SD Worker’s Letter Asking for “Review of Benefits” Was Inadequate to Toll Limitations Statute
Acknowledging the relative informality within the South Dakota workers’ compensation laws as well as the public policy that the state’s Workers’ Compensation Act and its rules should be construed liberally in favor of the claimant, the Supreme Court of South Dakota nevertheless agreed with the Department of Labor and Regulation and a circuit court that a letter sent by the injured worker to his employer’s workers’ compensation insurer did not constitute a petition for hearing under ARSD 47:03:01:02 [May v. Spearfish Pellet Co., LLC, 2021 SD 48, 2021 S.D. LEXIS 89 (Aug. 18, 2021)]. The Court found that the rule specified the relevant information that must be communicated to the Department in order to constitute a petition. The Court ruled the worker’s letter had omitted important details and could not, therefore, constitute a petition. Because the injured worker did not seek counsel and instruct his counsel to file a petition on his behalf until after the two-year statute of limitations had run, the worker’s claim was denied as untimely.
Background
May injured his left shoulder at work in 2009, and in 2010, he injured his right shoulder at work. The workers’ compensation insurer for his employers treated May’s injuries as compensable and paid workers’ compensation benefits, including multiple surgeries, until 2014. In December 2013, May sent a letter to the insurer seeking a review of his workers’ compensation benefits. May sent a copy of this letter to the Department of Labor and Regulation. A claims adjuster informed May that the insurer had discontinued his disability payments because the employer had offered May work within his restrictions, and he had declined the position due to reasons unrelated to his shoulder injuries. The adjuster further noted that documentation did not support a conclusion that May’s shoulder injuries caused his claimed ailments. The adjuster also noted that May had “2 years to file a petition” with the Department if he disagreed with the Insurer’s determination.
In February 2014, May sent another letter to the insurance adjuster, with a copy to the Department, which mirrored his December 2013 letter. In April 2015, May retained counsel. In March 2017, May’s counsel wrote to the adjuster contending that the February 2014 letter constituted a valid petition for hearing. The adjuster responded that the insurer’s January 2014 letter informed May that he had two years to file a petition for a hearing with the Department and argued that the February 2014 letter was not a petition for hearing.
Department Says Improper Notice
In November 2018, May filed a motion with the Department requesting a determination that the February 2014 letter constituted a valid petition for hearing. The Department determined that ARSD 47:03:01:02 required a petition to include all of the information listed in the rule, and it determined that the February 2014 letter failed to include all the rule’s required information. Specifically, it noted that the letter did not clearly identify a specific injury for which May was seeking compensation, the time and place of a specific accident, the manner in which the accident occurred, the nature and extent of the disability, and that May’s employer received proper notice of the injury. The Department concluded that the February 2014 letter did not constitute a petition for hearing.
Circuit Court Agrees with Department
On appeal to the circuit court, the court determined that ARSD 47:03:01:02 was unambiguous, that a petition for hearing must include all the information listed in the rule, and that the February 2014 letter failed to meet the rule’s requirements because it did not state clearly the cause of action for which May sought the hearing, failed to specify the time, place, and manner of May’s injuries, and failed to describe the nature and extent of May’s disability. The circuit court affirmed the Department’s decision, and May appealed.
SD Supreme Court Affirms
May acknowledged that his 2014 letter did not state that the employer had proper notice and did not contain the exact dates of his work injuries. However, May contended that requiring the inclusion of each specific piece of information listed in ARSD 47:03:01:02 ran contrary to the informal nature of South Dakota’s workers’ compensation procedures. Further, he argued that to conclude otherwise would result in the dismissal of claims based on mere technicalities.
The Supreme Court noted that ARSD 47:03:01:02 began by stating that the petition “need follow no specified form.” Further, in earlier decisions, the Court had said that workers' compensation administrative rules, like the statutes that the rules implement, were to be construed liberally in favor of the claimant. The Court stressed, however, that even when construed liberally, May’s letter failed to meet the content requirements of ARSD 47:03:01:02. May had not addressed his letter to the Department, but rather merely copied the Department on a letter addressed to Insurer. The letter failed to include even such basic information as the name of either of May’s employers. It also did not state where the injury to his left shoulder occurred, nor did it state the time, location, or details describing his right shoulder injury.
Finally, because May intertwined in the explanation of his disability a description of his other physical ailments, the letter could not be read to identify the nature and extent of his disability. The Court noted that May first discussed a heart problem, then a shoulder injury, returned to a heart problem, went back to shoulder issues, and finally discussed a myriad of health issues that allegedly resulted from his shoulder surgeries. Given these inadequacies, the Department and the circuit court did not err in determining that the February 2014 letter was not a petition for hearing under ARSD 47:03:01:02.
Author’s Note: For additional discussion of this issue, see Larson’s Workers’ Compensation Law, §§ 124.01, 124.04.