State News : South Dakota

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South Dakota

BOYCE LAW FIRM, LLP

  605-334-0618

In South Dakota, Claimants must prove that "employment or employment-related activities were a major contributing cause of the condition of which the employee complained, or, in cases of a preexisting disease or condition, that the employment or employment-related injury is and remains a major contributing cause of the disability, impairment, or need for treatment." Norton v. Deuel Sch. Dist. No. 19-4, 2004 S.D. 6, ¶ 7, 674 N.W.2d 518, 521. Additionally, the South Dakota Supreme Court has held that “the claimant's work activities do not have to be ‘‘the’ major contributing cause’’ of the injury; they only have to be ‘‘a’ major contributing cause.’” Hughes v. Dakota Mill & Grain, Inc., 2021 S.D. 31, ¶ 20, 959 N.W.2d 903, 909 (citations omitted). “[T]he claimant has the burden of establishing a ‘causal connection between the employment and the disability.’” "Day v. John Morrell & Co., 490 N.W.2d 720, 724 (S.D. 1992) (quoting Lawler v. Windmill Restaurant, 435 N.W.2d 7010 (S.D.1989)).

Causation is a medical question, and “[t]he testimony of professionals is crucial in establishing this causal relationship because the field is one in which laymen ordinarily are unqualified to express an opinion.” Id.

We have started to encourage our clients to challenge claimants treating doctor(s) and their medical opinions with competing IMEs. In two separate 2023 cases, both of which are currently under appeal, the South Dakota Department of Labor (“the Department”) sided with the employer and the insurer finding that the claimants failed to meet their burden of proving that the work injuries were a major contributing cause of their conditions.

First in Roem v. E & N Street, LLC., HF No. 69, 2020/21, the claimant was suffering from a wide range of injuries including neck issues, headaches, right shoulder and arm pain, potential CRPS and chronic pain. The claimant had three separate treating doctors who looked at the neck injury. One of the doctors found the claimant’s injuries to be a major contributing cause, another stated that there could be other causes of the claimant’s neck issues but he did not know if the condition was preexisting, and the other did not see any objective evidence of acute injuries. The employer had an IME completed and the doctor found that the claimant had some degeneration in the neck as well as a lack of any acute findings. The Department found the IME doctor's opinions to be “more persuasive” and stated that his findings were “particularly significant.” As to the neck injuries, the Department held that the work incident was not a major contributing cause of the injury. When looking at the claimant’s shoulder injury, one of the treating doctors failed to provide an opinion connecting the shoulder issues to work, thus the Department held there was not sufficient evidence to meet the claimant’s burden of proof.  The Department continued to side with the IME doctor’s opinions on all alleged injuries often stating that the IME was “more persuasive” or that the treating doctor's opinions failed to establish the claimant’s burden of proof. Specifically, as to the CRPS diagnosis, the Department was not persuaded by the treating doctors' opinions because the opinions were “not definitive” and one of the doctors concluded that CRPS was “merely possible, but not probable.” The Department held that the claimant’s expert opinions did not meet her burden of proving medical probability or that the work was a major contributing cause of any of the injuries.

Similarly, in Pham v. Smithfield Foods, Sioux Falls, HF No. 8, 2020/21, the Department sided with the employer’s IME doctor's findings as opposed to the claimant’s treating doctors. Specifically, the Department was moved by the fact that the IME doctor reviewed all of the claimant's prior medical records when forming his opinion whereas the treating doctor failed to review the claimant's entire medical history. The Department stated that due to the treating doctor’s failure to review the claimant’s medical history in its entirety, his opinion was “not well-supported.” Additionally, the Department found the IME doctor’s opinion to be “more persuasive” and described his analysis of the claimant’s injuries as “particularly significant.”  

All in all, we are finding that an IME with strong opinions therein can persuade a factfinder that just because the claimant’s treating doctor makes an opinion or recommendation, does not mean that their opinion is always the most informed or proper under the circumstances. 

