Clinical Care in the Montana Workers' Compensation System

Treating physicians in the Montana workers’ compensation system are primarily responsible for the delivery and coordination of the worker’s medical services for the treatment of a compensable injury or occupational disease. Eligible licensed providers are statutorily defined in 39-71-116, MCA, to include physicians, chiropractors, physician assistants, dentists, advanced practice registered nurses, and physical therapists. Per 39-71-1101, MCA, a treating physician, if designated by the insurer, is eligible for additional reimbursement when fulfilling responsibilities as outlined by 39-71-1101, MCA.

There is only one treating physician per claim. If a treating physician requests a consultation from another provider, there is no change in the status of the treating physician. All medical records and recommendations for work restrictions should be provided to the treating physician. If the consulting provider wants to assume care of the injured worker’s medical management, the insurer would need to authorize the change.

Workers’ compensation documentation requires additional information from medical providers to determine compensable benefits and treatment. Providing certain information for a work-related injury at the time of the initial visit ensures that workers receive timely treatment and compensation.

Recommended information gathering during an initial workers’ compensation encounter:

• Detailed account of the injury
• Presenting symptoms with timing of onset (e.g., new or not)
• Prior injuries or underlying conditions relating to the affected area
• Comprehensive assessment of associated symptoms documenting pertinent positives and negatives
• Occupational history (e.g., job tasks, duration of employment)
• Past medical history
• Baseline medications, including preinjury opioids and their indication
• Objective medical findings from a thorough physical examination
• Clear diagnosis, when possible
• Relationship of the presenting symptoms and medical conditions to the injury — document whether each diagnosed condition is or is not related to the work injury or illness. Access the American College of Occupational and Environmental Medicine’s Practice Guideline on Work-Relatedness to learn more about causation assessment.
• Time-limited treatment plan/next steps

In addition to the information noted above, the treating physician is responsible for the following (39-71-1101, MCA).

• Coordinate the worker’s receipt of medical services; and
• Submit medical records and the Medical Status Form to the insurer after each office visit; and
• Provide or arrange for treatment in accordance with the Montana Utilization and Treatment Guidelines or seek prior authorization, when necessary for treatment; and
• Provide timely determination of maximum medical improvement (MMI), physical restrictions, return to work, and approval of job analyses; and
• Conduct or arrange for timely impairment ratings.

Treating physicians may contact the insurer’s claim examiner for clarification on a claim.

The Department of Labor and Industry (DLI) sets the fee schedule for services provided to the injured worker. All workers’ compensation insurers or insurers’ benefit payers are required to use DLI’s schedule. This includes the Montana State Fund, private workers’ compensation insurance carriers, and self-insured employers.

When a treating physician is designated by an insurer on a workers’ compensation claim, the treating physician is paid at 110% of the workers’ compensation fee schedule. When the insurer designates a treating physician, all other medical providers who care for the injured worker will be paid at 90% of the fee schedule. Prior to the insurer’s designation or approval of a treating physician, all services are paid at 100% of DLI’s fee schedule. Many insurers will not designate a treating physician on claims that resolve relatively quickly and, therefore, bills will be paid at 100% of the fee schedule. If a provider feels the injured worker would benefit from the designation of a treating physician on a claim, they may request this of the insurer.

Please see the Montana Work Comp Fee Schedules website for information on reimbursement for services.

Receiving care in the workers’ compensation system can be overwhelming, particularly if it is an individual’s first work-related injury. There are several provider best practices that can enhance the injured workers’ experience in the system.

• Set expectations about recovery and return to work. This should be done early and often. Emphasize the importance and health benefits of work. Medically safe work is good medicine!
• Have a sense of urgency. Provide early and active treatment and ensure patients are frequently monitored in their recovery with close follow-up visits. Keep the claim moving and minimize delays.
• Ask about the nature of the worker’s job and activity at home or in the community. Try to understand the worker’s functional capacity and how it relates to the worker’s job responsibilities. Work is part of the recovery process.
• Focus on ability as opposed to disability. Acknowledge and recognize improvements. Provide positive reinforcement. - Explain and provide the worker with information on the workers’ compensation system (Benefits Brochure).
• Actively listen and answer questions. Promote trust.
• Facilitate medically safe return to work.
• Provide timely and complete documentation. Respond promptly to requests for information. In some cases, the insurer may reimburse providers for the time needed to complete the necessary forms and additional communication. Contact the insurer for additional information.
• Proactively be on the lookout for barriers to recovery including psychosocial factors and address them in a timely manner.
• Be the hub of the claim. As treating physician, you are responsible for managing the care, ensuring coordination and treatment of the injury, and documenting progress including release to work.
• Provide early and active treatment and ensure patients are frequently monitored in their recovery with close follow-up visits.

As the treating physician, your duty is to explore the relationship of the presenting symptoms and underlying medical conditions to the reported injury. Explore the link between what happened at work and the clinical diagnosis. Examine how other factors from the past medical and social histories might contribute to the diagnosis or create barriers to recovery.

Document whether each diagnosed condition is or is not related to the work injury or illness. Access the American College of Occupational and Environmental Medicine’s Practice Guideline on Work-Relatedness to learn more about causation assessment.

Set expectations about recovery and return to work. This should be done early and often. Emphasize the importance and health benefits of work. Medically safe work is good medicine!

Ask about the nature of the worker’s job and activity at home or in the community. Try to understand the worker’s functional capacity and how it relates to the worker’s job responsibilities. Work is part of the recovery process.

