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STATE OF MONTANA EDI Implementation Guide State of MontanaDepartment of Labor and IndustryEmployment Relations Divisional Management Unit1805 Prospect Avenue, Helena MT 59601Table of Contents Workers
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To fill out the ERDdlimtGovWork-Comp-ClaimsData-ManagementWorkers Compensation claim form, follow these steps:
02
Start by providing your personal information such as your name, address, and contact details.
03
Fill in your employer's information including their name, address, and contact details.
04
Indicate the date and time of the injury or illness that resulted in the workers compensation claim.
05
Provide a detailed description of the incident, explaining what happened and how it led to the injury or illness.
06
Note any witnesses to the incident and include their contact information if available.
07
If you sought medical treatment, include the name of the healthcare provider, their contact details, and any relevant medical records.
08
Specify the body parts affected by the injury or illness and the symptoms experienced.
09
If you have already missed work or anticipate missing work due to the injury or illness, state the dates and provide documentation if available.
10
Sign and date the form to confirm the accuracy of the information provided.
11
Keep a copy of the completed form for your records and submit it to the appropriate authority or insurance company as instructed.

Who needs erddlimtgovwork-comp-claimsdata-managementworkers compensation claim by?

01
Employees who have suffered work-related injuries or illnesses and require compensation and medical benefits need to fill out the ERDdlimtGovWork-Comp-ClaimsData-ManagementWorkers Compensation claim form.
02
Employers may also need the filled-out claim form to process workers compensation benefits for their employees.
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ERD-DLI-MTGVWORK-Comp-ClaimsData-Management Workers compensation claims must be filed by the injured employee.
The injured employee is required to file the workers compensation claim.
The claim can be filled out online or through a paper form provided by the employer or insurance company.
The purpose of the workers compensation claim is to request benefits for injuries sustained in the workplace.
The claim must include details of the injury, how it occurred, and any medical treatment received.
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