On August 24, 2022, the South Dakota Supreme Court issued its opinion in the matter of Douglas Ries v. JM Custom Homes, LLC, 2022 S.D. 52 indicating workers’ compensation was the only remedy available to Ries, an employee of JM’s subcontractor, under the workers’ compensation statutes SDCL 62-3-2 and SDCL 62-3-10.

Pine Tree Plumbing (“Pine Tree”) was a subcontractor of JM Custom Homes, LLC (“JM”). Ries was injured when he fell through a plywood stair while working as an employee of Pine Tree. Ries filed for workers’ compensation benefits against Pine Tree and Pine Tree’s insurer, Acuity Insurance. After Pine Tree and Acuity paid Ries’ workers’ compensation benefits, Ries filed a negligence claim against JM for failing to anchor the plywood or install handrails. In response, JM asserted the affirmative defense of statutory immunity under SDCL 62-3-2 and 62-3-10.

SDCL62-3-2 is an exclusivity provision, which limits an employee’s right to sue. The statute provides that, when an employer accepts liability for workers’ compensation, the employer is provided immunity against all other rights and remedies of an injured employee in return (except those arising from intentional torts). Also known as the “great compromise” the trade-off is a “quid pro quo” exchange inherently ingrained in South Dakota’s Workers’ Compensation Act.

SDCL 62-3-10 provides that a principal contractor (JM) is liable for workers’ compensation “to the same extent as the immediate employer” (Pine Tree). The statute extends liability upwards to general contractors for workers’ compensation claims from sub-contractor employees. However, it also extends the exclusivity provisions of SDCL 62-3-2 to general contractors, limiting a sub-contractor employees’ claims for injuries against higher-rung general contractors to workers’ compensation.

Under these statutes, JM argued that Ries’ sole remedy for his injuries was through workers’ compensation, and he could not sue JM for negligence. The circuit court agreed, and Ries appealed.

On appeal, Ries argued that JM’s insurance policy overrode the exclusive remedy provisions of SDCL 62-3-2. Ries argued that, under the language of the policy, JM was not liable for workers’ compensation claims of its subcontractors and, therefore, could not claim immunity from Ries’ negligence claims. In response, JM argued: (1) the language of the insurance policy was irrelevant; and (2) the policy provided coverage for workers’ compensation by stating “we will pay promptly when due the benefits required of you by workers compensation law.”

The Court determined the ultimate issue was whether JM accepted its obligation to be liable for workers’ compensation claims. If JM was deemed to have accepted its obligation by purchasing insurance coverage, Ries’ claims would be limited to workers’ compensation under SDCL 62-3-2, and JM would be entitled to immunity from Ries’ negligence claims. The Court determined that a private employer is deemed to have accepted its obligation under the Workers’ Compensation Act when it (1) purchases insurance (or enters into a reciprocal insurance agreement); or (2) complies with self-insurance rules.

The Court held the language of the insurance policy was relevant to determine whether JM had accepted its obligation to be liable for workers’ compensation. However, the Court found that JM’s policy secured the relevant coverage, so JM was deemed to have accepted its obligation under the Act. Accordingly, the Court held Ries’ sole remedy was limited to workers’ compensation, and affirmed the circuit court’s dismissal of Ries’ negligence claims against JM.

            Although the opinion reinforced long-existing precedent, it is also significant because it clarified the importance of, not only securing insurance coverage for workers’ compensation claims, but also ensuring that the policy’s language is sufficient to establish the employer’s acceptance of its workers’ compensation obligations under the laws of South Dakota. Failure to do so in this case may have exposed JM to liability for injuries of its subcontractor’s employee under a theory of negligence. As always, please feel free to contact us for more information.

On July 20, 2022, the South Dakota Supreme Court issued its opinion in the matter of Baker v. Rapid City Regional Hospital and Hartford Insurance, 2022 S.D. 40 affirming the denial of Permanent Total Disability (“PTD”) to the Claimant based in part upon deference to the South Dakota Department of Regulation, Division of Labor Management’s (the “Department”) factual determinations.

