Changing Your Treating Physician in a South Dakota Workers' Compensation Case

After getting hurt on the job in Sioux Falls, Rapid City, or Aberdeen, many employees follow their supervisor's instructions and head straight to an occupational clinic chosen by the company. Weeks later, when the clinic doctor rushes them back to full-duty work despite severe back or shoulder pain, the frustrated worker schedules an appointment with their own family physician or an orthopedic specialist across town-only to discover months later that the workers' compensation insurer refuses to pay a single dime of the new doctor's bills.

In South Dakota, medical provider selection is governed by a strict statutory balance: employees hold powerful rights at the very beginning of a claim, but changing course later without following the exact legal protocol can trigger devastating financial consequences. Understanding how initial selection, specialist referrals, second opinions, and unauthorized care work under South Dakota law will protect both your physical recovery and your bank account.

Initial Doctor Selection Rules in South Dakota

Unlike states that allow employers to dictate medical care from day one, South Dakota is an initial employee-choice state. Under S.D. Codified Laws § 62-4-43, an injured worker has the statutory right to make the initial selection of their medical practitioner or surgeon from among all licensed practitioners in the state. To lock in this right, you must notify your employer in writing of your chosen physician either prior to the injury or within a reasonable time after the accident.

However, two important nuances affect how this initial choice plays out in practice:

• Emergency Care vs. Ongoing Treatment: Being taken by ambulance to an emergency room at Sanford USD Medical Center, Avera McKennan, or Monument Health immediately after a workplace trauma does not typically count as exercising your voluntary choice of a continuing treating physician. Once emergency stabilization ends, you can designate your primary treating doctor in writing.
• Certified Case Management Plans: Under S.D. Codified Laws § 58-20-24 and S.D. Admin. R. 47:03:04:05, insurers often utilize state-certified medical case management plans. Even when a case management plan is in place, you still retain the right to make your initial selection of a treating doctor, and if the insurer denies compensability of your claim altogether, S.D. Admin. R. 47:03:04:05 explicitly allows you to treat with a provider outside the plan while holding the employer liable for reasonable and necessary expenses if you later prove your claim is compensable.

When Do You Need Employer/Insurer Approval?

Once you have selected-or acquiesced to-your initial treating physician, your ability to see other medical providers depends entirely on whether the new doctor is part of a formal referral chain or represents a complete change of primary physician.

Under S.D. Codified Laws § 62-4-43, South Dakota law draws a sharp legal line between referrals and doctor switches:

1. Referrals Do Not Require Separate Insurer Permission: Your authorized initial treating physician has full statutory authority to arrange for any consultation, referral, or extraordinary or specialized medical services that the nature of your injury requires. For example, if your authorized primary care doctor refers you to an orthopedic spine surgeon, a neurologist, or a physical therapist, that specialist automatically steps into the authorized chain of care without needing separate permission to switch doctors.
2. Changing Your Treating Doctor Requires Written Approval: If you are unhappy with your initial doctor's bedside manner, diagnostic thoroughness, or return-to-work restrictions and want to switch to a different primary doctor on your own, S.D. Codified Laws § 62-4-43 mandates that you obtain approval in writing from the employer or insurer before making the change.

South Dakota Supreme Court case law reinforces these strict statutory rules:

• In Dittman v. Rapid City School District, 976 N.W.2d 797 (SD Supreme Court 2022), the court examined S.D. Codified Laws § 62-4-43 alongside S.D. Admin. R. 47:03:04:05, confirming that when an insurer denies compensability, the employer remains liable for reasonable and necessary medical services under S.D. Codified Laws § 62-4-1 once the worker establishes the treatment was causally related and necessary.
• In Cozine v. Midwest Coast Transport, Inc., 454 N.W.2d 548 (SD Supreme Court 1990), the court emphasized that once an injured employee selects a treating physician, the statutory framework governs any subsequent referrals or attempts to change providers.
• In Kendall v. John Morrell & Co., 809 N.W.2d 851 (SD Supreme Court 2012), the court addressed disputes involving medical treatment compliance under S.D. Codified Laws § 62-4-43 and held that any formal written notice denying medical coverage triggers the strict 2-year statute of limitations under S.D. Codified Laws § 62-7-35.

Seeking Second Opinions for Surgery

When an injured worker is told they either need invasive spinal or joint surgery-or, conversely, that nothing surgical can be done to fix their torn tendon-seeking a second opinion is a natural step. In South Dakota, how you arrange that second opinion determines who pays the bill:

• Physician-Referred Consultation (Insurer Pays): Ask your current authorized treating doctor to write a formal clinical referral to a specialist for a surgical consultation. Because S.D. Codified Laws § 62-4-43 empowers your treating practitioner to arrange consultations and referrals as the nature of the injury requires, a properly referred surgical consult is covered by the workers' compensation insurer under S.D. Codified Laws § 62-4-1.
• Independent Second Opinion (Employee Pays): If your treating doctor refuses to write a referral and the insurer refuses to authorize a switch, S.D. Codified Laws § 62-4-43 states that an employee may seek a second opinion without the employer's approval at the employee's expense. While you have to pay for that single consultation visit out of pocket, if the second-opinion surgeon discovers a missed tear or herniation on your MRI, a workers' compensation attorney can use that report to petition the Department of Labor to authorize the surgery.

