If you live and work in South Dakota you may not realize that you have protection built in to your employment in the event that you are injured or become sick as a result of the conditions at work. With limited exceptions, employers throughout the state are required to have workers’ compensation insurance. A workers’ comp. claim after a workplace injury or illness may help to pay for medical treatment and compensate for earnings that have been lost. Not all claims are accepted and you may need to appeal the decision if the claim is denied. A workers’ comp. attorney can help you with advice and represent you at hearings. Workers’ Compensation Law in South Dakota South Dakota’s state agency for administering workers compensation and dealing with disputes is the Division of Labor and Management. The law in South Dakota requires all employers bar those that employ agricultural workers or independent contractors to have workers’ compensation insurance. Insurance can be with a private carrier (the majority) or the business can self insure. Employees must inform their employers within 3 days if they are injured or become sick. The employer is required to inform their insurer about the injury within 7 days. The employee then has two years to make a claim with the employer’s insurer showing evidence that the incident took place and the treatment received plus the cost. Medical expenses can be recovered if the claim is honored as well as a portion of the lost earnings. Rehabilitation must also be provided if necessary. Why a Workers’ Comp. Claim is Denied in South Dakota Not all claims are accepted by the insurance carrier providing workers’ comp. insurance. There are many reasons why a claim may be denied. Minor and generally easily correctable reasons include incorrect information passed on to the insurer by the employer after an incident has been notified. The insurer may allege any of the following reasons for a denial: the worker’s actions deliberately led to the injury through misconduct; the worker was drunk or affected by drugs when the incident happened; the worker failed to use safety equipment which was available or refused to follow normal procedures; the worker’s injury or illness predated the date that was claimed; the evidence for an injury or illness was missing. How to File an Appeal for a Workers’ Compensation Denial in South Dakota There are several ways that you can challenge what you feel is an unjust claim denial. The first step is mediation. This is an informal meeting between you, a mediator provided by the Division of Labor and Management and the insurer’s representative. The mediator’s role is to solve the dispute rather than provide a binding ruling. If no resolution occurs you can request a hearing with an administrative law judge. The judge will review all information provided including testimony from witnesses at a formal hearing. The hearing must be requested within 2 years of the claim being denied. Most appeals are decided by this stage, but if still dissatisfied you may be able to appeal further to the state’s Appeals Court. You Will Need an Attorney for a Workers’ Comp Denial Even if you have done everything by yourself up to the point of the claim being denied, you are strongly advised to seek legal representation if you are contemplating an appeal. The insurer will be inevitably well prepared legally if they are represented at mediation or at a formal hearing, so you should be too. Contact an experienced workers’ comp. attorney after a denial of your claim for advice and help with legal action.
