Petition For Settlement (Permanent Total Disability - Medical Benefits Closed on Accepted Claim) | Pdf Fpdf Doc Docx | Montana

 Montana   Workers Compensation 
Petition For Settlement (Permanent Total Disability - Medical Benefits Closed on Accepted Claim) | Pdf Fpdf Doc Docx | Montana

Last updated: 5/31/2024

Petition For Settlement (Permanent Total Disability - Medical Benefits Closed on Accepted Claim)

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Description

PETITION FOR SETTLEMENT (Permanent Total Disability) INJURY/OCCUPATIONAL DISEASE MEDICAL BENEFITS CLOSED BY SETTLEMENT ON AN ACCEPTED CLAIM. This form is used in Montana for the final settlement of workers' compensation claims involving permanent total disability. It is filed with the Department of Labor & Industry when the claimant and insurer agree to a lump sum settlement. This settlement covers all compensation payments and closes coverage for medical and hospital benefits. By signing, the claimant acknowledges that they understand the settlement ends all workers' compensation coverage for medical care related to the specified claims, and that the insurer is forever released from further payment obligations. The settlement is final and cannot be reopened by the Department. www.FormsWorkflow.com

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