As an employee, your livelihood is your lifeline. Earning a living supports not only you but also your family and future. When you get injured, it becomes difficult to work and earn money. Your abilities are significantly hampered due to the pain and limitations that come with the injury.
In cases like this, the only way out is medical intervention. However, this can be costly, with hospital visits typically ranging from $1,500 to $3,000. Without insurance, you are likely to bear the full cost.
Fortunately, you have the workers’ compensation system in South Dakota to aid in your recovery and financial stability. However, navigating this system can be extremely challenging due to its complex processes and hard-to-understand requirements.
This guide aims to shed light on the complexities of South Dakota workers’ comp and provide you with essential information to manage the system effectively. Whether you are dealing with a recent workplace injury or simply want to prepare, this article will walk you through the key aspects of workers’ comp in South Dakota, from coverage and benefits to claim filing and settlements.
What is workers’ compensation?
South Dakota workers’ comp protects employees who suffer work-related injuries or illnesses. It provides medical care and financial support to help you recover and return to work. As a no-fault insurance program, it allows injured workers to receive benefits without proving their employer was at fault for their injury. These benefits include:
- Medical expenses
- Wage replacement
- Disability benefits
- Rehabilitation services
- Death benefits
Although you still need to take certain steps to get these benefits, generally, these are the benefits you have the right to receive as per state law.
How does workers’ comp work in South Dakota?
As an employee in South Dakota, it’s essential to understand how workers’ comp coverage works and what it means for you. While this insurance is not mandatory for all employers in the state, those who choose not to carry it may be subject to civil liability. If your employer does not have workers’ comp insurance and you get injured on the job, they could face legal consequences.
To avoid these risks, South Dakota’s Department of Labor and Regulation (DLR) strongly recommends that all employers obtain workers’ compensation coverage. This coverage protects you from financial hardship and your employer against lawsuits.
In South Dakota, employers have several options for obtaining workers’ comp coverage:
- Private insurance companies: Most employers purchase workers’ comp insurance from private insurance carriers licensed to sell such policies in South Dakota. This is the most common method and ensures coverage under a comprehensive insurance plan.
- Self-insurance: Some large employers who meet certain financial requirements may choose to self-insure. This means that instead of purchasing insurance, the employer assumes the financial risk for their workers’ comp claims. If your employer is self-insured, they are responsible for directly covering your medical expenses and lost wages in the event of a work-related injury.
Workers’ comp protections help you receive timely medical treatment and financial support during recovery. For example, consider a scenario where you suffer a back injury while lifting heavy equipment at work. In that case, workers’ comp will cover your medical bills, physical therapy, and a portion of your lost wages while you are unable to work. This is how workers’ comp works and your rights under the workers’ comp system.
Who is qualified for workers’ compensation in South Dakota?
Businesses with one or more employees who choose to carry workers’ comp insurance can provide coverage to their employees, including part-time workers. As a worker in South Dakota, you are typically covered from your first day on the job, whether you work full-time, part-time, or seasonally.
However, some workers are excluded from this coverage, including:
- Domestic servants
- Farm or agricultural laborers
- Independent contractors
- Certain corporate officers
If you are covered, workers’ comp in South Dakota typically pays for:
- Medical expenses related to the work injury
- Lost wages
- Disability benefits
- Rehabilitation services
- Death benefits for dependents in case of fatal work injuries
If you have any concerns about your employer’s coverage or experience difficulties in receiving benefits, consult with workers’ comp lawyers in South Dakota who can provide valuable assistance and protect your rights as an employee.
How can I apply for a workers’ comp claim in South Dakota?
To apply for workers’ comp benefits, you have to follow several important steps to ensure you receive benefits. Here’s a step-by-step guide to help you through the process:
- Report the injury: Notify your employer about the injury within three business days of the incident. Reporting as soon as possible helps your employer file the necessary paperwork and begin the claims process.
- Seek medical attention: Get medical treatment for your injury and inform the healthcare provider that it is work-related.
- File a First Report of Injury: Ensure your employer files a First Report of Injury with their insurance carrier within seven days of knowledge of the occurrence of the injury.
- Follow medical advice: Adhere to all medical recommendations and attend all follow-up appointments.
- Keep records: Maintain detailed records of your injury, treatment, and any related expenses.
- Complete the employee’s workers’ compensation claim: You may need to fill out additional forms provided by your employer’s insurance carrier or the DLR. Make sure to provide all required information accurately.
- Submit the Claim: Submit the completed claim form and any supporting documentation to your employer’s insurance carrier. Your employer should assist you with this process.
