State Accident Fund v. SC Second Injury Fund

Claimant Johnny Adger suffered an accidental injury to his left knee on while working as a police officer with the Manning Police Department. As a result, he 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 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. 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. The State Accident Fund appealed an order from the Appellate Panel of the South Carolina Workers' Compensation Commission denying its request for reimbursement from the South Carolina Second Injury Fund for benefits paid to Claimant. The Supreme Court reversed and remanded. The Commission denied Appellant's claim for reimbursement in full. Without mentioning medical payments, the Commission stated that "Claimant's preexisting diabetes did not create substantially greater liability for permanent disability nor did it result in substantially greater lost time from work." However, these facts fell under the compensation liability prong of the applicable statute. Furthermore, the Supreme Court found that the Commission ignored expert opinion that Claimant's injury most probably aggravated his diabetes and resulted in substantially greater medical costs than would have resulted from his work-related injury alone. The Second Industry Fund presented no evidence or expert opinion that contradicted the statement concerning medical costs. Therefore, based on the fact that the medical evidence supported the conclusion that the Claimant's work-related injury aggravated his diabetes and resulted in increased medical costs, the Court held that the State Accident Fund satisfied the requirements of section 42-9-400(a), and the Commission's decision to deny its claim for reimbursement of medical payments was clearly erroneous. View "State Accident Fund v. SC Second Injury Fund" on Justia Law