Workers' Compensation Toolkit

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This kit is provided to new workers' compensation policyholders and their agents, as well as to all current policyholders when their policies renew. It contains important claims department contact information, instructions, and forms.


South Dakota Contact Information:

Nationwide Insurance - West Office
One Nationwide Gateway, Dept. 5574
Des Moines, IA 50391-5574
(800) 532-1212
Fax: (800) 562-4339

Harleysville Insurance
PO Box 244
Harleysville, PA 19438-0244
(888) 595-9876
Fax: (800) 441-4118

Agribusiness Mailing Address for Claims Related Mail
1100 Locust St., Dept 3010
Des Moines, IA, 50391-3010
Phone: (800) 228-6700
Fax: (800) 842-1482

 

NOTE: If you experience difficulty opening/accessing the PDF's using the links below:

Open to access the documents


South Dakota Compliance Information

Posting Requirements

Reporting Of Claim By Employer

Penalties for Late Reporting

Physician Selection


Posters and Publications

POSTER - Safety on the Job Poster Required


POSTER - Safety on the Job Poster (Spanish) Required

BROCHURE - An Employee's Guide to the South Dakota Workers' Compensation System


Forms

First Report of Injury - Employer's form (insurers must use online management system to file the First Report of Injury with the Department of Labor and Regulation.)


Request for Extension of Time (Complete and submit online using the First Report of Injury Management System)

Statement of Weekly Earnings






Please Note: The information on this site is maintained by a third-party, Nationwide does NOT warrant or represent that the information will be error-free. Your use of the site is on an as-is basis, at your sole discretion and risk. The site is for informational purposes, and nothing included in the site shall replace the need for qualified legal counsel. We recommend that you consult with legal counsel, agents, or risk managers regarding workers' compensation obligations.

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