In 2011, sweeping changes were adopted for Montana Workers’ Compensation in 39-71-704 MCA including adoption of fee schedules, U&T Guidelines, Medical Status Form and the 60-month termination of medical benefits. This closure applies to claims with a date of injury on or after July 1, 2011.
Only the injured worker or their legal representative is eligible to complete this form and the purpose of the form is to:
The purpose of this form is to:
INSURANCE ADJUSTORS: May submit medical records to Maximus through the MOVEit XChange Secure File Transfer at http://edi.maximus.com or can fax at 585-869-3344.
The reopening of medical benefits DOES NOT apply to:
Program Manager
