Figuring out your Montana workers’ compensation benefits doesn’t have to be difficult
Montana workers' compensation insurance exists to provide benefits to employees hurt on the job. The law provides for three main types of benefits: medical costs, wage loss, and death benefits.
The Montana Department of Labor & Industry (L&I) regulates and manages workers' compensation benefits. Your employer's workers' comp insurance is through a private, state-approved carrier but Montana L&I will intervene when there are claim disputes, unpaid benefits, settlement approval, and mediation if you and the insurer can't agree on what benefits you need.
Montana workers' compensation medical treatment costs
If you were hurt in an accident, or if your work caused a condition that developed over time, you're entitled to receive benefits to cover the cost of treatment of that injury or condition.
The first step is to seek a diagnosis.
This is usually faster if the injury is from a specific accident or event — the workers' compensation system allows you to seek any emergency medical care you need and you can get a diagnosis from the doctor of your choice, including your primary care physician. Once you have a diagnosis, you can either use a provider approved by L&I or obtain approval to continue treatment with your own doctor.
Once there's a treatment plan, you have a better understanding of what your medical care will cost. If you've already received medical services, you can calculate what costs have already been accrued.
Medical costs covered under Montana's workers' compensation law include:
- Doctor and hospital visits
- Ambulance transportation
- Surgical procedures and followup appointments
- Diagnostics (MRI, CT scan, X-ray, ultrasound, bloodwork, etc.)
- Prescription medication
- Physical or occupational therapy
- Physical rehabilitation
- Medical devices like an oxygen tank or hearing aid
- Adaptive equipment like wheelchairs, braces, walkers, etc.
- Home adaptations like ramps, widened doorways, and other required physical changes
- Any other required items or services necessary for medical treatment
- Date of appointment, treatment, or purchase
- Provider's name
- Type of service (surgical procedure, diagnostic test, office visit, etc.)
- Amount billed (including what was paid by either workers' compensation or your own health insurance)
- Amount paid, by whom (include amounts you paid as copays or out-of-pocket expenses and insurance payments), and date
- Amount owed
Maintaining a log of this information along with copies of all receipts will be helpful in establishing the amount of benefits you can receive.
Download our free Damages/Expenses Worksheet to get started.
Wage loss benefits under Montana workers' compensation
If your injury requires you to be out of work for a long period of time, or if it permanently changes the nature of work that you can perform, you're entitled to wage loss benefits under Montana workers' compensation. The nature and severity of injury will determine if and when you can return to work, and it will be included within one of the following categories:
Temporary disability benefits
The maximum benefit for temporary total and partial disability payments is currently $793 per week.
- Temporary total disability (TTD). You have a temporary total disability if you're unable to return to the same or similar job for a specific period of time. You'll receive exactly two-thirds (66%) of your gross wages at the time of injury, up to the cap. If you also receive Social Security disability benefits from the injury, the workers' compensation benefit could be reduced by up to half that amount.
- Temporary partial disability. You might be able to continue to work as you recover, but in a limited capacity or for a job that pays less than what you earned prior to the injury. If that's the case, then your benefits would cover the difference between your pre- and post-injury wages, but not exceed the temporary total disability rate.
Permanent disability benefits
After completing treatment for your injury, your doctor can determine that you've reached maximum medical improvement (MMI). In other words, you've recovered to the extent expected.
- Permanent partial disability benefits. At that time, you'll also get an impairment rating, which means that the doctor will assign a percentage to the amount of lost function. If you're only experiencing minor impairment, you'd receive permanent partial disability benefits to cover lost wages. If you have a severe impairment, you can receive benefits even if you haven't lost wages.
- Permanent total disability benefits. When you're determined to have reached MMI, if you still have serious injuries and cannot do any work, you'll receive permanent total disability (PTD) benefits. This equals exactly two-thirds (66%) of your gross wages up to the state maximum ($793) and continues until you reach Social Security retirement age.
After 104 weeks of benefits, you can also get annual cost of living increases of 3.25%.
Montana workers' compensation death benefits
If you've lost a family member in a work-related accident or illness, you're eligible for survivor's benefits for up to 500 weeks. To qualify as a survivor, you must be a spouse, child, or other dependent who relied on the worker for financial support.
Who qualifies as a survivor?
- A spouse who was living with the deceased worker or who was legally entitled to support from that person
- Unmarried children under age 18 (or under the age of 22 if they're a full-time student)
- A physically or mentally incapacitated child who was the worker's dependent at the time of the death
- A parent or sibling who qualified as a dependent at the time of the fatal injury
How much are death benefits?
The total amount paid to all dependents is up to two-thirds (66%) of the worker's average weekly wage. This has the same $793 per week maximum as disability payments. Here's how these benefits are dispersed among different surviving family members:
- If there is a spouse and no children, the spouse would receive the full 66% of the wage.
- If there are children but no spouse, they would share 66%.
- If there's a spouse and children, the spouse would receive the full 66% for their benefit plus the children.
- If there is no spouse or child, a dependent parent can receive an amount that is determined by how much the parent was relying on the deceased worker for support.
- If there is no spouse, children, or parents, a dependent sibling under 18 years old could qualify for death benefits depending how much the sibling relied on the deceased worker for support.
- If there are no dependents, the worker's nondependent parents would receive a lump sum of $3,000.
Montana workers' compensation also pays for burial costs up to $4,000.
Obtaining benefits under Montana workers' compensation
If you have questions about the workers' compensation claims process, or you feel that the benefits you're given aren't covering all of what you need, consider talking to a Montana injury lawyer. An experienced attorney can help guide you through the process, mediate disputes or handle negotiations on your behalf, and help you get what you deserve.