Update: Reopening of Closed Workers' Compensation Medical Benefits
Effective April 1, 2016 the new administrative rules will be in place as well as the business process for injured workers to begin submitting petitions requesting reopening of their medical benefits that were statutorily closed by MCA 39-71-704(1)(f). This process is only for those dates of injury on or after July 1, 2011.
MCA 39-71-717 allows the reopening of closed medical benefits through a medical review. The Department of Labor and Industry has developed a process for injured workers to petition for reopening of their medical benefits which must keep them at work or return them to work. The insurer must provide medical records as requested by the department.
The link on the right provides access to forms for injured workers and/or their counsel. Insurance adjustors may access information on how to submit medical records. Contact information for questions is provided.
Medical Regulations Unit
The Medical Regulations Unit is the primary liaison for the Department with providers, claims examiners and insurers who have questions, need assistance or require direction on all issues relating to the medical regulation of workers’ compensation claims, including medical fee schedules, utilization and treatment guidelines, and timely payments. The unit maintains and updates medical fee schedules for providers and payers and ensures access through a web based delivery system. The unit has a Medical Director, who is responsible for the maintenance, annual updates, distribution and training of the Montana Utilization and Treatment Guidelines. The Medical Director also performs independent medical reviews for denied services. The unit certifies injured workers for the Subsequent Injury Fund (SIF), applies the fee schedules to medical expenses, makes decisions on requested settlements as needed, manages the SIF fund balance, and authorizes payments for eligible SIF expenses.
Periodically the Department may post clarifications on the medical fee schedules. These can be located once the user has accepted the website usage permissions and logged into the site. See the Montana Facility Fee Schedule for the following clarification:
April 1, 2015: Facility Fee Schedule (outpatient) J1 Status Indicator
Professional Fee Schedule Modifier 59
For further information, please email or phone us at (406) 444-6604.
Work Comp Claims Assistance Bureau
PO Box 8011
Helena, MT 59604-8011