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What to Do If Your Workers’ Compensation Claim Is Denied in Sioux Falls

Worker’s Compensation

South Dakota workers’ compensation can be tricky. There is no law requiring employers in South Dakota to carry workers’ compensation insurance, so sometimes, employees are forced to take legal action to recover lost wages and medical bills. If the employer does have workers’ compensation coverage, they must submit a First Report of Injury (Form 101) and to the South Dakota Department of Labor and Regulations within three days of learning about your work-related injury or illness. 

Without workers’ compensation coverage, employers can be sued in civil court by their employees. But what happens in the case of workers’ compensation denial? This is often the case when there is not enough medical documentation to support a claim. 

Alvine Law Institute can help you recover wages and expenses you deserve. Your mind should be on recovering, not struggling to cover bills or worrying about how you’ll care for your family. Please contact us to book a free consultation with a Sioux Falls workers’ compensation lawyer.

Read on to discover what to do if your workers’ compensation is denied in South Dakota.

Reasons Workers’ Compensation Claims Are Denied

The most common reason workers’ compensation is denied in South Dakota is a lack of medical documentation. The insurance company will want substantial evidence that your work-related accident or injury merits reimbursement. You should have a doctor’s note and medical reports to provide the insurer, whether that comes from a primary care physician, specialist, an urgent care clinic, or the emergency room.

You may also be denied workers’ compensation if the insurer does not believe the accident you experienced caused your injury. This could be contested using a medical professional’s report. Documentation is vital to getting your claim approved.

Another potential reason for workers’ compensation denial is that you fall outside of coverage or your injury was sustained while under the influence, off company property, or outside of work hours. Failure to use equipment properly can also result in claim denial. 

The South Dakota Department of Labor & Regulation’s Employee’s Guide to Workers’ Compensation lists reasons for potential denial and stresses that medical evidence is usually necessary for approval. 

You have seven days to notify your employer of your accident, so long as you are able to do so. If you wait longer than this, you can waive your benefits. It is crucial to follow the workers’ compensation timeline and ensure your claim is submitted within the allotted period.

What to Do After Receiving Denial Letter 

When you want to argue a denial, you can file a formal request called an appeal with the South Dakota Department of Labor and Regulation, Division of Labor and Management if your workers’ compensation claim is denied. You can request mediation or a Petition for Hearing. 

Mediation allows you to negotiate with the insurance company in hopes of reaching a settlement. A neutral third-party will help you navigate discussions to reach a conclusion. This can be an effective way to receive benefits you’re owed without going to court, especially when you have an experienced workers’ compensation lawyer representing you.

If you decide to go to court, you can request a Petition to Hearing. If approved, you will appear before an administrative law judge, present your evidence supporting your right to benefits, and they will decide whether to reverse or uphold your denial. 

If you disagree with the judge’s findings, you have 10 days to request a review from the Department of Labor and Regulations. They can either accept or deny this request, and they may require you to submit medical evidence for them to review.

Consulting with an attorney can help you during this period. Workers’ compensation law can be difficult to navigate, and managing an appeal on top of your injury and stress can feel overwhelming. Let us fight for you. Contact Alvine Law Firm to book a free consultation with Sioux Falls workers’ compensation lawyer. 

How a Lawyer Can Help 

When you receive a workers’ compensation denial letter, there is a set period of time to file an appeal. You have two (2) years after receiving a denial to file a Petition to Hearing, but most people cannot afford to wait this long. The sooner you file an appeal, the better your chances of reaching a desired outcome.

An attorney can help you understand the basis for denial and help you build a strong case to contest it. They can suggest what additional resources may benefit your claim, as well as identify any errors your employer may have made when filing your Form 101.

Lawyers understand the intricate details of workers’ compensation law in South Dakota. They can help clients build strong cases that highlight the extent and impact of their work-related injuries and present them in a manner that proves you inarguably are entitled to benefits.

When Should You Hire a Workers’ Compensation Attorney? 

If you feel your denial is unfair or ungrounded, then an appeal can help you achieve a better outcome. You can also file an appeal if it is denied due to sufficient medical evidence. Gathering the appropriate documentation could help you get the benefits you deserve. 

An attorney can offer valuable legal advice throughout the claims appeal process, such as how long you have to file an appeal, whether you should request mediation or a Petition to Hearing, and what type of evidence you should gather to support your claim. 

You should also consult with a workers’ compensation lawyer if:

  • Your employer denies your claim or refuses to file for benefits
  • The settlement you receive does not cover the cost of your medical expenses or lost wages
  • Your claim is taking too long
  • You cannot return to work due to your injuries
  • You have sustained a temporary or permanent disability that prevents you from working
  • Your doctor recommends treatments that your insurance company won’t cover

Working with a lawyer ensures you can reach important deadlines. They can also identify when an employer has violated workers’ compensation laws and help you take appropriate action.

Attorneys are there to help you receive coverage, so you can heal and rebuild after a workplace injury. If you would like to speak with a lawyer, your first consultation at Alvine Law Firm in Sioux Falls is always free. Send us a message or call 605-275-0808. We are here for you. 

Get the help you need today!

Our legal team’s expertise allows us to quickly evaluate your claim to allow you to get back to living your life.