After applying, your claim will either be approved or denied. If denied, you should consider legal guidance and representation as you appeal the decision. However, if your claim is approved, the amount of compensation you receive will depend on several factors, including the nature and severity of your injury, your average weekly wage and the type of benefits you are eligible for.
What are the types of benefits you can receive?
Workers’ comp provides various benefits to support you during recovery from your injury and beyond. These benefits help you receive the necessary assistance to help you return to work or with the management of long-term disabilities.
South Dakota workers’ comp offers several types of benefits to injured workers, including:
- Medical benefits: Coverage for all necessary medical treatment related to the work injury. This includes doctor visits, hospital stays, surgeries, medications, and rehabilitation services. Coverage for medical bills is a crucial aspect of the workers’ comp system.
- Temporary total disability (TTD): If you cannot work temporarily due to your injury, you may receive TTD benefits. These benefits are typically calculated as two-thirds of your average weekly wage, subject to minimum and maximum limits set by state law.
- Temporary partial disability (TPD): You may receive TPD benefits if you can return to work but earn less due to your injury. These benefits compensate for the difference between your pre-injury wages and your post-injury earnings.
- Permanent partial disability (PPD): If you suffer a permanent impairment that does not completely prevent you from working, you may receive PPD benefits. The amount is based on the severity of your impairment and your average weekly wage.
- Permanent total disability (PTD): If you are permanently unable to return to any form of gainful employment due to your injury, you may receive PTD benefits. These benefits are typically calculated as two-thirds of your average weekly wage and may continue for life.
- Death benefits: In the unfortunate event of a fatal work injury, the worker’s dependents may receive death benefits. These benefits include compensation for funeral expenses and ongoing financial support for surviving dependents.
The very core of workers’ comp insurance is to help workers manage the high costs of medical treatment and recovery. It’s only fitting for you to receive the care you need without financial burden. To illustrate how benefits are calculated, here is an example calculation:
- Average weekly wage: $700
- TTD rate: Two-thirds of $700 = $466.67 per week
The exact amount you receive will depend on your specific circumstances. It’s important to note that you will only receive these benefits after a claim approval. You cannot get benefits after a rejected or disputed claim. Fortunately, problems with your claim may just put you on hold, not stop you from receiving benefits. Going to court can help you navigate this situation and resolve the disputes. This can involve legal representation and potentially a settlement process.
How long do most workers’ comp settlements take?
A workers’ comp settlement is an agreement between you and your employer’s insurer to resolve a workers’ comp claim in case of denials and disputes. For example, suppose you suffer a disabling back injury at work and insurance disputes the extent of your injury. You might reach a settlement in that case. This settlement typically includes a lump sum or structured payments to cover medical expenses, lost wages and other related costs.
The duration of workers’ comp settlements can vary depending on how complex your case is. Simple cases might settle within a few months, while more complicated cases could take a year or more.
Factors affecting settlement duration include:
- The severity of the injury
- Clarity of the work-relatedness of the injury
- Disputes over medical treatment or disability ratings
- Negotiations between parties
It’s worth noting that many people wonder if surgery increases a workers’ comp settlement. Generally, if surgery is necessary due to your work injury, it may increase the potential settlement amount due to the increased medical costs and potentially longer recovery time.
Can I refuse workers’ comp as an employee?
In general, you cannot waive employee rights to workers’ compensation in South Dakota. The workers’ comp system protects you and your employer, and it is typically not in your best interest to refuse these benefits. However, there are some limited situations where you might choose not to file a claim:
- Minor injuries: For very minor injuries that do not require medical attention or time off work, you might choose not to file a claim.
- Alternative arrangements: Sometimes, your employer might offer to cover medical expenses directly, though this approach can be risky for both parties.
- Fear of retaliation: You might be hesitant to file a claim because you fear job loss or other retaliation, although it is important to note that such retaliation is illegal.
Refusing to file a workers’ comp claim can have serious consequences. If the injury worsens over time, you may lose your right to benefits if you do not file within the required timeframe. Always consult with a workers’ comp attorney before making any decisions about refusing workers’ comp benefits.
Employees’ rights and responsibilities under the workers’ comp system
Understanding your rights as an employee and the steps you need can significantly affect the outcome of your workers’ comp claim. Knowing what benefits are available, how to file a claim and what to expect during settlement is crucial. Being informed helps ensure you receive the compensation and care you deserve.
Remember, the workers’ comp system protects you in case of work-related injuries or illnesses. By knowing how the system works, you can focus on what is most important—your recovery and return to work.
If you need assistance with a workers’ compensation claim, consider reaching out to a qualified attorney in Sioux Falls, South Dakota. They can provide personalized advice based on your specific situation. This ensures you receive the full benefits you are entitled to under South Dakota law.