When communicating with the patient and completing the Medical Status Form, focus on ability as opposed to disability. Acknowledge and recognize improvements. Provide positive reinforcement.

As noted in 39-71-1036, MCA, the physician or their designee shall complete the form after each visit. DLI offers instructions and three versions of the Medical Status Form on the Medical Status Form website. Only one version of the form should be completed after each visit. The selection of the form version is at the treating physician’s discretion. These forms are also available in Spanish.

Medical providers can program the form to work within their electronic medical record if the name of the form remains the same and all the data fields are included.

All Montana workers’ compensation health care providers shall use the Montana Utilization and Treatment Guidelines when providing treatment.

As noted in the Administrative Rules of Montana (ARM) 24.29.1611, in cases where treatment(s) or procedure(s) are recommended by the Montana Guidelines, and treatment is provided in accordance with the guidelines, prior authorization is unnecessary unless the Montana Guidelines specify otherwise. This is intended to facilitate the timely delivery of treatment and ensure healthcare facilities there is certainty of payment.

For more information on the Montana Utilization & Treatment Guidelines please visit the DLI Utilization and Treatment Guidelines page. Visit Montana Utilization and Treatment Guidelines to access the Guideline content.

If a treatment or procedure is recommended by the Montana Utilization and Treatment Guidelines, and treatment is provided in accordance with the Guidelines, prior authorization is unnecessary unless the Guidelines specify otherwise.

There are certain situations in which prior authorization of treatment is required, as noted in ARM 24.29.1621. Prior authorization must be obtained in cases where the treatment or procedures meets one of the criteria below.

• Treatment or procedures are not specifically addressed or recommended by the Montana Guidelines for a body part that is covered by a guideline or for body parts not covered by the Montana Guidelines.
• Treatment or procedures are recommended after maximum medical improvement.
• Treatment or procedures are beyond the duration and frequency limits set out in the guidelines.
• The guidelines require prior authorization before proceeding with the treatment.

If the claim examiner has denied your recommended treatment, you may request an Independent Medical Review from the Department’s Medical Director. Please see the DLI Independent Medical Review Process page for the applicable form. The Medical Director will review medical records and other information relevant to the denial and issue a nonbinding recommendation based on the provisions of the Montana Utilization and Treatment Guidelines.

Please contact our office at (406) 444-6543 for assistance with the Independent Medical Review Process. If either you or the claim examiner disagree with the Medical Director’s recommendation you may request a non-binding telephonic mediation conference. Please refer to the Dispute Resolution Section for additional information.

As noted in 39-71-116, MCA, the determination of Maximum Medical Improvement (MMI) occurs at a point in the healing process when further material functional improvement would not be reasonably expected from primary medical services. Other synonymous terms you may encounter in the Montana workers’ compensation system include “medical stability,” “maximum healing,” or “maximum medical healing.”

Some patients may require treatment after MMI to maintain their functional state. At the time of an MMI determination, the treating provider should develop a maintenance treatment plan that will allow the injured worker to remain at work, if necessary. This plan should include anticipated future medical or surgical care related to the accepted claim. Please see the Montana Utilization and Treatment Chronic Pain Disorder Guideline, Section I, Maintenance Management, for more information.

As noted in ARM 24.29.1621, prior authorization is required for treatment delivered after the MMI designation.

An impairment rating reflects permanent impairment in patients who have suffered an injury or illness resulting in long-term loss of a body part or reduction of body function.

An impairment rating is purely a medical determination and must be determined by an impairment evaluator after a claimant has reached maximum healing.

The American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment provide a reliable, repeatable measurement framework for rating permanent impairment. Once an individual has reached Maximum Medical Improvement, physicians use the AMA Guides to assess a patient’s impairment and document findings.

In Montana, eligible impairment evaluators use the AMA Guides to the Evaluation of Permanent Impairment, 6th edition (2008), as per 39-71-711, MCA.

As noted in 39-71-704, MCA, workers’ compensation medical benefits terminate 60 months from the date of injury or diagnosis of an occupational disease. A worker may request reopening of medical benefits that were statutorily terminated.

Background information on the reopening process are available in 39-71-717, MCA, Reopening Of Terminated Medical Benefits -- Medical Review.

Interested parties can find the forms to request benefit reopening on the DLI Re-Opening Closed Medical Benefits webpage.

If you are a treating physician within the Montana Workers’ Compensation system and you have questions about the medical content provided here, please email Dr. Maggie Cook-Shimanek.

• DLI Medical Status Form
• DLI Independent Medical Review Process
• DLI Reopening Closed Medical Benefits
• DLI Benefits Brochure

Greaves, W. W., Das, R., McKenzie, J. G., Sinclair II, D. C., & Hegemann, K. T. (2018). Work-Relatedness. Journal of Occuptional and Environmental Medicine. Retrieved March 10, 2026, from https://acoem.org/acoem/media/News-Library/JOEM-Work-relatedness-Dec-2018.pdf

Washington State Department of Labor & Industries. (2026, March 10). Frequently Asked Questions for Providers. Retrieved from https://www.lni.wa.gov/forms-publications/F252-138-000.pdf

Washington State Department of Labor & Industries. (2026, March 10). Initial Visit Checklist for Providers . Retrieved from https://www.lni.wa.gov/forms-publications/F252-137-000.pdf

Washington State Department of Labor & Industries. (2026, March 10). Top Ten Best Practices for Providers. Retrieved from https://www.lni.wa.gov/forms-publications/F252-136-000.pdf