Worker's Compensation Information

WORKER'S COMPENSATION CLAIMS PROCEDURE

As a South Dakota state employee, you are covered by an insurance program that pays medical and disability benefits for work-related injuries and diseases. The worker's compensation program for state employees is administered by the Bureau of Personnel. By following the basic procedures outlined here, you can help the Bureau of Personnel process your claim more efficiently.

Injury Reporting Procedure
If you are injured or contract an occupational disease and the injury or disease arises out of and in the course of your employment, you must report it electronically no later than three (3) business days after the occurrence. This can be done online by clicking on the reporting form: First Report of Injury.
Failure by the employee to file the claim on time may result in denial of a claim. Report the circumstance of the injury or disease to your immediate supervisor. If you need assistance, you may contact the secretary of your department or Human Resources.

Selection of Medical Practitioner
You have the right to initially select a medical practitioner. If you want to change medical practitioners, you must submit a written request to the Bureau of Personnel for approval. If your medical practitioner refers you to another practitioner for further treatment, you do not need permission to see that practitioner. However, if another medical practitioner is consulted for a second opinion without referral or the Bureau of Personnel's approval, it will be at your own expense.
You also need to give prior notification to the state's managed care program for hospitalization or surgery, unless it is an emergency.
If you have already seen a medical practitioner about your injury or disease, be sure that your employer included the medical practitioner's full name and complete address on the Employer's First Report of Injury form. If the medical practitioner's name and address are not on the Employer's First Report of Injury form, please send that information to the Bureau of Personnel as soon as possible. This same information applies to hospital or other medical practitioners.
Your medical practitioner must submit a report to Dakotacare within fourteen (14) days after treatment. A medical bill should be attached to the report for faster processing. If you receive medical bills, forward them to Dakotacare. Any and all original (not copies) of doctor’s statements or medical notes must be forwarded to the Bureau of Personnel for determination of lost time. The employee should note their Name, Health Insurance ID Number and Date of the Injury on each piece submitted. Also, if you are covered by the State's health plan, you should use your pharmacy card when purchasing prescriptions for the work related injury/illness. Pay the co-payment at the time of purchase and then send the co-payment slip and cash register receipt into Dakotacare for reimbursement. Medical supplies prescribed by your medical practitioner for the work related injury or disease should also be forwarded to Dakotacare. If you are not covered on the State's health plan, make sure your pharmacy submits an itemized bill at least once a month to Dakotacare. You must get prior approval from the Bureau of Personnel to purchase orthopedic devices or physical therapy equipment.

If the Claim is Denied
The employee will receive a letter from the Bureau of Personnel if the claim is denied. You have the option of writing a letter of appeal asking that your claim be reconsidered. In many cases the reason the claim is denied is because the Bureau of Personnel doesn’t have all the facts. That is what makes the First Report of Injury form so important.

If The Claim is Approved
You will know that the claim is approved when you start receiving explanation of benefits (EOB’s) from Dakotacare showing that the claim has been paid. You are not responsible for the difference between the billed amount and the approved amount of the charges. Worker’s Compensation approved charges are paid 100%. Remain in close contact with the HR Office and alert them if you are going to be off work for any period of time. Time off is compensated at the work comp rate if the employee is off work for over seven (7) consecutive days under doctors orders.

What if I'm not sure if I have a Claim?
FILE!!! If you think you may have a claim, you should file and let the system do the deciding. No claim is too small to file for you never know what may come of it later.

Time Lines
The employee must report the circumstances of the injury or disease through the electronic submission no later than three (3) business days after the occurrence.

Failure to Report
If the employee fails to report a claim on time, the claim may be denied. If the supervisor/ employer has knowledge of the claim and a report is not filed, it can result in a Class II Misdemeanor.

Filing for Disability Benefits
You cannot be paid for lost work time unless you are incapacitated for seven (7) consecutive days under Doctor’s orders. Make sure the person who files worker's compensation reports in your department notifies the Bureau of Personnel when you have been off work beyond this period. No compensation for lost time payments can be made until the Bureau of Personnel has received such notice.

  • Provide the Bureau of Personnel with a medical practitioner's slip indicating the period of time you will be unable to work
  • Notify the Bureau of Personnel if your medical practitioner releases you to return to work or if you intend to resign or change employers.

If you fail to furnish this information, your benefits could be delayed or suspended. Legal action is possible in cases of fraudulent claims. For example, if a person returns to work while receiving disability benefits.
If you are placed on disability benefits, an agreement regarding compensation will be mailed to your employer's office which filed the Employer's First Report of Injury. You must sign the agreement and return it to the Bureau of Personnel.
Every effort will be made to allow you to return to work as soon as possible. At a minimum, you should maintain weekly contact with your supervisor or Human Resource Director.

Use of Sick Leave/Vacation Pay as Supplement
If your worker's compensation benefits are not equal to your salary, state law (SDCL 3-6-8.2) says you may use sick leave or vacation pay in an amount necessary to make up the difference between your salary and the worker's compensation benefits.
If you have any questions concerning your Worker’s Compensation claim, please call the Bureau of Personnel, at (605) 773-3148.

Addresses


Bureau of Personnel
Attn: Workers Comp
500 E Capitol Ave
Pierre, SD 57501
605.773.3148

DakotaCare
1323 S Minnesota Ave
Sioux Falls, SD  57105
605.348.7410

 

BHSU Human Resources
1200 University St Unit 9568
Spearfish, SD 57799-9568
605.642.6549