Montana Code 39-71-1042. Request for and delivery of stay-at-work/return-to-work assistance
39-71-1042. Request for and delivery of stay-at-work/return-to-work assistance. (1) (a) A worker who is claiming an injury or occupational disease, an employer, or a medical provider may ask that the department furnish stay-at-work/return-to-work assistance. After the worker signs a claim for benefits, the department shall promptly attempt to determine which insurer is at risk for the injury or occupational disease and contact that insurer. The department shall advise the insurer of the request for stay-at-work/return-to-work assistance and shall coordinate the assistance with the insurer.
Terms Used In Montana Code 39-71-1042
- assistance: means the evaluation, planning, implementation, and provision of appropriate services prior to the determination that the worker meets the definition of a disabled worker that are designed to facilitate a worker's return to work as soon as possible following the worker's injury or occupational disease. See Montana Code 39-71-1011
- Assistance fund: means the stay-at-work/return-to-work assistance fund provided for in 39-71-1049. See Montana Code 39-71-1011
- assistance policy: means a written stay-at-work/return-to-work policy that explains to the worker the process of evaluation, planning, implementation, and provision of services by the insurer prior to the determination that the worker meets the definition of a disabled worker. See Montana Code 39-71-1011
- Disabled worker: means a worker who has a permanent impairment, established by objective medical findings, resulting from a work-related injury that precludes the worker from returning to the job the worker held at the time of the injury or to a job with similar physical requirements and who has an actual wage loss as a result of the injury. See Montana Code 39-71-1011
- Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
- Rehabilitation provider: means a rehabilitation counselor certified by the commission on rehabilitation counselor certification and designated by the insurer. See Montana Code 39-71-1011
- Rehabilitation services: means a program of evaluation, planning, and implementation of a rehabilitation plan to assist a disabled worker to return to work. See Montana Code 39-71-1011
- worker: means :
(a)each person in this state, including a contractor other than an independent contractor, who is in the service of an employer, as defined by 39-71-117, under any appointment or contract of hire, expressed or implied, oral or written. See Montana Code 39-71-118
- Writing: includes printing. See Montana Code 1-1-203
(b)If an insurer has accepted liability for the claim, the insurer shall provide stay-at-work/return-to-work assistance either in accordance with the insurer’s stay-at-work/return-to-work assistance policy or by designating a rehabilitation provider to provide rehabilitation services. The insurer is directly liable for paying for the stay-at-work/return-to-work assistance furnished.
(c)If an insurer at risk has not accepted liability for the claim, the insurer may choose one of the following actions:
(i)The insurer at risk for the claim may initiate stay-at-work/return-to-work assistance either in accordance with the insurer’s stay-at-work/return-to-work assistance policy or by designating a rehabilitation provider to provide rehabilitation services and shall notify the department within 3 business days of being contacted by the department that the insurer is acting under this subsection (1)(c)(i). If the insurer provides either type of assistance, the insurer becomes responsible for directly paying for the assistance. Payment of assistance pursuant to this subsection (1)(c)(i) does not constitute admission of liability or a waiver of any right of defense.
(ii)If the insurer at risk for the claim does not notify the department within 3 business days of being contacted by the department that the insurer will provide assistance, the department shall obtain stay-at-work/return-to-work assistance for the worker by designating a rehabilitation provider.
(d)If the department cannot promptly determine which insurer is at risk for coverage, the department shall obtain stay-at-work/return-to-work assistance for the worker by designating a rehabilitation provider.
(e)A rehabilitation provider designated by the department under this section shall bill the department for services provided. The department shall pay for the stay-at-work/return-to-work assistance out of the assistance fund until the maximum allowed amount of assistance is provided or until the insurer denies the claim and notifies the department of the denial.
(f)If an insurer is providing assistance pursuant to the insurer’s stay-at-work/return-to-work assistance policy, the insurer shall provide in writing to a worker, with a copy to the department, an explanation of the stay-at-work/return-to-work assistance being provided to the worker under this section and shall include contact information for the person providing the assistance.
(2)Rather than make a request to the department, a worker, an employer, or a medical provider may directly ask the insurer to provide stay-at-work/return-to-work assistance.
(3)In the absence of a request by a worker, an employer, or a medical provider, an insurer may initiate and provide stay-at-work/return-to-work assistance by providing the worker with a copy of the insurer’s stay-at-work/return-to-work assistance policy or by designating a rehabilitation provider to provide rehabilitation services.
(4)Stay-at-work/return-to-work assistance requested under this section is available as a service apart from a determination regarding indemnity benefits. A worker or an employer may decline to accept stay-at-work/return-to-work assistance. The failure of a worker to voluntarily agree to assistance is not a dispute concerning benefits. However, if the assistance provided under this part results in a job offer for a position that is within the worker’s physical abilities, for which the worker is qualified, and for which the wages are at least equal to the worker’s wages at the time of injury and the worker refuses the offer, the workers’ indemnity benefits may end as provided in 39-71-701 and 39-71-712.
(5)Stay-at-work/return-to-work assistance is available at any time unless:
(a)the worker, prior to a determination that the worker meets the definition of a disabled worker, has refused a job offer for a position that is within the worker’s physical abilities, for which the worker is qualified, and for which the wages are at least equal to the worker’s wages at the time of injury;
(b)the worker has actually returned to work; or
(c)the claim has been closed pursuant to 39-71-704(1)(f)(i) or indemnity benefits have been settled pursuant to the definition of a settled claim in 39-71-107.
(6)If the insurer determines that the worker has not suffered a compensable injury or occupational disease and denies liability for the claim, the insurer or the department shall terminate any stay-at-work/return-to-work assistance that was initiated before the insurer’s denial of liability.