What do I do if my boss won’t turn in my work comp claim?

You fell off a ladder. You slip and fall on a wet floor. You are lifting a patient and feel a pull in your low back. You hope for the best and get back to work. Hopefully, you will feel better tomorrow. You work through it for a while until one day it’s just too much. You have to go to the doctor and get this checked out. You don’t want to miss work, but it looks like you will need to take a break and heal up.

You talk to your boss. “Hey, I got hurt and I’d like to turn in a work comp claim.” Your boss doesn’t look too happy. “We will have to see about that,” he says. Days go by and nothing happens. Maybe you are told, “you should have turned it in when it happened, so you are out of luck.” Or maybe your boss fires you, for reasons that don’t seem right.

Your symptoms are getting worse and now you have medical bills coming in. Your spouse and friends say, “This isn’t the way it’s supposed to work.”

What do you do?

When you are in this spot, you need to take action right away. 

The first and best course of action would be to call a good workers comp lawyer and explain the situation and get specific advice. 

If you don’t want to do that, and you want to handle it yourself, you can contact the South Dakota Department of Labor at 605-773-3681.  You should ask them what to do when your boss won’t help you file a work comp claim. They will likely send you a “First Report of Injury Form” to fill out, or direct you to their website, where you can print out the form and then fill it in, or you can fill it out on the computer. This is the form that your employer should have given you, back when you asked to turn in a claim. Under the law, your boss is supposed to give you the form, help you fill it out, and send it in to their insurance company, so a decision can be made on whether your claim is accepted or denied.

Here’s the link to the Department of Labor form:

https://www.state.sd.us/eforms/secure/eforms/E1830V2-WCFRI.pdf

Once you fill out the form completely and accurately, you can send or email it to the Department of Labor, and they will then send it to your employer, and direct them to send it on to their insurance company. 

If the Department of Labor letter gets your employer to send in the form to their insurance company, then a claim will be set up, you will be assigned an adjuster (a person to investigate your claim) and given a “Claim Number.”  Usually within a few days to a week later, you will get a call from an adjuster, who will ask you questions about how you got hurt, where you went to the doctor, and how you are doing. The adjuster will send you a medical release, so your medical records can be gathered. The adjuster may question witnesses or other employees about the claim. When the adjuster’s investigation is done (usually within a few weeks), then the adjuster will let you know if your claim is accepted or denied. 

If it is accepted, your medical bills and off work benefits will get paid and hopefully over time you will get better and get back to work. If the insurance company denies the claim in writing, you generally have two years from that date to file an appeal with the South Dakota Department of Labor.

Our South Dakota Supreme Court has held that workers compensation is supposed to be a “non-adversarial process”. That’s a fancy way of saying you shouldn’t have to fight with the insurance company to get what’s legally yours. Sometimes the system works very well and people get what they are entitled to. But other times it’s a tough road and filled with hidden traps. Having the advice of a lawyer who has travelled this road a few times is a pretty good idea.

If you have legal questions, please give us a call at 605 716-1000 or email us at mike@simpsonsdlaw.com. There is no charge for the initial consultation.