The Claimant, William Baker, was attacked by a patient and struck on the head in 2013 and 2014 while employed by the Rapid City Regional Hospital (“RCRH”). Baker was subsequently diagnosed with Post Concussive Syndrome (PCS), Post Traumatic Stress Disorder (PTSD), and anxiety. Years after the initial attacks, Baker continued to suffer from paranoia and obsession that purportedly limited his ability to work in public or interact with co-workers. However, it was unclear whether Baker’s symptoms were caused by the attacks at work or the stress from Baker’s ongoing litigation.

Baker argued the injuries he sustained at work remained a contributing cause of his mental impairments and he was entitled to PTD benefits. The Department held that even if Baker’s mental impairments were disabling, they were not caused by physical trauma from the injuries, and, therefore, he was not entitled to PTD. Baker appealed the Department’s decision to the Sixth Circuit Court, County of Hughes, Judge Christina Klinger presiding. The circuit court remanded the causation issue but affirmed the denial of PTD benefits.

Baker appealed the denial of PTD benefits to the Supreme Court, arguing: (1) the circuit court erred in denying his claim for PTD as he made a prima facie showing of obvious unemployability; and (2) RCRH and Insurer failed to meet their burden of proving suitable employment was available to Baker, because their vocational expert failed to inform potential employers of all of Baker’s limitations.

The Court agreed Baker did make a prima facie showing of obvious unemployability. However, the Court declined to impose “the exacting requirement suggested by Baker that the employer must speak with each prospective employer and inform them of claimant’s limitations.” Instead, the Court concluded an employer need only “show more than a general availability of jobs to persons with some of claimant’s disabilities.”

Baker further argued he was unemployable as he could not work around other people due to his mental condition. However, RCRH and Insurer’s vocational expert provided examples of 24 different available jobs, most of which would allow Baker to work without significant interaction with other co-workers. The positions were approved by one of Baker’s treating physicians, and Baker testified the positions would allow him to work individually. However, Baker never applied to any job position. Deferring to the Department’s personal observations regarding Baker and whether he was permanently totally disabled, the Court affirmed the Department and the circuit court’s determinations that Baker failed to meet his burden to show his impairments prevented him from obtaining employment.

Although the opinion generally reaffirms long-established precedent regarding odd-lot disability benefits, the opinion is unique insofar as it is the first time the Supreme Court has encountered a claim for odd-lot benefits based upon a mental condition, rather than a “physical condition” as stated in SDCL 62-4-53 (stating “An employee is permanently totally disabled if the employee’s physical condition . . . causes the employee to be unable to secure [employment]”). The Court questioned whether the Legislature ever intended to allow PTD benefits for a mental condition in the first place under the statutory language of SDCL 62-4-53. However, the Court declined to answer the question, as the issue was not challenged on appeal.

On June 2, 2021, the Supreme Court of South Dakota released its opinion in the matter of Hughes v. Dakota Mill & Grain, 2021 S.D. 35, which addressed the Court’s interpretation of the causation standard of “a major contributing cause.”.  Although this opinion addresses aspects of the causation standard (i.e., what a claimant does not have to prove), it does not give clear direction regarding how medical experts should interpret the causation standard when there are multiple causes for the condition from which the injured worker complains.

Claimant, Taylor Hughes, worked various construction and heavy labor jobs from the time he left high school in the ninth grade (2004) until his employment with Dakota Mill & Grain (the “Employer”) in 2017.  In 2010 and 2011, prior to his employment with Employer, he underwent two back surgeries that he related to his work activities with a prior employer Hughes reported no real back issues between 2014 and 2017.  Hughes began working for the Employer in 2017.  Before being cleared to work for the Employer, Hughes underwent a physical examination.  At the physical, Hughes reported no back problems and was approved by the examining doctor to start work.  Hughes’ job duties with the Employer included heavy labor.  Several months after starting with the Employer, Hughes claimed that he injured his back when he fell off a skid-loader but did not report the injury.  Five days after the injury, Hughes went to the emergency room complaining of back pain similar to the pain experienced from his prior injury with his previous employer.  An MRI after the work injury in 2017 detected a herniated disk in Hughes’ back, and Hughes complained of shooting pain down his legs.  Hughes filed a worker’s compensation claim against the Employer.