What Happens If You See an Unauthorized Doctor?

Bypassing the statutory process and treating with an unapproved doctor without a referral or written insurer consent creates three severe financial and legal hazards:

• 100% Personal Liability for Medical Bills: S.D. Codified Laws § 62-4-43 explicitly provides that the employer is not responsible for medical services furnished or ordered by any medical practitioner or surgeon selected by the employee in disregard of the statute's provisions. If an unauthorized surgeon performs a $45,000 shoulder operation or orders a $3,000 MRI, the workers' compensation carrier can legally refuse to pay the bill.
• Private Health Insurance Denials: Many workers assume their private health insurance (such as Wellmark Blue Cross, Sanford Health Plan, or Avera Health Plans) will cover unauthorized care. However, group health policies routinely exclude work-related injuries or demand proof of a formal workers' compensation denial before paying, leaving the worker personally responsible for medical collection actions.
• Loss of Weekly Disability Checks: Insurers generally only honor off-work slips and light-duty restrictions issued by an authorized treating physician. If you stop seeing your authorized doctor and rely on an off-work note from an unauthorized provider, the insurer may suspend your Temporary Total Disability (TTD) payments or claim you abandoned authorized medical care.

Step-by-Step Process in South Dakota

If you are dissatisfied with your current medical care in Sioux Falls, Rapid City, Brookings, or anywhere in South Dakota, follow these steps to change providers legally without risking your coverage.

Step 1: Designate Your Initial Treating Doctor in Writing

Immediately after reporting your injury on Form 101, South Dakota, Department of Labor and Regulation, Employer's First Report of Injury, send a dated email or letter to your employer and the insurance adjuster stating the exact name and clinic of the licensed physician you are selecting as your initial treating doctor under S.D. Codified Laws § 62-4-43.

Step 2: Request a Specialist Referral From Your Current Doctor

Before trying to fire your current doctor, ask them during an appointment to refer you to an orthopedic surgeon, neurologist, or pain management specialist. Make sure the referral is documented in your clinical chart notes and transmitted to the insurance adjuster.

Step 3: Submit a Formal Written Request to Change Physicians

If your relationship with your initial physician has broken down and a referral is not an option, send a formal written request to the workers' compensation claims adjuster asking for written approval to transfer your primary care to a specific named physician pursuant to S.D. Codified Laws § 62-4-43. Explain the objective medical reasons for the request, such as the need for specialized care closer to your home or lack of clinical progress.

Step 4: Petition the Department of Labor Over Unreasonable Refusals

If the insurer refuses to approve a necessary change of physician or blocks valid referrals ordered by your treating doctor, you can file a Petition for Hearing under S.D. Codified Laws § 62-7-12 with the South Dakota Department of Labor and Regulation, Division of Labor and Management, Pierre. Decisions from the Department can be appealed to the Minnehaha County Circuit Court, Sioux Falls, the Pennington County Circuit Court, Rapid City, or the Brookings County Circuit Court, Brookings, and up to the South Dakota Supreme Court, Pierre.

How Much Does it Cost in South Dakota?

Comparing the financial impact of authorized versus unauthorized medical care highlights why following S.D. Codified Laws § 62-4-43 is essential:

If you hire a workers' compensation attorney to fight a denied treatment or referral dispute, there are no upfront legal fees. Under S.D. Codified Laws § 62-7-36, attorney contingency fees are capped at 25% of disputed benefits recovered by settlement, 30% after an administrative hearing or Circuit Court appeal, and 35% if won at the South Dakota Supreme Court.

How Long Does the Process Take?

Timing is critical when managing medical providers in a South Dakota workers' compensation claim:

• Initial Physician Notice: Under S.D. Codified Laws § 62-4-43, you must notify your employer in writing of your initial physician choice prior to the injury or within a reasonable time thereafter (ideally alongside your 3-business-day injury notice under S.D. Codified Laws § 62-7-10).
• Insurer Response to Change Requests: Insurers and case management plans typically take 7 to 21 days to review and respond in writing to a formal request to change primary treating physicians or pre-authorize non-emergency surgery.
• Statute of Limitations After a Medical Denial: Under S.D. Codified Laws § 62-7-35, if the insurer sends written notice to you and the Department of Labor denying a requested referral, surgery, or physician change, you have 2 years from the date of that written denial to file a Petition for Hearing.

Before scheduling an appointment with a new doctor on your own and risking thousands of dollars in unpaid medical bills, consult a local South Dakota workers' compensation lawyer in our directory to help you secure a valid referral or written insurer authorization.

Frequently Asked Questions (FAQ)