchange (EDI)Used by insurers and adjusters as a quick, efficient method of communicating data to the Department, Electronic Data Interchange (EDI) Forms
Electronic Prior Claims (EPC) Forms Prior Claims (EPC) FormsElectronic Prior Claims (EPC) Forms, Electronic Prior Claims (EPC) Forms
First Report of Injury (FROI) Forms Report of Injury (FROI) FormsUsed by an injured worker to report an injury or occupational disease to his/her employer, First Report of Injury (FROI) Forms
Independent Medical Review Form Medical Review FormThe forms listed below are those commonly used in the Medical Regulation Unit functions of the workers' compensation system, Independent Medical Review Form
Insurers - Third Party Administrators Reporting Forms - Third Party Administrators Reporting FormsUsed to report changes in adjuster, claim administrator, or third party administrators, Insurers - Third Party Administrators Reporting Forms
Medical Status Form Status Form​The REVISED Medical Status Form is now available. Based on feedback from medical providers, the Department determined there was a need to revise the form. The revised form reflects
Petition for Mediation Conference Form for Mediation Conference FormUnder Montana law, parties must attempt to resolve their disputes BEFORE seeking mediation. Mediation is required in most cases before a petition may be filed in the Workers' Compensation Court, Petition for Mediation Conference Form
Petition for Settlement Forms for Settlement Forms​​​The forms listed below are those commonly used in the Claims Assistance Units Functions of the workers' compensation system, Petition for Settlement Forms
Subsequent Injury Fund Injury FundThe department manages the Subsequent Injury Fund, a program designed to assist individuals with disabilities obtain employment, Subsequent Injury Fund



Domiciliary Care CareWhen a worker suffers from a condition that requires 24-hour care and that results from the accident but that requires domiciliary care other than as provided in Title 37, chapter 8, the care
HIPAA and Release of Workers' Compensation Information and Release of Workers' Compensation InformationThe Employment Relations Division of the Department of Labor and Industry released this bulletin effective March 2003
Mediation Guide for Insurers Guide for InsurersThe 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
Medical Regulations RegulationsThe Medical Regulations Unit is responsible for publishing updates to the Montana Professional Fee Schedule and the various Montana Facility Fee Schedule components on the Department’s website
Stay at Work/Return to Work Project at Work/Return to Work ProjectMinimize avoidable disruption caused by work-related injury or occupational disease and assist the injured worker to return as soon as possible to
Workers' Compensation Frequently Asked Questions' Compensation Frequently Asked QuestionsThe following are frequently asked questions and answers, you may also find answers in the Benefits Summary. Nothing on this website is intended as legal advice