SOUTH DAKOTA STATE EMPLOYEE
WORKERS’ COMPENSATION CLAIMS PROCEDURE
The South Dakota State Employee Workers’ Compensation Program is administered by the Bureau of Personnel. By following the basic procedures outlined below, the Bureau of Personnel can process your claim more efficiently.
SELECTION OF MEDICAL PRACTITIONER
You have the right to choose your primary treating physician at the time of your injury. Services may be denied under workers’ compensation if you change physicians without a referral from the primary treating physician you have chosen, or if you fail to obtain prior written approval from the Bureau of Personnel Workers’ Compensation Program.
Your physician must submit a medical report to Dakota Care, Attn: Workers’ Compensation 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 Dakota Care, Attn: Workers’ Compensation. The address is listed on the back page.
You may obtain a second opinion at your own expense.
All surgical procedures, MRI, CT Scans, etc., must be approved by the Bureau of Personnel Workers’ Compensation Program prior to receiving services.
You must also give prior notification to the state’s managed care program for hospitalization or surgery, unless it is an emergency.
All orthopedic devices, or physical therapy equipment must be approved by the Bureau of Personnel Workers’ Compensation Program prior to incurring the expense.
TRAVEL EXPENSES
Travel, lodging, and meal expenses incurred as a result of securing necessary medical treatment may also be covered at state rates, if you are required to travel outside the location of your home or work place to obtain medical treatment.
If you are eligible for travel reimbursement, you must submit to Dakota Care, Attn: Workers’ Compensation the date of the appointment, time of appointment, name of doctor who treated you, and the time you returned home from the appointment.
PRESCRIPTION DRUGS
Any medications prescribed by your physician for the work related injury or disease must be paid for with your PAID prescription card. You may submit the sales receipt and the prescription receipt to Dakota Care, Attn: Workers’ Compensation for reimbursement of your co-payment.
IF YOUR CLAIM IS DENIED
If your claim is denied you will receive a letter from the Bureau of Personnel Workers’ Compensation Program. You may write 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 does not have all the facts. If your claim is still denied, you may appeal the decision by contacting the South Dakota Department of Labor and requesting either a mediation or a hearing. The mediation process is a non-binding decision where an Administrative Law Judge reviews the information submitted by yourself and the Bureau of Personnel. A resolution may be reached. An attorney need not be present for the mediation. If a resolution cannot be reached at the mediation, a hearing may be requested.
IF YOUR CLAIM IS APPROVED
You will know your claim has been approved when you begin receiving explanation of benefits (EOB’S) from Dakota Care. You are not responsible for the difference between the billed amount and the amount paid, for services rendered as a result of your work related injury.
FILING FOR DISABILITY BENEFITS
Any and all originals (not copies) of doctor’s statements or medical records must be forwarded to the Bureau of Personnel Workers’ Compensation Program for determination of lost work time. The employee should note their name, social security number, and date of injury on each piece submitted.
You cannot be paid for lost work time unless you are incapacitated for seven (7) consecutive days per doctor’s orders. No compensation for lost work time will be made until the Bureau of Personnel Workers’ Compensation Program has received such notice.
Remain in close contact with your personnel officer and notify them if you are to be off work for any period of time.
If you are placed on temporary total disability (according to SDCL 62-4-3), it is your responsibility to:
- Provide the Bureau of Personnel Workers’ Compensation Program a work slip from your primary treating physician indicating the period of time you will be unable to work.
- Notify the Bureau of Personnel Workers’ Compensation Program if your physician releases you to return to work, or if you intend to resign or change employers.
If you fail to furnish this information, your benefits may be delayed or suspended. Legal action is possible in cases of fraudulent claims. 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 personnel officer. You must sign the agreement and return it to the Bureau of Personnel Workers’ Compensation Program.
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 personnel officer.
If you are unable to return to work for a period of time due to your injury, your retirement benefits may be affected. Please contact the South Dakota Retirement System for further information. See back page for address and telephone number.
USE OF SICK LEAVE/ANNUAL LEAVE AS SUPPLEMENT
Workers’ compensation benefit payments are not equal to your salary. Therefore, State Law (SDCL 3-6-8.2) allows you to use sick or annual leave in an amount necessary to make up the difference between your salary and the worker’s compensation benefit.
If you have any questions concerning your worker’s compensation claim, please call the Bureau of Personnel Workers’ Compensation Program at (605) 773-3148.
ADDRESSES
Bureau Of Personnel
Workers Compensation Program
500 E Capitol
Pierre SD 57501-5070
605) 773-3148
Dakotacare
Attn: Workers Compensation
1323 S Minnesota Ave
Sioux Falls, SD 57105
1-800-831-0785
605) 334-4000
South Dakota Retirement System
216 E Capitol
PO Box 1098
Pierre, SD 57501-1098
605) 773-3731
Contact: SDSM&T Human Resources
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Last Modified: 03/30/2006 |
