South Dakota Workers' Comp Claims: Eligibility, Filing, and Appeals
Know your rights under the workers' compensation system in South Dakota.
South Dakota workers’ compensation laws apply to nearly all employers in the state. As in other states, the workers’ compensation system in South Dakota is a no-fault system that compensates injured workers for medical bills, lost wages, and permanent impairments resulting from their injuries. To take advantage of these benefits, injured workers must follow certain procedures required by South Dakota law.
Who Is Eligible for Workers’ Comp Benefits?
Most employees are covered by workers’ compensation in South Dakota. However, there are a few exceptions for employees engaged in certain types of work. For example, workers’ comp does not cover farm workers or domestic workers, unless they work a certain number of hours in a 13-week period.
Workers’ compensation covers all injuries or illnesses that happen in the course and scope of employment, including traumatic injuries and occupational illnesses. Traumatic injuries are those that result from a one-time accident at work, such as a broken bone from a slip and fall. Occupational diseases are injuries or illnesses that occur over a period of time, including injuries caused by repetitive movements at work (such as carpal tunnel syndrome) and illnesses developed from exposure to toxic substances at the workplace (such as cancer from exposure to asbestos).
What Should I Do if I’m Injured at Work?
To receive workers’ comp benefits, you must report your injury to your employer. You should do so within as soon as possible, but no later than three business days after your injury. Your claim for benefits may be denied if you fail to give notice. Once your employer has notice of your injury, it should submit a First Report of Injury to the South Dakota Department of Labor & Regulation (DLR) within seven days. This is the official start of your claim.
How Do I Get Medical Treatment?
If you need emergency medical treatment, you can go to the nearest hospital or urgent care center. For non-emergency care, you may select your own treating doctor, but you must notify your employer of your choice beforehand. However, if you want to switch doctors later on, you will need to get the insurance company’s approval.
What Benefits Can I Receive?
All reasonable and necessary medical treatment related to your work injury will be covered through workers’ comp in South Dakota, including the cost of doctors’ visits, hospital bills, prescriptions, and prosthetic devices. You may also receive reimbursement for travel, meals, and lodging necessary to secure medical treatment. In addition to medical benefits, you will also be eligible to receive disability benefits.
Temporary Disability Benefits
If you need time off from work while you are recovering from your injuries, you can receive temporary total disability benefits. These benefits are two-thirds of your average weekly wages, subject to a minimum and maximum set by law each year. As of July 2016, the minimum weekly rate is $381 and the maximum weekly rate is $762. You will receive these benefits until you are able to return to work or until your doctor finds that your condition has improved as much as it is going to (this is called “maximum medical improvement”).
If you are able to work while recovering from your injury, but you’re earning less than you did before your injury, you can receive temporary partial disability benefits. These benefits are 50% of the difference between your pre-injury wages and post-injury earnings or earning capacity, subject to the same maximum mentioned above.
Permanent Disability Benefits
Once you reach maximum medical improvement (MMI), your doctor will evaluate you to determine whether you have a permanent disability. If your injury has left you permanently and totally disabled, you can receive permanent total disability benefits. These benefits are available only for the most serious injuries—such as the loss of both hands, arms, legs, feet, or eyes—and are paid at the same rate as temporary total disability benefits for the rest of the worker’s life.
If you have a permanent impairment, but you are not totally disabled, you can receive permanent partial disability benefits. In South Dakota, you will receive two-thirds of your pre-injury average weekly wage (subject to the same maximum described above) for a certain period of time. The length of time is determined by a scheduled of injuries, which takes into account the body part injured and the impairment rating assigned by your doctor. For example, for the total loss of use of a hand, you would receive 150 weeks of payment. If you have lost 50% of the use of a hand, you would receive 75 weeks of payment.
What If My Claim Is Denied?
If your claim is denied, you can file a petition for hearing within two years of the date that your benefits were denied. You will have a hearing before a workers’ comp judge, who will make a decision in your case. If you disagree with the judge’s decision, you will have an opportunity to appeal the decision. For more information on the appeals process, see our article on appealing a denial of your South Dakota workers’ comp claim.