After the emergency room, the skin grafts, and the first wave of shock, many burn survivors in Rapid City run into a new problem. Insurance that seemed straightforward at first suddenly starts pushing back on the cost of rehabilitation. Adjusters question therapy, deny certain procedures, or say you have reached the end of what the policy will cover, even though your doctors are still talking about months or years of recovery.
Meanwhile, bills keep arriving for physical therapy, wound care, surgeries, pressure garments, and counseling. You might have more than one insurer involved, such as workers compensation, health insurance, and possibly an auto or liability policy, and none of them clearly explain who will pay for what. If you are worried that you will not be able to afford the care you need to heal and get back to work, you are not alone.
At Beardsley, Jensen & Lee, we have represented injured people and workers across South Dakota since 1997, including many who faced serious injuries and complex rehabilitation needs. Our attorneys bring over 100 years of combined experience in personal injury, workers compensation, and bad faith insurance cases. In this guide, we draw on that experience to explain how burn injury insurance coverage usually works, where it often breaks down, and what you can do to protect your rehabilitation.
What Burn Injury Rehabilitation Really Involves
Serious burn recovery extends far beyond the initial hospital stay, often requiring a structured rehabilitation process lasting months or years. The primary goals are wound closure, functional restoration, pain management, and the return to independent living and employment.
Key components of burn rehabilitation include:
Surgical Intervention: A series of reconstructive surgeries or skin grafts often follow the initial operation.
Specialized Wound Care: Frequent, complex dressing changes are performed at specialized clinics.
Physical and Occupational Therapy: Essential for maintaining joint mobility, preventing contractures, rebuilding strength, and relearning daily living skills.
Medical Equipment: The use of pressure garments and custom splints to manage scarring and maintain the range of motion.
Pain Management: Ongoing medication and interventional treatments post-discharge.
Psychological Counseling: Support for trauma, anxiety, and social reintegration related to changes in appearance.
Vocational Rehabilitation: Training for new career paths if physical limitations prevent a return to previous employment.
How Workers' Compensation Handles Burn Rehab After a Work Injury
In South Dakota, workers' compensation covers medical treatment and rehabilitation for workplace burns, including emergency care, surgeries, follow-up visits, travel expenses, and prescribed equipment.
However, insurers frequently attempt to limit these benefits. Common tactics include:
Limiting Care: Accepting initial hospitalization but questioning the duration of physical/occupational therapy or the necessity of reconstructive surgery.
Terminating Benefits: Claiming you have reached maximum medical improvement to stop coverage for ongoing functional improvements.
Disputed Wage Replacement: Pushing for a premature return to work or cutting off temporary disability benefits during active recovery.
Restricted Vocational Rehab: Withholding retraining or job placement services for those unable to return to their previous roles.
Adverse Medical Opinions: Using independent medical exams or conservative providers to argue that further therapy is unnecessary.
Legal representation helps counter these denials by presenting medical evidence and navigating the specific patterns used by local insurers to restrict burn rehabilitation.
When Health Insurance Pays for Burn Rehabilitation
If you’re dealing with a burn from something like a house fire, a kitchen accident, or a car fire, you’ll usually rely on private health insurance, Medicare, or Medicaid to cover the costs of treatment, rehab, and permanent/total disability.
Unlike workers' compensation, these plans involve unique financial and clinical constraints:
Cost-Sharing and Networks: Coverage is subject to deductibles, co-pays, and co-insurance. Insurers prioritize in-network providers, which can create barriers to accessing out-of-network burn specialists.
Service Limitations: Plans often cap the annual number of physical or occupational therapy sessions and require preauthorization for specialized care.
Medical Necessity Denials: Insurers may deny trauma counseling or label reconstructive surgery as "cosmetic," even when the procedure is necessary for physical function.
Internal Cost Controls: Insurance companies frequently use standardized software and internal guidelines that may not account for the complexities of long-term burn recovery.
Subrogation: If you receive a legal settlement, health insurers often claim a right to reimbursement from those funds for the medical bills they previously paid.
Other Insurance Policies That May Help Pay for Burn Rehab
Many burn survivors think workers' comp or health insurance are their only ways to pay for recovery. But if a third party or a faulty product was involved, other insurance policies can be total lifesavers. It’s also important to watch out for bad faith insurance when a company unfairly denies or stalls your claim. Catching these options and any red flags early on is key to making a full recovery.
Vehicle-Related Coverage
If a vehicle crash or fire caused the injury, several auto insurance layers may apply:
Medical Payments: Covers immediate bills regardless of fault.
Liability Coverage: Pays for rehab, pain and suffering, and lost income if another driver is at fault.
