What Happens After Reporting a Work Injury?
In a previous blog posting, I wrote about reporting a work injury to the employer. In this blog, I want to discuss what happens in a worker’s compensation claim immediately after the injured worker reports the injury to the employer.
In South Dakota, the employer is obligated to send the First Report of Injury to the South Dakota Department of Labor, Division of Labor and Management. Simultaneously to sending the First Report of Injury to the Department of Labor, the employer usually sends the same report to its worker’s compensation insurance company. The Department of Labor also will send the First Report of Injury to the employer’s worker’s compensation insurance company.
Once the employer’s worker’s compensation company receives the First Report of Injury, it has several responsibilities. The first thing the insurer must do is file a Calculation of Compensation (Form 110). This is the form that set the benefit rate. In South Dakota, the benefit rate is two-thirds of the employee’s average weekly wage. The employee’s average weekly wage is calculated by averaging the employee’s wages fifty-two (52) weeks prior to the injury. (In Iowa it’s thirteen (13) weeks). If the employee hasn’t been working for fifty-two (52) weeks, the average weekly wage is calculated using the number of weeks the employee work prior to the injury.
Keep in mind that the average weekly wage can be reduced when the employee takes vacation and /or sick time and doesn’t earn a wage. Because the employee’s average weekly wage is diminished because of vacation and/or sick time, the benefit rate is necessarily reduced.
In addition to filing the Calculation of Compensation, the employer is also tasked with investigating the claim to determine whether the insurer owes benefits. Usually, an adjuster will take the recorded statement of the injured employee. Also, the insurer will usually require the injured worker to sign an authorization to obtain the employee’s medical record. By law, the employee is obligated to sign the authorization. If the employee refuses to sign a medical authorization impeding the insurer’s investigation, the employee runs the risk of claim denial.
After finishing its investigation, the worker’s compensation insurance company must decide whether to accept compensability of the claim (pay benefits) or deny the claim. In South Dakota, the worker’s compensation insurer has thirty (30) days to do this. If the insurer can’t make a decision in thirty (30) days, it can ask that Department of Labor for an additional twenty (20) days.