Re-opening of Workers’ Compensation Closed Medical Benefits

In 2011 sweeping changes were adopted for Montana Workers’ Compensation in Montana Code Annotated 39-71-704 including adoption of fee schedules, U&T guidelines, Medical Status Form and the 60 month termination of medical benefits.

39-71-704. Payment of medical, hospital, and related services -- fee schedules and hospital rates -- fee limitation

(f) (i) The benefits provided for in this section terminate 60 months from the date of injury or diagnosis of an occupational disease. A worker may request reopening of medical benefits that were terminated under this subsection (1)(f) as provided in 39-71-717.

In addition the statute 39-71-717 allows for the reopening of the terminated medical benefits and has charged the Department of Labor & Industry to develop the process to handle the reopening of the terminated medical benefits.

39-71-717. Reopening of terminated medical benefits -- medical review

(1) A petition to reopen medical benefits that terminate under 39-71-704(1)(f) must be reviewed as provided in this section.

(2) Medical benefits may be reopened only if the worker's medical condition is a direct result of the compensable injury or occupational disease and requires medical treatment in order to allow the worker to continue to work or return to work.

39-71-717 specifically outlines exceptions to reopening.

The reopening of medical benefits DOES NOT apply to:

  • Medical benefits that are closed by settlement or court order, or
  • Permanent total disability, or
  • Those with a prosthesis.

Administrative Rules Unofficially

24.29.3101, 24.29.3103, 24.29.3107, 24.29.3111, 24.29.3114, 24.29.3117, 24.29.3124, 24.29.3127

INJURED WORKERS: May petition to re-open closed medical benefits by using:

 
Petition to Reopen Closed Medical Benefits

Only the injured worker or their legal representative is eligible to complete this form.

The purpose of this form is to:

  1. Allow the injured worker the opportunity to reopen medical benefits which could allow him/her to stay at work or return to work.
  2. Obtain the necessary information for the Department to review the request and when appropriate approve the petition.


Or


Joint Agreement and Petition to Reopen Closed Medical Benefits

The purpose of this form is to:

  1. Facilitate a fast and easy way for medical benefits to be reopened that both the injured worker and the insurer agree to and will help the injured worker stay at work or return the injured worker to work.
  2. Obtain the necessary information for the Department to review the request and when appropriate approve the petition.

For any questions or for submitting any supporting documentation to DLI:

 

INSURANCE ADJUSTORS: May submitted medical records to Maximus through the MOVEit XChange Secure File Transfer at http://edi.maximus.com or can fax at 585-869-3344. Any questions or to request training in person can be arranged by e-mailing your request to DLIERDReopenWCMedBenefits@mt.gov or calling 406-444-6543.