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Title - Workers' Compensation

Case Management

The case management system strives to ensure that injured workers get medical treatment that is prompt, efficient and returns them to work as quickly as possible. The idea behind case management is to save money by making medical care faster, more efficient and more effective. One recent study showed that aggressive case management, including making contact with the injured worker within 24 hours, saved 70 percent on claim costs.

Every on-the-job injury must be reported to the employer's case management plan. However, the insurer may consider some claims to be so minor that management of the treatment is unnecessary, and may elect not to have the claim managed. Employees retain the right, in any case, to have access to medical services within 48 hours after requesting it.

Insurer Requirements

All workers' compensation insurers (including self-insured employers) in South Dakota are required to provide case management services in their policies. Therefore, workers' compensation insurance companies are required to contract with one or more case management plans.

All plans must be certified by the Department of Labor. A self-insured employer may also have its plan certified by the department.

While some insurance plans work with rehabilitation specialists and case managers, insurers and self-insurers often contract with such people separately.

Case Management Plan Requirements

Case management plans are required to have a system of communicating with employees, employers and medical providers. They must

  • Establish a place of business in South Dakota where records are kept and the plan is administered
  • Have a 24-hour toll-free number for individuals to receive information and advice about medical services
  • Provide employers a monthly report on the employees it is involved with.

Working with the Physician

Injured workers have the right to choose the first physician they see. (Seeking emergency room treatment does not count as their choice.) Employees are required to tell the treating physician which plan covers them before treatment is provided.

Employers must report the injury to the plan within 24 hours of the time it is reported to them. The plan must then contact the physician and inform him or her of its rules. All physicians must follow the rules of the plan as well as the state's Optimal Recovery Guidelines (ORGs) in providing treatment. The plan also has control over subsequent consultations or referrals.

Certified Case Management Plans

The following are Certified Case Management Plans for Workers' Compensation in South Dakota effective January 1, 2008 through December 31, 2008.

Alaris Group, Inc.
825 E. Leslie Drive
Garretson, SD 57030
877.487.6194
605.594.8161 fax

Avera Sacred Heart Managed Care
501 Summit
Yankton, SD 57078
888.668.7747

CorVel Corporation
6001 S. Sharon Ave. Suite 6
Sioux Falls, SD 57108
800.838.0077
605.361.1370 fax

Coventry
805 Hudson Circle
Spearfish, SD 57783
800.353.1039

DynaPro Enterprises, Inc.
4009 E. Huntington Street
Sioux Falls, SD 57103
888.336.7577
605.336.7579 fax

GENEX Care for South Dakota
2500 W 49th St., Suite 206
Sioux Falls, SD 57105
877.858.1886
888.508.5832 fax

Intracorp
2702 South Carolyn Avenue, Suite 3
Sioux Falls, SD 57106
800.790.0220

OHARA
300 Cherapa Place Suite 502
Sioux Falls, SD 57103
800.363.4272
605.361.1106 fax

Rehab Associates
4901 Isabel Place Suite 130
Sioux Falls, SD 57101
800.719.4604
605.333.9835 fax

Stubbe Dakota Case Management
227 E. St. Joseph
Rapid City, SD 57701
800.582.4091

Disclaimer

The information provided on this Web page should in no way be considered legal advice. For specific information about your legal rights, you should consult your personal attorney. If you have a general question, contact us.

South Dakota Department of Labor
Division of Labor and Management
700 Governors Drive
Pierre, SD 57501
Phone: 605.773.3681
e-mail

 


Pamela S. Roberts, Secretary
700 Governors Drive
Pierre, SD 57501-2291
Tel. 605.773.3101
Fax. 605.773.6184

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