Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

Workers' Compensation in South Dakota

Forms and Resources

The following forms and resources are provided in Adobe .pdf format unless otherwise noted.

First Report of Injury (online reporting system; requires log-in)

Independent Contractor Affidavit of Exempt Status and Fact Sheet

Loss Cost Multipliers

Policy Filing Fee Voucher

Schedule Rating Worksheet (See Bulletin 10-04.)

South Dakota Medical Data Report 2013

State Instructions for Assigned Risk Plan

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Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369