South Dakota’s worker’s compensation program provides both medical and disability benefits for work-related injuries or illnesses. If an employee becomes injured or ill due to their work, they may qualify for disability benefits that help cover lost wages.
If you are injured or become ill as a result of your job, it is important to understand the different types of disability benefits before filing a claim. Knowing what each benefit does makes it easier to obtain compensation from the employer. However, there are challenges that injured employees face when filing a claim.
Read on to learn how to navigate South Dakota’s disability benefits.
Temporary Disability Benefits
Temporary Total Disability (TTD)
Temporary total disability benefits are given to workers who are completely unable to work due to a work-related injury. TTD acts as a replacement to a portion of an employee’s lost wages while they are unable to perform their duties, but are expected to make a recovery and return to work.
In terms of compensation, employees usually receive 66 and 2/3% of their weekly earnings (SD Codified Law 62-4). This will last until the doctor deems the employee fit to work again.
Temporary Partial Disability (TPD)
TPD benefits are provided to employees who were injured, but can still work, albeit in a limited capacity and are not able to receive their full wages. The purpose of TPD benefits is to help employees make up the difference between their full wages and the wages they earn as they recover. Eligible employees will be able to receive half the difference between their pre-injury and post-injury wages.
Permanent Disability Benefits
Permanent Total Disability (PTD)
PTD benefits are given to employees who are permanently unable to work due to suffering from a severe work-related injury or illness. This benefit is for people whose injury prevents them from performing any type of labor. PTD also offers 66 and 2/3% of an employee’s wages for as long as they need them, which could be for life.
However, it should be noted that the eligibility requirements for PTD are very strict. Injured workers must reach their maximum medical improvement (MMI). This means their condition has become stable and doctors do not expect any significant recovery in the future.
Another key factor in eligibility is being unable to perform any type of work that would give them a substantial source of income. Employees must also provide distinct evidence regarding their injury, such as comprehensive medical documentation and evaluations that prove their disability is permanent.
Permanent Partial Disability (PPD)
PPD benefits are given to workers when they sustain a permanent impairment, but are still able to work in some capacity. These benefits are meant to compensate for the permanent loss in function due to the injury. Compared to PTD, there are two types of PPD: scheduled losses and non-scheduled losses.
Scheduled losses are for permanent impairments to a specific body part, such as the arm or leg. The compensation is obtained through a schedule set by the state. Non-scheduled losses are for injuries affecting body parts or systems that are not covered under scheduled losses, such as back injuries. These types of cases are determined by the severity of the impairment and its impact on the employee’s ability to earn wages.
Navigating the System
Now that you understand the differences between permanent and temporary benefits for South Dakota’s worker’s compensation, we will cover how to navigate the system.
Upon sustaining an injury or illness, employees must immediately notify their employer. It is highly recommended to do this in writing, so there is physical documentation and the employer can begin the claims process. Next, the employer will have to submit the First Report of Injury (FROI) to their worker’s compensation carrier.
The Importance of Medical Documentation
During this time, the injured employee must receive medical attention, so the injury can be properly documented. Depending on the carrier, the injured employee might have to fill out certain forms to either the insurance carrier or the South Dakota Department of Labor and Regulation.
Medical documentation is absolutely critical as it supports the injury claim, demonstrates the severity and can help the appropriate parties decide on what type of compensation is necessary. Independent medical examinations (IME) play an essential role in the claims process, especially when there is uncertainty or the employer files a dispute.
IMEs are conducted by a physician who is not involved in the initial treatment of the injured worker. They are meant to provide an unbiased assessment of the injury’s severity and gauge the employee’s ability to work. IME can single-handedly influence the benefits an injured employee can receive while also settling any potential disputes.
Possibility of Disputes
Unfortunately, not every case will be handled smoothly. It is possible for disputes to occur due to a disagreement between either the employer or the insurance carrier. The dispute can be about the cause of the injury, how severe it is or the provided benefits.
If a dispute occurs, they can be resolved either through negotiation between the employee, employer and the insurance carrier. If there is no agreement, the injured employee can then file a petition for a hearing with the South Dakota Department of Labor and Regulation.
From there, an administrative judge will review the compiled evidence, hear testimonies from each party and make a final decision. Should the injured employee disagree with the decision, they are able to appeal further to a state circuit court.
Importance of Meeting Deadlines and Compliance
There are time frames to where an injured employee can file a claim. Failure to meet this deadline can put their claim at risk. In South Dakota, employees have one year from the date of the injury to file a claim. Any employee that files for a worker’s compensation claim must follow the rules and regulations, attend scheduled medical examinations and provide all necessary documentation.
Conclusion
The type of disability benefits you receive from your worker’s compensation depends on the severity of the injury and how it impacts your ability to work. If you are able to perform some of your duties, you will most likely receive PPD or TPD. If you are not able to hold a job at all, then you may qualify for PTD.
For more information, contact Alvine Law Firm at 605-275-0808 today.
Sources