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State Accident Fund v. South Carolina Second Injury Fund

Supreme Court of South Carolina

July 30, 2014

State Accident Fund, Appellant,
v.
South Carolina Second Injury Fund, Respondent, In Re: Johnny M. Adger, Employee,
v.
City of Manning, Employer, and State Accident Fund, Carrier

Heard: February 6, 2014.

Appeal from the South Carolina Workers' Compensation Commission. Appellate Case No. 2012-212722.

F. Earl Ellis, Jr., of Adams and Reese, LLP, of Columbia, for Appellant.

Latonya Dilligard Edwards, of Dilligard Edwards, LLC, of Columbia, for Respondent.

CHIEF JUSTICE TOAL. KITTREDGE, HEARN, JJ., and Acting Justice James E. Moore, concur. PLEICONES, J., concurring in result only.

OPINION

Page 20

[409 S.C. 242] TOAL, CHIEF JUSTICE:

The State Accident Fund (Appellant) appeals an order from the Appellate Panel of the South Carolina Workers' Compensation Commission (the Commission) denying Appellant's request for reimbursement from the South Carolina Second Injury Fund (Respondent) for benefits paid to Johnny Adger (Claimant), who suffered from preexisting diabetes when a work-related injury occurred. We reverse and remand.

Facts/Procedural Background

Claimant suffered an accidental injury to his left knee on August 17, 2007, while working as a police officer with the Manning Police Department. As a result, Claimant was treated using various non-operative methods, including steroid injections. In January 2008, Claimant reached maximum medical improvement (MMI) and was assigned a 32% permanent impairment rating to his lower left extremity. However, in April 2008, Claimant returned to the doctor because he continued to experience swelling and pain in his left knee. Ultimately, Claimant underwent knee replacement surgery. Claimant continued to experience swelling and pain in his left [409 S.C. 243] knee, and Claimant followed up with the orthopaedic center for several months after the surgery.

At the time of his injury, Claimant suffered from preexisting diabetes, which Claimant's employer was aware of prior to the injury. Claimant experienced problems with his diabetes for years before the accident and required medication to control the condition.[1] Claimant's diabetes was medically controlled around the time of the injury; however, Claimant's diabetes was uncontrolled on several occasions during the course of his knee treatment.

Page 21

Claimant's primary care physician, Dr. William Aldrich, opined that Claimant's injury " most probably aggravate[d] the diabetes" and resulted in " substantially greater medical costs" than would have occurred from the injury alone. However, in Dr. Aldrich's opinion, the aggravation of Claimant's diabetes " most probably" did not result in " substantially greater time lost from work" or " substantially greater disability" than would have occurred from the injury alone.

The workers' compensation carrier, Appellant, filed a claim for partial reimbursement from Respondent, alleging that it incurred substantially greater liability for compensation benefits and medical benefits because Claimant's preexisting diabetes was aggravated by his work-related injury. Respondent denied that the claim met the requirements of the statute governing reimbursement. See S.C. Code Ann. § 42-9-400 (Supp. 2013).[2]

South Carolina Workers' Compensation Commissioner T. Scott Beck (the Single Commissioner) held a hearing on this matter on September 27, 2011. Thereafter, the Single Commissioner filed an order denying Appellant's claim for reimbursement and dismissing the claim with prejudice. The [409 S.C. 244] Single Commissioner concluded that Appellant " had the burden to prove that Claimant's preexisting diabetes was permanent and serious enough to constitute a hindrance or obstacle to Claimant's employment," but also found that " the evidence in the record rebuts the presumption that Claimant's diabetes was a hindrance to his employment." In addition, the Single Commissioner determined that Appellant did not prove that " Claimant's preexisting diabetes created substantially greater lost time from work and permanent disability than would have resulted from the work injury alone" based upon his findings that " [t]he evidence in the record does not indicate a fluctuation in blood sugars, a modification in diabetic medication or delayed post-surgical healing" and that " the medical records reveal that Claimant was written out of work for only three (3) days immediately after the work injury." Therefore, the Single Commissioner denied Appellant's claim for reimbursement, concluding that it did not meet the standard of reimbursement in section 42-9-400.

On appeal, the Commission affirmed the Single Commissioner's order in its entirety.[3] Appellant appealed the Commission's order to the court of appeals. This Court ...


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