Marcia Hultman

Cabinet Secretary

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Division of Insurance

Workers' Compensation Information Related to the Division of Insurance

Workers' Compensation Program Information

The South Dakota Workers' Compensation program is an insurance program that pays medical and disability benefits for work-related injuries and diseases. Visit the Workers' Compensation Program webpage here.

Company 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

Pursuant to South Dakota Codified Law (SDCL) 10-44-2(4), fourteen dollars for each insurance policy issued or renewed for workers' compensation coverage shall be remitted to the Division of Insurance. The Policy Filing Fee Voucher is provided to allow for quarterly remittance of workers' compensation policy filing fees. Payment is due 30 days after the quarter period ends. Policy fee is not due on those policies that are canceled flat on the inception or renewal date.

Schedule Rating Worksheet (See Bulletin 10-04)

State Instructions for Assigned Risk Plan

Contact the Division of Insurance