Denial letter doesn't revive expired claim for medical services

When an employer sends a denial letter after the statute of limitations for inactive matters has expired, the letter does not revive the running of a new statute of limitations.

Case name: Thurman v. Zandstra Construction, No. 25425 (S.D. 06/16/10).

Ruling: The South Dakota Supreme Court ruled that an employee's claim for additional benefits was barred under a three-year statute of limitations.

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What it means: When an employer sends a denial letter after the three-year statute of limitations for inactive matters has expired, the letter does not revive the running of a new two-year statute of limitations, which usually commences after a denial letter is sent.

Summary: The employee suffered a work-related injury, and the employer paid permanent partial disability benefits. The employee received his last medical treatment which the employer paid for. Nearly three years later, the employee contacted the employer to request additional benefits for past medical services. The employer did not pay the additional benefits. A year later, it sent a formal letter indicating that the request was denied. The employee petitioned for the additional benefits. The South Dakota Supreme Court ruled that a three-year statute of limitations barred the claim.

South Dakota law provides different statutes of limitation, and the parties disputed which applied. The employee argued that a two-year statute of limitations, which goes into effect when an employer gave formal notice that it denied or disputed an employee's claim, applied in his case. The employer argued that a three-year statute of limitations, which applies when an employer provided the employee with benefits for a period of time and gave no denial notice, leaving the matter inactive, applied. The court noted that the employee's position overlooked the fact that the three-year period to petition for benefits had already expired when the employer sent the denial letter. The court pointed out that many claimants seeking additional benefits after the three-year statute of limitations has expired will receive a denial letter from the employer.

The court concluded that when the employer sent a denial letter after the three-year statute of limitations expired, the letter did not begin another two-year period of limitations.

Read more at the WorkersComp Forum homepage.

September 2, 2010

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