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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


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

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Note: Older versions of Adobe or similar PDF readers may not save your typed text in the form. Open and review your saved document BEFORE submitting to us.


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, TIFF, GIF, 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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