Frequently Asked Questions About Personal Injury and Workers’ Compensation
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Can I be retrained for other work?
Yes, you may be eligible for vocational benefits under Section 39-71-1003, MCA. Under Montana law, an injured worker may be eligible for up to 104 weeks of TTD benefits as well as payment of in-state tuition at one of the state’s universities or vocational programs.
In addition, the workers compensation insurance carrier may be required to pay for books and moving expenses. An injured worker must make this request within 78 weeks after reaching Maximum Medical Improvement.
What can I do if my employer does not have Workers Compensation insurance?
If your employer does not have Workers Compensation insurance, you are entitled to receive workers compensation benefits through the Uninsured Employer’s Fund (UEF).
You are entitled to the same benefits as other workers whose employers have Workers Compensation insurance. However, because your employer broke the law and did not provide you with mandatory coverage, you may bring a separate civil lawsuit, separate from your claim with the UEF.
If I am not a U.S. citizen, can I still apply for workers' compensation benefits?
Yes, you are still eligible for Workers Compensation benefits, even if you are here in this country illegally. Our office has represented a number of undocumented workers who were eligible for workers' compensation benefits.
How long can I receive medical benefits?
A claimant can only obtain medical benefits for a period of 60 months after the date of the injury or diagnosis. This limitation is set out under Section 39-71-704(f), MCA. This 60-month limitation can be waived by the Department of Labor and Industry and does not apply if the injured worker is permanently totally disabled. A claimant who is permanently totally disabled will continue to receive medical benefits as long as he or she is considered permanently totally disabled.
What do I do if I cannot return to the same type of work I was doing when I was injured?
Injured workers in Montana may be eligible for Permanent Partial Disability (PPD) benefits under Section 39-71-703, MCA and vocational benefits under Section 39-71-1003, MCA. There are certain criteria that must be met before the claimant is eligible for benefits under these statutes. To be eligible for benefits under Section 39-71-703, MCA, an injured worker must show that he or she is unable to return to the time of injury job and has realized an actual wage loss, and suffered an injury qualifying for an impairment rating. An injured worker who meets these criteria will be eligible for either wage loss compensation of less than $2 per hour or wage loss compensation greater than $2 per hour. Once these criteria are determined, a claimant’s entitlement to compensation can be figured using a formula which considers the impairment rating, amount of wage loss, and lifting restrictions. These benefits can be paid out on a bi-weekly basis or in a lump sum.
My workers comp claim has been denied, what do I do? Do I have to hire a lawyer?
If your claim has been denied, you can appeal the insurance carrier’s decision to the Montana Department of Labor and Industry (DLI). Under Montana law, the DLI has jurisdiction over workers compensation disputes until a mediator from the DLI has rendered his or her recommendation.
A claim cannot be filed with the Workers Compensation Court until this process has been completed. You do not have to have a lawyer to complete the mediation process. The mediator’s recommendation is not binding and merely begins the process of a worker’s compensation claim.
What compensation do I receive if I cannot work?
If you have been injured at work and are unable to return to work, you are likely entitled to Temporary Total Disability (TTD) benefits under Section 39-71-701, MCA. TTD benefits are calculated by taking the workers four previous pay periods and determining the Average Weekly Wage (AWW). Once the AWW is determined, the TTD rate is calculated multiplying the AWW by 2/3. Tax deductions are not withheld from the TTD funds received by the injured employee. These benefits are paid on a bi-weekly basis.
How do my medical bills get paid?
If your claim has been accepted, or accepted on a conditional basis under Section 39-71-615, MCA, your medical benefits will be paid by the workers compensation insurance carrier. You will be provided a workers compensation claim number which you can provide to the health care provider. The provider will pay the provider directly.
How much time do I have to file a workers' compensation claim?
It depends. Montana law distinguishes between an industrial injury and an occupational disease. An industrial injury is defined as an incident that occurs during a single work shift. In contrast, an occupational disease occurs over more than one work shift. A claimant has different deadlines depending upon whether the injury occurred over a single work shift or more than one work shift. If you have suffered an injury that occurred during a single shift it is an industrial injury and the deadline for reporting the injury is under Section 39-71-603, MCA Under Section 39-71-603, MCA, a claimant must notify his or her employer of a workplace injury within 30 days of the incident.
Under 39-71-601, MCA, a claimant must file a written claim with either the Department of Labor and Industry, the employer, or the insurer within 12 months of the incident. This time limit is extended to 24 months if the claimant can establish lack of knowledge of disability, latent injury; or equitable estoppel.
If your injuries occurred over more than a single shift, you have suffered an occupational disease. As such, the 30-day reporting period does not apply.
Does my health insurance play a role in paying my medical bills?
Yes, your health insurance plays a vital role in your automobile insurance claim. How you pay medical bills impacts whether there will be enough money for you and your family to achieve stable financial footing following an automobile crash. Your health insurance, Medicare, or Medicaid cards must be presented to all your health care providers. For reasons explained below, your health care providers will likely object to billing anyone other than your automobile insurance carrier. However, you have only a specific amount of insurance coverage to pay your bills, and your health insurance is a necessary tool for getting your family’s financial situation on track. You must insist that your health insurance carrier accepts your health insurance, Medicare, or Medicare.
Health care providers in the United States use an incredibly complicated method for billing patients. Health care providers NEVER expect to be paid the full amount they bill. Instead, they have agreements with health insurance carriers, Medicare, and Medicaid to accept payment for a fraction of the amount they bill. In contrast, a person paying cash or using automobile insurance for payment is billed an amount sometimes two and three times higher than the amount the health care provider will accept from Medicare, Medicaid, or a health insurance carrier. If you allow a health care provider to receive money directly from your or the negligent driver’s automobile insurance policies, you are losing money that is rightfully yours to keep.