Uninsured/Underinsured Motorist: Provides funds if the at-fault driver has insufficient coverage.
Premises and Product Liability
Burns caused by unsafe environments or defective goods may trigger:
Homeowners or Renters Insurance: For injuries occurring on private property.
Business Liability: For incidents involving unsafe premises or commercial equipment.
Product Liability: For injuries caused by faulty products, such as space heaters or electrical systems.
Unlike health insurance, these policies typically pay via lump-sum settlements, requiring careful coordination with your existing coverage.
Where Insurers Often Limit or Deny Burn Rehabilitation
Insurers often limit burn rehabilitation through several predictable methods. Recognizing these patterns early can help you determine when to seek legal advice.
Common Tactics Used by Insurers
Therapy Caps: Insurers may approve initial physical or occupational therapy, but halt coverage by claiming you have reached maximum medical improvement. They often reclassify necessary treatment as maintenance rather than active rehabilitation, even if you cannot yet perform basic tasks or job functions.
Mental Health Restrictions: Despite the high prevalence of PTSD, anxiety, and depression following a burn injury, insurers frequently treat psychological counseling as optional or strictly limit the number of sessions.
The Cosmetic Label: Reconstructive surgeries and scar revisions are often denied as cosmetic. This ignores functional impairments such as difficulty speaking, eating, or moving caused by severe scarring on the face or neck.
Premature Settlements: Adjusters often push for early settlements before the full extent of necessary rehabilitation, future surgeries, or vocational retraining is known.
How to Protect Your Claim
Functional Documentation: Ensure medical records emphasize how injuries limit your physical abilities (e.g., grip strength, range of motion) rather than focusing solely on appearance.
Reject Early Offers: Avoid accepting settlements before your doctors have identified your long-term care requirements.
Leverage Legal Pressure: A firm with a track record of significant verdicts can prevent insurers from devaluing your future rehabilitation needs.
Steps You Can Take To Protect Your Burn Rehab Coverage
Adhere to Medical Advice
- Attend all scheduled therapy, wound care, and follow-up appointments.
- Notify providers immediately of barriers like pain, transportation, or scheduling conflicts to avoid gaps in care arguments.
- Document the specific reasons for switching providers rather than simply stopping treatment.
Maintain Detailed Documentation
- Keep a journal tracking pain levels, functional limitations, and sleep quality.
- Record how specific therapy sessions or adaptive devices impact your recovery.
- Take dated photos of healing progress and scarring.
- Collect notes from supervisors regarding workplace limitations or required accommodations.
Exercise Caution with Insurers
- Consult with legal counsel before providing recorded statements or signing broad medical releases.
- Review settlement offers, insurer-mandated doctor changes, or return-to-work plans with a professional before agreeing.
- Verify that any settlement covers the projected costs of long-term rehabilitation and future medical needs.
How Our Rapid City Legal Team Evaluates Burn Injury Insurance Coverage
When someone with serious burns comes to us, we do not look at just one policy or one decision. We start by gathering all potentially relevant information, including workers' compensation files, health insurance plans, auto or liability policies, medical records, and any correspondence from insurers. Then we piece together the full picture of your rehabilitation needs and how each insurer is responding.
Our attorneys have over 100 years of combined experience across personal injury, workers' compensation, bad faith insurance, and insurance defense. That depth matters in burn cases because these claims often sit at the intersection of several systems. We understand how South Dakota workers' compensation carriers approach long-term rehab, how health insurers use medical necessity standards, and how liability insurers value future care when negotiating serious injury settlements.
We also prepare cases as if they may go to trial. Our award-winning firm holds the highest possible rating from Martindale Hubbell, and we have a reputation for multi-million dollar verdicts in significant injury cases. Insurers pay attention to which law firm is on the other side. Our trial readiness and reputation can influence how seriously they take your burn rehabilitation needs when we challenge denials or negotiate for sufficient funds to cover future care.
Talk To A Rapid City Attorney About Your Burn Rehab Coverage
Burn rehabilitation is a long and sometimes painful road, and the last thing you need is a fight with an insurance company while you are trying to heal. The good news is that you often have more options than insurers suggest, especially when multiple policies may apply and when a full picture of your future medical and vocational needs is developed.
If you are seeing denials for therapy, counseling, or surgery, if you have been told to go back to work before you feel ready, or if you are being pushed to accept a fast settlement, you do not have to navigate these decisions alone. Our Rapid City legal team can review your burn injury insurance coverage, your rehabilitation plan, and your potential claims in a free, confidential consultation, then help you decide on the next steps that make sense for you and your family.
Call to discuss your burn rehabilitation coverage with an attorney at .