Work Comp Claim Reporting for Non-Montana Based Employee of the Montana University System

*Non-MT based MUS employees are provided workers’ compensation coverage in one of two ways, initial reporting is the same: 

  1. ND, OH, WA & WY employees are covered by a policy purchased through your campus HR Department 
  2. All Other non-MT employees are covered by a policy with The Hartford.  

To Report an injury and initiate a workers’ compensation claim:    

  1. Employees: report the injury incident to your Supervisor immediately. Provide the requested information and be responsive to outreach from the campus claim coordinator and insurance examiner.
  2. Supervisors: Contact your campus claim coordinator to initiate a work comp claim with or for the injured worker. Be prepared to provide as much of the information below as soon as possible, but don’t delay initiating claim waiting for every detail, it can be added:

Employee information:

      • Full Name, DOB, Address (permanent), Address (current), Phone

      • Social Security Number

      • Age, Gender

      • Marital Status, Number of Dependents

Incident Information:

      • Type of injury (burn, cut, etc.)?

      • Exact body part(s) injured (include descriptors such as Left, Right)?

      • What caused the accident?

      • Any witnesses?

      • Address or specific location description where injury occurred?

      • When was the accident reported to you and by whom (date, time)?

      • Name, address, phone of medical provider/facility where the injured employee treated?

      • Any reason to question the injury? 

  1. Claim Coordinators:  Determine appropriate non-MT policy; either Monopoly State (ND,OH,WA,WY) & coordinate through campus HR,  or The Hartford & follow the process outlined below.   

File online at https://wcclaims.thehartford.com/.  Call 800-327-3636 if you need assistance.  A Hartford claim number is provided immediately after the online form is completed. Please forward the claim and contact information to the injured employee so that they can easily contact the examiner if needed. Once a workers’ compensation claim has been filed with The Hartford, instruct the employee to create and log on to their Hartford Account online, to view claim status, receive timely information, and more.

You will need: 

    • MUS Policy Number:  53 WEAC6218
      Note:  Insurance carrier name varies by state, the Policy number is the same for The Hartford or Twin City Fire Insurance or Sentinel Insurance. 
    • Policy Term:  July 2022 - June 2023
    • Insured/policy holder (and dbas) and FEIN#s:   
      • Montana University System/OCHE FEIN#: 16-1670804
      • University of Montana (UM, UM Western, MT Tech, Helena College) FEIN #: 81-6001713
      • Montana State University (MSU) FEIN# 81-6010045
      • Montana State University Billings (MSUB) FEIN# 81-6001642
      • Montana State University Northern (MSUN) FEIN# 81-6001663
      • Great Falls College (GTFMSU) FEIN# 81-0522790

Be prepared to provide all the information identified under Supervisor section and:

      • Hire Date, Years in Current Position
      • Wage Information 

Medical Providers - Each state has unique rules regarding qualified workers’ compensation medical providers.  The Hartford provides a listing of state rules and a list of Network providers or call 1-800-327-3636.

Claim Compensability, Reporting rules and procedures vary from state to state.  Timely reporting to the insurer is critical to ensure employee access to benefits, to optimize recovery, and to ensure MUS complies with federal and state laws.  If you need additional assistance, contact your Leah Tietz, Director MUS Work Comp Program at 406-449-9156 or ltietz@montana.edu.

COVID-19 and Work Comp.  Work Comp regulations vary state-to-state, but generally,  workers’ compensation does not cover routine community-spread illnesses because exposure usually cannot be tied to a specific time/place.  However, in 2020 numerous states enacted laws to extend WC to cover COVID-19, the illness caused by SARS-CoV-2, a new type of coronavirus.  Employees wanting to file a COVID-19 related work comp claim should follow the instructions above. 

Statutory Notices of Work Comp Coverage are on the MUS Work Comp Website:   Non-MT Employee Notices of WC Coverage.

 *Employees who work and live outside of Montana on more than travel status basis are typically non-Montana employees.  MUS provides workers’ compensation insurance for its Non-Montana employees.  In event of a work-related injury/illness incident all non-MT  employees of the MUS  should notify their supervisors immediately and file a claim.  Time limits for reporting and filing a workers’ compensation claim vary by state – to protect your access to work comp benefits, file a report as soon as possible after immediate medical needs have been addressed. 

 

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