The South Dakota Department of Labor (the “Department”) held an administrative hearing.  At the hearing, conflicting expert testimony was submitted regarding whether Hughes’ symptoms were the result of degenerative back conditions from the prior injuries sustained while working for his previous employer, or whether they were caused by Hughes’ fall from the skid-loader and related to the work injury of June 26, 2017, reported to the Employer.  The Department determined that Hughes failed to show that his disability was caused by a workplace injury and failed to show that his work activities with the Employer were a major contributing cause of the injury.  The Department’s decision was appealed.  The decision was appealed to the Sixth Judicial Circuit in Hughes County, South Dakota.  The Circuit Court reversed the Department’s decision, finding that the Department committed clear error in reaching the decision, and the matter was then appealed to the South Dakota Supreme Court (the “Court”).

On appeal, the Court addressed two issues.  The first issue was whether the Department erred in determining Hughes failed to establish that he sustained an injury that arose out of his employment. The Court identified three instances where an injury is said to “arise out of” the employment under South Dakota law: (1) the employment contributes to causing the injury; (2) the activity is one in which the employee might reasonably engage; or (3) the activity brings about the disability upon which compensation is based.  The Court determined that an employee need only show that the employment was “a contributing factor” to the injury to establish this element.

The Court agreed with the Circuit Court and overturned the Department’s determination that Hughes’ disability was not “caused by” a workplace injury. The Court held that the correct standard to determine whether an injury “arose out of” Hughes’ employment should have been whether Hughes’ work activities “contributed to” his injury.  The Court held that, under the correct standard, Hughes established that his injury arose out of and in the course of his employment with the Employer by a preponderance of the evidence because Hughes reported that he felt “100 percent” before beginning work with the Employer, Hughes informed his supervisor that his back was sore the day he fell off the skid-loader, and the work Hughes performed with the Employer included activities that would aggravate one’s back.

The second issue determined by the Court was whether Hughes established that his’ work activities were a major contributing cause of his condition.  The Court determined that, under SDCL 62-1-1, the test for causation when a person has a pre-existing work injury is whether the injury was a major contributing cause of the injury.  Relying on Orth v. Stoebner & Permann Constr., Inc., 2006 S.D. 99, 724 N.W.2d 586, the Department found that a major contributing cause was “a cause which cannot be exceeded.”  The Department determined that because 60% of Hughes’ condition was caused by other factors, any of which could have exceeded 40%, Hughes did not meet the causation threshold.

The Court found that a claimant does not need to reach a 50% threshold to establish causation or show that the work activities were the sole cause of the injury.  Instead, the Court determined that the injury only needs be determined to be a major contributing cause.  Although both experts agreed that from 2012 through 2017 Hughes’ showed an increasing disc bulge in his back, the Court ultimately sided with Hughes’ expert and found that the work activities were a major contributing cause of his condition and he had proven this by a preponderance of the evidence.  In doing so, the Court adopted the opinion of Hughes’ expert determined that because Hughes was symptom-free before working for the Employer; because he had worked full-time for months without complaint prior to his injury with the Employer; and, because he had not been utilizing pain medication or back injections for years prior to the injury, his work activities were a major contributing cause of his condition.

As noted above, this decision gives direction from the Court on what “a major contributing cause” standard is not.  However, the Court left open the definition of “a major contributing cause” by adopting the definition provided by Hughes’ expert stating that “a major contributing cause” is “not the only cause, not the most significant cause, just a major contributing cause.”  When reviewing cases for causation, this new direction from the Court should be taken into consideration.

