Understand when you may be able to reopen your workers’ comp claim in Montana if your injury gets worse after your benefits stop
If you’ve been injured on the job in Montana, workers’ compensation benefits are a critical lifeline for covering medical costs and lost wages. However, some workers find themselves facing new or ongoing medical challenges long after their initial benefits have been terminated.
Fortunately, in Montana, there are specific situations where workers may be able to reopen a workers’ comp claim to address these continued needs.
This article will guide you through the circumstances under which reopening a claim might be possible, the process involved, and what you’ll need to prove to resume your benefits. Whether your condition has worsened, new treatment is required, or your ability to work has been affected, understanding your rights and the steps to take can help you regain access to the support you need.
If you have specific questions about reopening your workers’ comp claim or would like help getting the benefits you deserve, reach out to the experienced Great Falls work injury lawyers at Murphy Law Firm to schedule a free consultation.
Can a workers’ comp case be reopened in Montana?
A workers’ compensation claim in Montana can be reopened under certain circumstances, primarily when there is a significant change in the worker’s medical condition that directly relates to the original workplace injury or occupational disease.
The purpose of reopening is to address medical needs that can help the worker recover further, continue working, or return to work after an initial recovery period.
In Montana, a workers’ comp claim is generally eligible to be reopened if:
- The original work injury is worse. If the worker’s condition deteriorates after the initial resolution of the claim, they may seek to reopen the claim to obtain additional medical treatment or therapies.
- Additional medical treatment is required. Claims can be reopened when ongoing or new medical interventions are deemed necessary to address the worker’s condition and aid in maintaining or regaining their employment.
- The claim was not closed through a settlement or court order. If the claim was closed as part of a settlement agreement, it typically cannot be reopened. In settlement agreements, workers typically waive the right to seek additional benefits in exchange for a lump sum payment. Claims that were resolved through a court order are also generally not eligible for reopening, as these cases are considered legally finalized.
If you believe your condition warrants reopening your claim, it’s important to discuss your situation and next steps with a qualified Montana workers’ compensation attorney.
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How do I reopen a workers’ comp claim in Montana?
To reopen a workers’ compensation claim for additional medical benefits in Montana, you’ll need to take certain steps, which we’ll describe below. Because the amount of time you have to reopen a claim is limited, it’s crucial to begin the process as soon as possible.
Step 1. Determine eligibility
To reopen a claim, you must demonstrate that:
- Your current medical condition is directly related to the original workplace injury or occupational disease.
- Additional medical treatment is necessary to help you return to work or continue working.
Step 2. Submit a petition
To reopen your claim, you must first submit a “Petition To Reopen Closed Medical Benefits” with the Montana Department of Labor and Industry. This petition should include:
- Documentation of the original injury or occupational disease
- An explanation of how your medical condition has changed and why you believe you need further treatment
It’s important to understand that in most cases, you must file this petition within 5 years of your benefits ending or your case cannot be reopened.
Step 3. Provide supporting evidence
You and your attorney will need to gather and submit relevant information to support your petition, such as:
- Medical records detailing the worsening of the condition
- Opinions from treating physicians or specialists explaining the necessity of additional treatment
The burden of proof lies with you, the worker, to show by a preponderance of the evidence that reopening the claim is warranted.
Step 4. Medical review
Next, the petition will be reviewed by a medical review panel or, if both you and the insurer agree, by the department’s medical director. The panel typically includes:
- The department’s medical director
- Two licensed physicians with expertise related to the worker’s condition
The panel evaluates your medical records and the evidence submitted to determine whether reopening the claim is justified.
Please note that if both you and the insurer agree to reopen benefits (through a joint petition), the process skips the medical review panel, and benefits are automatically reopened. The petition can specify how long benefits will remain open.
Step 5. Decision issued
Within 60 days of the petition, the medical review panel or medical director will issue a written decision. If the claim is reopened, the report will specify:
- The scope of medical benefits approved
- How long the benefits will remain open (typically up to 2 years or until you’ve reached maximum medical improvement (MMI) after treatment or surgery)
If benefits are approved for longer than 2 years, periodic reviews are conducted every 2 years to determine whether continued benefits are necessary.
Step 6. Appeal (if necessary)
If either the worker or the insurer disagrees with the decision, they can file an appeal with the Montana Workers’ Compensation Court. The decision from the medical review panel or medical director is presumed correct and can only be overturned with clear and convincing evidence.
Need help reopening a workers’ comp claim in Montana?
If you suffered a work-related injury or illness in Montana that got worse after your benefits stopped and you returned to work, please know that help is available.
With more than 75 years of combined experience, the team at Murphy Law Firm understands the challenges that injured workers face and is here to guide you through every step of the process. From gathering evidence to appealing denied benefits, our knowledgeable Great Falls workers’ compensation attorneys will work tirelessly to ensure you receive the medical treatment you deserve.
Contact Murphy Law Firm today to schedule a free consultation to learn more about how we can help you get the benefits you need to move forward.
References
39-71-704. Payment of medical, hospital, and related services — fee schedules and hospital rates — fee limitation, MCA. (2023). Legmt.gov. https://archive.legmt.gov/bills/mca/title_0390/chapter_0710/part_0070/section_0040/0390-0710-0070-0040.html
39-71-717. Reopening of terminated medical benefits — medical review, MCA. (2023). Legmt.gov. https://archive.legmt.gov/bills/mca/title_0390/chapter_0710/part_0070/section_0170/0390-0710-0070-0170.html
