South Carolina: High Court Says Employer/Insurer Should Receive Partial Reimbursement for Extra Medical Costs and Outlays Related to Pre-existing Diabetes Condition

South Carolina: High Court Says Employer/Insurer Should Receive Partial Reimbursement for Extra Medical Costs and Outlays Related to Pre-existing Diabetes Condition

As did a number of other states, South Carolina established a Second Injury Fund to encourage employers to hire disabled or handicapped persons.  Generally, under the provisions of S.C. Code Ann. § 42-9-400, if an employer can show that the injured worker's disability, following the compensable injury, is greater than it would have been had there been no prior disability, the employer can be awarded partial reimbursement of the workers' compensation outlay.  Applying that statute, the Supreme Court of South Carolina has reversed a split Commission decision that had denied an employer's request for partial reimbursement related to a claimant's preexisting diabetes.   First, the high court found that the employer was entitled to a presumption that claimant's diabetes was permanent and constituted a hindrance or obstacle to his employment or reemployment.  Second, the Commission's finding that the claimant had rebutted any such presumption was also erroneous.  The Court said the Commission focused on medical evidence indicating that prior to the injury, claimant's diabetes was medically managed and was not uncontrolled or problematic. The Commission relied on this evidence in discussing whether Claimant's preexisting diabetes was a hindrance to Claimant's employment at the time of his injury, not whether it was a hindrance to obtaining employment, as the statute required. The Commission also failed to consider the substantial evidence in the record indicating the significant symptoms and problems claimant  experienced after his work-related injury.  The court also agreed that the insurer had shown that the aggravation of claimant's preexisting diabetes resulted in substantially increased medical costs, and therefore, the Commission erred in denying Appellant reimbursement under section 42-9-400(a).

Thomas A. Robinson, J.D., the Feature National Columnist for the LexisNexis Workers’ Compensation eNewsletter, is a leading commentator and expert on the law of workers’ compensation.

LexisNexis Online Subscribers: Citations below link to Lexis Advance. Bracketed citations link to lexis.com.

See State Accident Fund v. South Carolina Second Injury Fund, 2014 S.C. LEXIS 297 (July 30, 2014) [2014 S.C. LEXIS 297 (July 30, 2014)]

See generally Larson’s Workers’ Compensation Law, § 91.02 [91.02]

Source: Larson’s Workers’ Compensation Law, the nation’s leading authority on workers’ compensation law.

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