S.D. Admin. R. 47:03:04:05

Current through Register Vol. 51, page 71, January 6, 2025

Section 47:03:04:05 - Access to outside medical providers

A medical provider who is not a participating provider in the case management plan may provide medical services to an employee in any of the following circumstances:

(1) When the employee makes the initial selection of a medical provider pursuant to SDCL 62-4-1 and 62-4-43 and notifies the case management plan of that selection before treatment or as soon as possible after treatment has been provided;

(2) When the employee requires emergency treatment;

(3) When the case management plan refers the employee or approves a referral to a medical provider outside the case management plan for medical services; or

(4) When compensability for an injury or disability is denied by the insurer. The employer is liable for reasonable and necessary medical services if the injury or disability is later determined compensable. At the point that the injury or disability is accepted as compensable by the insurer or is determined to be compensable, the medical provider must comply with the requirements of § 47:03:04:06.

S.D. Admin. R. 47:03:04:05

20 SDR 45, effective 10/6/1993; 21 SDR 225, effective 7/5/1995; 26 SDR 10, effective 8/3/1999.

General Authority: SDCL 58-20-24, 62-5-21.

Law Implemented: SDCL 58-20-24, 62-4-45, 62-5-21.