Let’s take a moment to consider this hypothetical scenario:

 

John Smith is at work for the Widget Company working on the assembly line.  Mr. Smith has been working for about 10 hours when he faints, causing him to fall and hit his head on the ground beneath him.  The Widget Company gets Mr. Smith to an emergency room where several tests are run to determine the cause of Mr. Smith’s fainting spell.  A review of the diagnostic testing and Mr. Smith’s medical history uncovers that Mr. Smith has a history of fainting due to a personal health condition and he has experienced these fainting spells several times in the background. The Emergency Room physician tells Mr. Smith that the fainting spell was related to his personal health condition and provides him recommendations how to address this issue in the future.

 

Now, the million-dollar question:  Is the diagnostic testing performed on Mr. Smith a covered benefit under South Dakota workers’ compensation law?

 

Whenever the purpose of the diagnostic test is to determine the cause of a claimant’s symptoms, which symptoms may be related to a compensable accident, the cost of the diagnostic test is compensable, even if it should later be determined that the claimant suffered from both compensable and noncompensable conditions.  Mettler v. Sibco, 2001 S.D. 64, ¶ 9, 628 N.W.2d 722, 724.  

 

We get several questions about whether or not diagnostic testing is compensable when the ultimate outcome relates the reason for the event pointing to a personal health condition.  However, keep the above case law in mind when evaluating the responsibility for payment of diagnostic testing to determine the medical explanation for an accident or injury.

 

As always, please call us if you have any questions, we are happy to help. 

 

The first decision of 2018 involves a permanent total disability claim heard by Judge Thronson. This is the first decision we have seen from Judge Thronson following a hearing. There were a number of issues presented at hearing and the Department found in Claimant’s favor on all of them.

The first issue was whether the work injury was a major contributing cause of Claimant’s condition. Frankly, this part of the opinion is difficult to understand. The opinion starts by stating the Insurer argued that Claimant could not prove that the accident, and not some other unrelated medical condition, was responsible for her condition. There is then some discussion of cervical stenosis and the Department of Labor states the injury need only be a major contributing cause, not the major contributing cause. Despite that, the Department then states that Dr. Cederberg, the IME doctor, provided the medical opinion that the work injury was a major contributing cause to the disability. If the IME doctor relates the injury to work, it is not at all clear why it would have been an issue at hearing. Regardless, the Department found the injury was a major contributing cause of the condition complained of.

The next question was whether Claimant was permanently and totally disabled. Claimant had a $691.00 per week comp rate. She was 61 years old with a high school diploma, and her vocational expert, Tom Audet, testified she would be unable to work within her restrictions and make at least her workers’ compensation rate. The Employer and Insurer did not have their own expert at the hearing. The Department of Labor accepted Audet’s testimony that Claimant was in the odd-lot category. The most interesting part of this opinion was in the Department’s analysis of whether Claimant conducted a good faith job search. Claimant looked for 26 jobs between December of 2014 and May of 2015. It appears she did not make any other job search and the hearing was in August of 2017. If that is correct, Claimant would have gone more than two (2) years without looking for work. The Department held that “no case law in South Dakota specifies that a job search need be made in any particular timeframe.” What constitutes a reasonable job search depends on the facts, but it’s curious that the Department of Labor found the job search to be reasonable as it focused only on the 26 job contacts over a five-month period and did not make any mention that Claimant failed to look for work for more than two (2) years, or attempt to address why the Department was not concerned with this seemingly relevant fact. The Employer and Insurer’s lack of an expert may have been the determining factor here as there was no evidence that a job search would have made a difference.

The final claim was that Claimant refused medical care, and thus, aggravated her condition. Claimant was prescribed a second round of physical therapy but did not proceed forward with it. The IME doctor indicated the failure to complete the second round of physical therapy aggravated Claimant’s shoulder. The Department of Labor stated the evidence was insufficient to establish that the physical therapy would have helped Claimant’s condition as the first round of physical therapy did not provide much benefit. Moreover, the Department of Labor did not find Claimant at fault for failing to attend physical therapy as Claimant had difficulties in obtaining authorization from the Insurer on getting therapy. The Department stated, “Claimant cannot be penalized for failing to attend physical therapy sessions which are not available to her.”

