HomeMy WebLinkAbout2011 05 01 Workers Comp Bozeman Posting NoticeERD800.(Rev 5/02)
WORKERS’ COMPENSATION
COVERAGE
EMPLOYEE NOTICE
Montana Municipal Interlocal Authority Date: April 13 , 201 1
Workers’ Compensation Coverage Program
City of Bozeman
PO Box 1230
Bozeman MT 59771 Plan 1 Self -Insured Group
The above -named employer’s workers' compensation coverage is active and in good standing for the period of
5/01/20 1 1 to 4/30/2012 , provided the employer meets all assessment and reporting requirements.
IF YOU ARE INJURED
You should report any on -the -job injury to your supervisor, employer, or the MMIA as soon as possible. You
must report the accident within 30 days. A sole proprietor, partner, manager of a man ager -managed limited
liability company, member of a member -managed limited liability company, or corporate officer covered
under the Montana Workers’ Compensation Act must report an accident to the MMIA within 30 days.
Report minor injuries to your employ er whether or not you receive medical treatment. After you report the
injury, your employer has 6 days to notify the MMIA . You must submit a written First Report of Injury within
12 months from the date of the accident. You can submit this form to your employer,the MMIA , or the
Department of Labor and Industry.
All employees sustaining a compensable work related injury or occupational disease, other than those who are
exempted by statute (Section 39 -71 -401, MCA), are covered for medical and wage -loss benefits.
You have the right to choose your initial treating physician.
You may continue to receive treatment from your physician unless you receive written notice of referral to
a preferred provider or a managed care organization. After providing you wi th a referral notice, the
MMIA is no longer liable for treatment provided by your physician unless authorization is obtained to
continue treatment.
For specific information about this policy, call or write the Montana Municipal
Interlocal Authority :
Fo r general information about workers’ compensation, call or write: Montana
Department of Labor and Industry, Employment Relations Division, P.O. Box 8011,
Helena, MT 59604 -8011, Phone (406) 444 -6543.
FAILURE TO POST THIS SIGN OR POSTING AN ALTERED SIGN IN THE
WORKPLACE WILL RESULT IN A $50 FINE AGAINST THE EMPLOYER!