State Accident Fund v. SC Second Injury Fund – Reimbursement for “Second Injuries”

Workers who are injured on the job in South Carolina are entitled to receive compensation for those injuries, even if they suffered a pre-existing condition that was exacerbated by the injury.
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In these instances, our Rock Hill workers’ compensation lawyers know that employers and insurers have the option of seeking some degree of reimbursement from the state’s “Second Injury Fund.” In order to collect, employers/insurers have to show the costs for treatment for a worker’s injury exceeded what otherwise might have been paid because the incident resulted in a “second injury” that aggravated a pre-existing condition.

This would seem like a boon to employers, but many are trying to do away with it, arguing it tends to cost them more than what they are ever repaid. This is why employers and insurers fight so hard to avoid paying any benefits in cases where a “second injury” is alleged. Injured workers are still entitled to benefits, but they should expect a tougher fight. An experienced attorney can help ensure workers receive the rightful degree of compensation.

The recent case of State Accident Fund v. SC Second Injury Fund details how employers must sometimes fight for reimbursement of these expenses – again, making them more prone to denying such claims from the outset.

This case stemmed from a work-related knee injury sustained by a police officer in Manning. There was little dispute the injury was work-related, though at the time, he also suffered from diabetes, a fact known to his employer. The diabetes was controlled at the time of the injury, though at various points thereafter, it was uncontrolled.

Initially, the officer sought conservative treatment with steroid injections. In January 2008, a physician determined the officer reached maximum medical improvement, assigning a 32 percent injury to his lower left extremity. However, just a few months later, the officer returned to the doctor with complaints of pain and swelling in the knee. His doctor subsequently recommended knee replacement surgery, which was carried out. The officer had to seek numerous treatments after that, as pain and swelling persisted even after the surgery.

The officer’s primary care physician would later opine the diabetes, a pre-existing condition, was exacerbated by the work-related knee injury. This, he said, resulted in substantially greater medical costs, though he did not believe it caused a substantially greater disability to the officer.

It was on this basis that the police department’s workers’ compensation insurer sought reimbursement from the Second Injury Fund. However, lawyers for the fund argued the claim failed to meet the requirements of governing statutes – specifically, S.C. Code Ann. 42-9-400.

A hearing was held before the South Carolina Workers’ Compensation Commissioner, who denied the insurer’s right to reimbursement and dismissed the claim. He concluded the insurer had the burden of proving the officer’s pre-existing diabetes was permanent and serious enough to constitute a hindrance on the officer’s employment. He indicated the record didn’t prove a substantially greater disability than the worker might have otherwise incurred.

On appeal, a panel for the commission affirmed the earlier order. However, it was reversed by the South Carolina Supreme Court.

In its ruling, the court indicated the commission had ignored testimony from an expert witness (i.e., the doctor) who testified about the substantially greater medical cost attributable to the pre-existing condition. Further, the state high court noted the Second Injury Fund failed to present any evidence or expert opinion that contradicted this statement on increased medical costs.

Therefore, the state supreme court held the insurer had met its burden of proof to receive reimbursement. The earlier decision was reversed and the case remanded.

If you have been injured at work in Rock Hill, contact the Lee Law Offices at 800-887-1965.

Additional Resources:
State Accident Fund v. SC Second Injury Fund, July 30, 2014, South Carolina Suprem Court

More Blog Entries
Isack v. Acuity: Workers’ Compensation and Reimbursement Rights, July 29, 2014, Rock Hill Workers’ Compensation Lawyer Blog

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