If you have questions regarding this decision or any other South Dakota questions, please contact the Boyce Law Firm at 605-336-2424 or contact Charles Larson at calarson@boycelaw.com

I hope this finds you doing well. I have received many inquiries over the last couple of weeks on when temporary disability benefits are owed. I think that the confusion comes from the mislabeling of the benefits. There is a difference between TTD and TPD benefits, even though the amount may be the same. TTD is paid when the employee is ordered completely off of work. If there is a compensable claim, benefits are owed regardless of other factors. For instance, if the employee is ordered completely off work, and is unable to work because he is in jail, you’d still owe TTD benefits. The reason for this is that the standard for whether any benefit is owed is whether the work injury is and remains a major contributing cause to the benefit sought. If the employee is ordered completely off work, the employee being in jail makes no difference as he couldn’t work whether he is in jail or not as the doctor has taken him off of work.

The analysis changes once employee has been released to work by the doctor, even if the employee has not actually returned to work. Let’s take our employee who is in jail. When he was ordered completely off of work, his incarceration did not matter as he wouldn’t be able to work even if he was a law- abiding citizen. Once he is released to work, you would ask whether the work injury is and remains a major contributing cause to his inability to work. If the employer could accommodate the restrictions, you would stop paying benefits because the reason the employee cannot work is not related to his work injury, but, instead, from the fact that he is incarcerated. However, let’s say the employer cannot accommodate the restrictions when the employee is released to work, then what? You would still pay TPD in that situation because whether he is in jail or not makes no difference as he would not be working anyway. You would continue paying benefits until the employee is released to work full duty, receives an impairment, or the employer is able to accommodate the restrictions.

If confused, just ask yourself whether the work injury is a major contributing cause to the inability to work. If the employee is ordered off of work by the doctor because of the work injury, the answer is yes and you would owe TTD benefits. If the employee has been released to work but is not working, ask yourself “Why isn’t he working? Is it related to his injury?”

TTD and TPD are often interchanged, however the distinction is important because TPD benefits have defenses available. Always look to the doctor’s restrictions – not whether the employee is actually working. The proper question does not begin with the work status. Instead, the proper question is whether the employee has been released to work. If you have questions on this or any other issue, please contact Boyce Law Firm at 605-336-2424.

South Dakota is a rural, expansive state with many smaller towns throughout. There are very few major health care providers within the state. There are also very few doctors that will perform independent medical examinations within the state. On occasion, we are forced to ask a claimant to travel outside his community to have the IME performed. The question then becomes what time and (more importantly) place are “reasonably convenient for the employee” to attend the IME. Unfortunately, there is no hard and fast rule and each claim must be reviewed independently.
SDCL 62-7-1 allows for compulsory medical examinations (a/k/a IMEs) at employer’s/insurer’s request. However, the IME must occur “at a time and place reasonably convenient for the employee.” Sometimes it will be necessary for a claimant to travel several hours or several hundred miles to attend the IME due to the location of the IME doctor. On occasion, a claimant will claim the distance is not “reasonably convenient” due to being in pain from sitting for long periods of time or simply unable to travel due to finances. The South Dakota Supreme Court has not interpreted what “reasonably convenient” means. However, the South Dakota Department of Labor has taken into consideration a Claimant’s pain when traveling for an IME and determined that sometimes traveling is the best of a bad situation. See, Dale L. Dobson vs. Homestake Mining Company, 1995 WL 529827, HF No. 87, 1994/95 (SD Dept. Labor). In these situations, it is best to calculate the approximate costs the claimant will incur to attend the IME (mileage, hotel, meals) and prepay those amounts. Sometimes it is worth allowing the claimant several days to travel to and from the IME in order to reduce the amount of time in a car or bus. On other occasions, it may be best to fly the claimant to the IME instead of making them drive. If these considerations are given to the employee, you have the best chance of convincing the Department of Labor the IME was at a time and place reasonably convenient to the employee if the claimant refuses to attend the IME.
As mentioned above, each claim is a different so determining what is reasonably convenient for the employee depends on that particular set of circumstances. If you have any questions on this topic, feel free to contact us.

