Claim Resources

Claims Reporting

Early Reporting of Injuries is very important to managing workers compensation costs. Do not wait! Early claim reporting is an area that our member districts have direct control over.  A delay in claim reporting and claim management has a significant impact on the cost of a claim.  An employer is required to report to their insurer within 6 days of notification or knowledge of a work related accident or injury.

Timely communication between all employees of a school district creates positive outcomes in many areas. The claims process including the workers’ compensation laws, the process for filing a claim, and the general expectations of employees and district management are explained upfront by our self-insured pool. Don’t wait to report an incident to your supervisor and in turn to our insurance program. Starting the communication process early keeps all parties focused on helping our insured employees in Montana’s public schools.

Direct any questions you may have about the claim reporting process to your school district administration office or MTSBA Insurance Services at 1-877-667-7392.We are here to help.

Timely Reporting

The timelines for reporting a claim are set by statute in the Montana Workers’ Compensation Act (WCA). For an injury, there are a couple of claim reporting standards for self-insured pool members to be aware of:

1)  Notice to the Employer – for a claim to be compensable under the workers’ compensation act for an injury an employee shall provide notice of the injury to their employer within 30 days of the accident occurring. MCA 39- 71-603.

2)  Immediate Notice to the Self-Insured Pool – the WCRRP member agreement in section 7 part 3 requires immediate notice to be provided on the prescribed forms of any accident and reported claim for any benefits whatsoever payable under the Workers' Compensation and Occupational Disease Acts.

3)  Proper Claim Filing – a written claim must be completed and signed by the claimant or their representative and presented to the employer, the insurer, or the Department of Labor within 12 months of the date of the accident. MCA 39-71-601.

Occupational disease claims are a little different. The employee has up to 1 year to file a written claim for occupational disease benefits from the date they “knew or should have known” that they had such a condition. The Courts have generally held that this is the date they were diagnosed with a work related disease.

Checklist for Reporting a Claim

Did you give the employer the Workers' compensation First Report of Injury (FROI)?

Did you explain items to them and sit with them while it was filled out?

Has the employer and the employee signed the form?

Was the report turned in to the administration office to be faxed and/or mailed to the insurer (the report must be sent to the insurer no later than 6 calendar days from the date of the incident)?

Did you investigate the incident?

Did you go to the scene of the incident?

Did you speak with the witnesses?

Has the root cause of the incident been identified?

Is training (more training) needed?

Has a plan been identified to prevent a similar incident from occurring?

Is maintenance required?

Have you identified who is responsible for corrective action?

Has this person been notified that they are responsible for corrective action? 

Has a target date for completion been identified?

Have the results of the investigation been passed to the proper people/committee?

Has the employee been given the Workers' Compensation Benefit Summary brochure?

Has the employee been informed of what to expect in this process?

   - Employee will hear from the claims examiner either in writing or by phone.

   - Employee will receive information from the examiner and should contact the examiner with any questions regarding this information.