Department of Labor and Regulation

Title - Workers' Compensation

First Report of Injury

You may file your First Report of Injury (Form 101), your Monthly Payment Reports (Form 107) and a Request for Extension of Time online using the First Report of Injury Management System.

Filing Online using the First Report of Injury Management System
(for insurance companies only)

If you are doing simple online data entry, all you need is a userid and a password. These can be obtained by emailing or calling the Division of Labor & Management at 605.773.3681.

If you want to do a bulk file transfer of these forms, you will need a userid, a password and initial transfer testing. Call Bill Bishop, Senior Programmer/Analyst, at 605.626.2222, ext. 4275 to arrange for testing.
Instructions for using the online system are in the Claim Administrators documentation. (Adobe .pdf file*)

First Report of Injury Management System

Fillable Adobe .pdf First Report of Injury Form
(for employees and employers only)

Another option for completing the First Report of Injury (Form 101) is to complete a fillable Adobe .pdf* file on the computer, then print and mail it to us, following the instructions on page 2 of the form.

First Report of Injury - Fillable Adobe .pdf format*

*Opening and printing Adobe .pdf files requires Adobe Acrobat Reader. Click here as needed to download the free Adobe Acrobat Reader.

 

 


Marcia Hultman, Secretary
700 Governors Drive
Pierre, SD 57501-2291
Tel. 605.773.3101
Fax. 605.773.6184