There can be little doubt as to the popularity and effectiveness of alternative dispute resolution (ADR) when dealing with workers’ compensation claims. The uncertainty, expense, and time involved necessitates that most claims get resolved through mediation outside of an administrative hearing and likely appeal through the court system.

Through my years of practice, I have discovered that one seldom used form of ADR is mediation followed by arbitration of issues on which the parties are deadlocked. Med-Arb, as it is referred to in the ADR world, can be a very effective tool for many claims.

Because the Department of Labor (DOL) must approve all workers’ compensation resolutions, the parties must first agree that the decision of the arbitrator will be binding, and the decision will be submitted to the DOL for adoption and approval. Such an agreement is then presented to the DOL, followed by an order entered by the DOL agreeing to adopt, as its own, the arbitrator’s decision, findings and conclusion. The parties then proceed to attempt mediation of the case. If a settlement is reached on all issues, a settlement agreement is prepared, signed and submitted for DOL approval. If the parties are deadlocked on some, or all issues, the mediation is then converted to an arbitration and submitted to the arbitrator for decision and later adoption by the DOL.

While theoretically any claim could utilize Med-Arb as an ADR tool, the claims that stand to benefit the most are those where medical causation is in dispute on some portion of the claim, and entitlement to future medical expenses is an issue. In those situations, my experience has proven that often the underlying claim is more easily resolved if the medical dispute can be resolved as well.

Med-Arb deserves your consideration on many claims. If there are questions, please do not hesitate to let me know.

By now, those of you reading this blog know that in order for an injury to be compensable in South Dakota, the injury must arise out of and be in the course of the employment. Pretty straight forward, right?

Not so much.

While South Dakota adopts the “coming and going rule, establishing that an employee is not covered for purposes of workers’ compensation while coming from and going to work, the law has also established a ‘gray area’ regarding what is, and what is not. covered. Three seminole cases in South Dakota address this topic: Norton v. Deuel Sch. Dist. 2004 S.D 6; Fair v. Nash Finch Co., 2007 S.D. 16; and Terveen v. South Dakota Dept. of Transp. 2015 S.D. 10. These cases make it clear that a fact investigation into a workers’ compensation claim must include an analysis of minute details of the claim.

In Norton, the SD Supreme Court found that personal activities involving self-care, such as eating, resting, smoking, or using bathroom facilities should be considered in the course of employment. In Fair, the Court found that an employee’s deviation from work duties does not ‘automatically constitute departures from employment, but may … be found insubstantial.’” Fair was injured while she was exiting Family Thrift after a brief deviation from her usual direct route to her vehicle. The Court found that while it was reasonable to expect employees to exit the premises after work, it was also reasonable to expect Fair to engage in personal shopping after her shift had ended. Thus, the Court found that mere fact that an employee deviates from their work does not preclude a finding that the injuries are compensable.

Insubstantial deviations have been defined as those “largely the kind of momentary diversions which, if undertaken by an inside employee working under fixed time and place limitations, would be compensable under the personal comfort doctrine.” Arthur Larson, Larson Workers’ Compensation § 17.06[3] (2014). If someone engaged in an act for personal comfort, they do not leave the course of employment unless the extent of the departure is so great that an intent to abandon the job temporarily can be inferred. Id. at §21. In Terveen, the Court adopted the majority rule around the nation, finding that an employee who has made a personal side-trip has to ‘get back on the beam’ before being deemed to have resumed the business trip. Id. § 17.03[5]. Additionally, the Court noted that the deviation cannot be substantial.

Now you are probably wondering, what information you need to find out during an investigation. Some information you need to know will include finding out what the employee was doing at the time of the injury; did the employer authorize, expressly or impliedly, that running personal errands was acceptable; was the employee on their typical route home, did they get lost, or, perhaps, were they stopping for food? These cases are very fact specific so be sure to take the time to gather all the facts you need to make a determination.

As always, we are here and happy to help. Give us a call anytime.