24.29.3107    TIMELINES AND EXPLANATION OF STATUS CLASSIFICATIONS OF A PETITION

(1) The time in which a petition can be delivered to the department and considered filed is the period 90 days prior to the termination of medical benefits through the ten-year anniversary of the date of the injury.

(2) A petition which has been delivered to the department undergoes a preliminary evaluation to determine which of following three initial status conditions is appropriate:

(a) the petition is accepted if it is eligible for medical review;

(b) the petition is dismissed if it is ineligible for medical review because:

(i) the petition concerns a claim that is not subject to the medical benefits reopening process; or

(ii) the petition concerns a claim for which a previous petition has been accepted; or

(c) the petition is returned if it is eligible for medical review, but the petition form is incomplete.

(3) Upon a petition being accepted, it is considered filed with the department. A petition that is dismissed or returned is considered not to have been filed with the department.

(4) The 60-day period for medical review to occur and the medical director to issue a report begins on the date the petition is considered filed.

(5) Once filed, the parties have 14 days to submit medical records and additional information to be considered during the medical review. Once the medical review is completed and the report is issued by the medical director, the petition will have one of the two following status conditions:

(a) the petition is approved, with a recommendation in the report that medical benefits should be provided by the insurer for not more than two years before being subject to a biennial review; or

(b) the petition is denied, with a recommendation in the report that no further medical benefits should be provided by the insurer.

(6) There is a rebuttable presumption that the petition relates to a claim which the insurer acknowledges is compensable. An insurer may dispute that presumption in writing by delivering to the department and the petitioner notice of the dispute regarding compensability within 14 days of the department's acceptance of the petition.

(a) Upon receiving the insurer's notice disputing compensability of the claim, the acceptance of the petition is suspended until:

(i) the compensability dispute is resolved by agreement of the parties;

(ii) the compensability dispute is resolved by the final judgment of the courts; or

(iii) the time in which to bring the compensability dispute to the Workers' Compensation Court expires, without a party bringing that dispute to the Workers' Compensation Court for adjudication.

(b) A petition that has had its acceptance status suspended is considered to be timely made for the purposes of the filing time limits provided by 39-71-717, MCA. While the acceptance status is suspended, the timelines for medical review and submission of documents do not begin to run. If the claim is deemed compensable, the department will notify the parties of the beginning of the 60-day review period, and that there are 14 days in which to submit medical records and additional information. If the claim is deemed not compensable, the status of the petition will be changed to dismissed.

(7) A petitioner disagreeing with the department's classification of a petition as either dismissed or returned may bring the dispute to the Workers' Compensation Court after following the mediation requirements provided by law. 

 

History: 39-71-203, MCA; IMP, 39-71-717, MCA; NEW, 2016 MAR p. 204, Eff. 2/6/16; AMD, 2018 MAR p. 2527, Eff. 1/1/19.