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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.
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.
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.
Please note: It is no longer necessary to file the annual Medical Case Management Compliance Certificate with the South Dakota Division of Labor and Management.
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. 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.
The ALARIS Group, Inc., dba Paradigm Complex Care Solutions
4009 W. 49th St., Suite 201
Sioux Falls, SD 57106-5221
Avera Sacred Heart Managed Care
610 W. 23rd Street, Suite 1
Yankton, SD 57078
Broadspire Services, Inc., a Crawford Company
1001 Summit Boulevard, 10th Floor
Atlanta, GA 30319
3001 NE Broadway
Minneapolis, MN 55413
Coventry Health Care
5130 Eisenhower Blvd., Suite 150
Tampa, FL 33634
DynaPro Enterprises, Inc.
4009 E. Huntington Street
Sioux Falls, SD 57103
Excel Managed Care & Disability Services
3840-C Watt Avenue, Suite 200
Sacramento, CA 95821
Genex Care for South Dakota
2500 W. 49th Street, Suite 218
Sioux Falls, SD 57105
Healthcare Management Partners
2301 W. Russell Street
Sioux Falls, SD 57104
OHARA Managed Care
P.O. Box 89527
Sioux Falls, SD 57109
OMNI Case Management, LLC
503 S Cedat
Canton, SD 57013
NetCare Administrators, LLC
2301 Research Park Way
Brooking, SD 57006
4901 Isabel Place, Suite 130
Sioux Falls, SD 57101
Stubbe Dakota Case Management
610 East Boulevard, Suite 3
Rapid City, SD 57701
The information provided on this 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.