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The employer’s refusal to claim opened the door to costs outside the network



A teacher who injured her back at work and who was operated on outside the state and outside her employer’s network should be compensated for her operation because the school district had initially denied her claim, the South Dakota Supreme Court ruled unanimously on Wednesday.

By amending an earlier decision of the Circuit Court, the state Supreme Court ruled that Rapid City School District’s initial position that Melissa Dittman’s claim from a 2017 back injury was not compensable opened the door for her to seek care that happened to be outside their network, in this case by a doctor in Vail, Colorado, to whom her doctor referred her, according to Melissa Dittman v. Rapid City School District and Dakota Truck Underwritersfiled in Pierre.

State law would have allowed the district and its employees̵

7; compensation insurers to be liable for the cost of an off-network provider if compensation had been denied, according to the court. A judge in the previous ruling said the ordinance did not apply because the school district and the insurer did not deny compensation in their amended letter decision to Ms. Dittman’s lawsuit.

Nevertheless, the state Supreme Court upheld the original decision to deny the claim: “The original response can only be read as a denial by the employer / insurer that Dittman’s injury was compensable … Long after the employer / insurer denied compensation and the referral occurred, (South Dakota Department of Labor and Regulation) allowed employers / insurers to change their response and accepted their claim that they had never denied compensation. ”


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