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Important Information
Document submission:

The regular business hours of the State Insurance Fund are 8 a.m. to 5 p.m. MT, weekdays except state holidays.

Documents received after business hours are recorded as received the next business day.

Download a State Insurance Fund Form


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Policy Application About this form Form Instructions
Trucking Supplemental Application About this form Form Instructions
Worker Relationship Questionnaire About this form
First Report of Injury About this form Form Instructions
Employers Supplemental Report About this form Form Instructions
Light Duty Work Supplemental About this form Form Instructions
Physical Medicine Request Form About this form Form Instructions
Surgery and/or Diagnostics Testing Request Form About this form Form Instructions
Agency Web Authorization Form About this form Form Instructions
Online Payroll Reporting Authorization Form About this form Form Instructions
Third-party Web Authorization Form About this form Form Instructions
Provider Web Authorization Form About this form Form Instructions

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Note: Adobe 11 or higher is recommended as it allows you to save typed text in the form to a file on your hard drive. Older versions of Adobe or similar PDF readers may not save your typed text and the document will be blank after saving. Open and review your saved document BEFORE submitting.


Submit a Completed State Insurance Fund Form (Secure)

Instructions

  1. Enter the name, phone number, and email address of the person to contact if we have an error reading your form after it has been submitted.
  2. Click "Browse" to locate the completed form on your computer. Acceptable formats are PDF, TIF, PNG, JPG, and BMP. The file can be no larger than 4 megabytes. If you need a blank form, choose from the download options above.
    NOTE: Please ensure you have reviewed your saved document before sending. Older versions of Adobe or similar PDF readers may not save your typed text in the form.
  3. Navigate to your form in the popup window, and click "Open" to select the file.
  4. If you have any comments to make regarding the form, enter them under "Comments". This field is optional.
  5. Click the "Secure Submit" button to submit your form.

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