Petition For Hearing

SD EForm - 1657 V1 - PETITION FOR HEARING. This form is used in South Dakota for workers' compensation claims. It is filed with the South Dakota Department of Labor and Regulation, Division of Labor and Management when an injured worker (the claimant) seeks a formal hearing to resolve a dispute regarding their workers' compensation benefits. The form requires details about the claimant, their employer, and the insurance company providing workers' compensation coverage. It also documents the date and location of the injury, the body part(s) affected, a description of how the injury occurred, and any resulting disabilities. The claimant must also state whether their employer had knowledge of the injury within three days, as required by law. By submitting this form, the claimant is requesting a hearing to determine their eligibility for workers' compensation benefits, which may include medical expenses, lost wages, and disability compensation under the South Dakota Workers’ Compensation Act. www.FormsWorkflow.com