First Report of Injury Montana State Fund Form
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People also ask
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Which states have second injury funds?
Alaska, Arizona, Georgia, Louisiana, Massachusetts, New Hampshire, and Nevada are examples of states with active second injury fund statutes with a strong employer knowledge element. -
How do I report an injury to the Montana State Fund?
We recommend reporting the injury online. If you are unable to report online, call us at 800-332-6102 and a Customer Service Specialist will complete the First Report of Injury form with you over the phone. -
What is the subsequent injury fund in Montana?
Established in 1973, Montana's Subsequent Injury Fund assists persons with disabilities to become employed by offering a financial incentive to employers who hire certified workers. To be considered a "person with a disability," an employee must become certified with the Subsequent Injury Fund. -
What is the first report of injury form in Montana?
Form ERD-991 First Report of Injury or Occupational Disease (FROI). (click link above) Employees must submit a written and signed First Report of Injury (FROI) within 12 months from the date of their accident or occupational disease. They can submit this form to you, EMPLOYERS or the Department of Labor and Industry. -
What is form 43 CT WC?
The Form 43 is to be completed by the respondent (employer/workers' compensation insurance carrier) to notify the Administrative Law Judge, the claimant (employee/decedent), and all parties to the claim of its intention to deny the compensability of all or part of the claimant's claim to workers' compensation benefits. -
What must the first report of injury contain?
The Employer's First Report of Injury or Illness provides information on the claimant, employer, insurance carrier and medical practitioner necessary to begin the claims process. Details of the claimant's employment and circumstances surrounding the injury or illness are also requested. -
How do I report an injury to the Montana State Fund?
We recommend reporting the injury online. If you are unable to report online, call us at 800-332-6102 and a Customer Service Specialist will complete the First Report of Injury form with you over the phone. -
Who is responsible for completing the first report of injury forms when treatment for a work related illness or injury is sought?
The employer is required to file an Employer's First Report of Injury or Illness [DWC FORM-001 Rev. 10/05] with the injured worker's insurance carrier, and the injured claimant or the claimant's representative within 8 days after the employee's absence from work or receipt of notice of occupational disease.
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