Settlement/Advance Recap Sheet - Montana 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1 by entering the Claimant Name, ensuring correct spelling. Fill in the D/A or OD date of injury and the Claim # using the insurer’s claim number. Don’t forget to include the SSN# and Date of Birth accurately.
3. In Section 2, document financial sustainment by detailing pre and post lump sum income and expenses. Ensure these reflect monthly figures from all sources.
4. Proceed to Section 3, where you will provide the MMI rating percentage, indicate if it has been paid, and include details on wage supplement rates and social security offsets.
5. Complete Section 5 with settlement information including MMI dates, settlement amounts, and rationale for calculations.
6. Finally, ensure Sections 6 and 7 are signed by both claimant and insurer representatives. If applicable, list the attorney’s name and fees in Section 7.

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