Articles Posted in Insurance Law

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Employee-petitioner Judy Barnes was employed as an administrative assistant at Charter 1 Realty. On the day of her injury, Barnes was asked to check the e-mail of one of the realtors before noon. Around 11:30 a.m., Barnes left her desk and walked toward the realtor's office. However, she stumbled, fell, and sustained serious injuries: a broken left femur, broken left humerus and a torn rotator cuff.Barnes subsequently filed a claim for workers' compensation. At the hearing, Barnes testified she was hurrying to the realtor's office to check her e-mail and that caused her to fall. Evidence was also introduced that her husband did not like the shoes she wore, and he had told her she needed to pick up her feet when she walked. The single commissioner and appellate panel found that her fall was idiopathic and therefore noncompensable. The court of appeals affirmed. The Supreme Court disagreed with the commissioner and appellate panel's findings, reversed, and remanded the case for further proceedings. View "Barnes v. Charter 1 Realty" on Justia Law

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Claimant-petitioner Carolyn Nicholson, a supervisor in the investigations area of child protective services for the South Carolina Department of Social Services (DSS), was on her way to a meeting when her foot caught on the hall carpet and she fell. She received treatment for pain to her neck, left shoulder, and left side connected with her fall. Nicholson's claim for workers' compensation was denied by the single commissioner because she failed to prove a causal connection between her fall and employment. The commissioner held there was nothing specific to the floor at DSS which contributed to Nicholson's fall and that she could have fallen anywhere. The question this case presented for the Supreme Court's review was whether petitioner was entitled to workers' compensation. "Despite how straightforward this issue appears to be," both the commissioner and the court of appeals found petitioner was not entitled to recover. The Supreme Court disagreed with both, reversed, and remanded the case for further proceedings. View "Nicholson v. SC Dept. of Social Services" on Justia Law

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Roger Brock was passenger in a vehicle driven by Brian Mason, which was involved in an accident with a logging truck, driven by Ryan Stevens. At the time of the accident, Stevens was insured through the owner of the logging truck, Malachi Sanders' policy issued by Aequicap Insurance Company. Brock sustained severe injuries as a result of the wreck and filed suit. Soon after the litigation began, Brock settled his claim against Stevens and Sanders with Aequicap for $185,000 for the release of all claims. Shortly after the settlement was reached but before Brock received any payment, Aequicap was declared insolvent. Because Aequicap was an insurer licensed to do business in the State of South Carolina and the insured was a resident of South Carolina, the claim was referred to South Carolina Property and Casualty Insurance Guaranty Association (Guaranty). As a result, Brock made demand on Guaranty for payment of the full settlement amount of $185,000. The issue this case presented for the Supreme Court's review centered on the construction and application of the South Carolina Property and Casualty Insurance Guaranty Association Act (the Act), S.C. Code Ann. Secs. 38-31-10 to -170 (2002 and Supp. 2013), and specifically the exhaustion/non-duplication provision in section 38-31-100(1). Guaranty and Brock moved for summary judgment on the issue whether Guaranty may offset payments from solvent insurance carriers against Brock's settlement under section 38-31-100. The circuit court found section 38-31-100 was ambiguous and granted partial summary judgment to both parties, holding that Guaranty may offset some but not all of the benefits received by Brock from solvent insurance carriers. The Supreme Court disagreed that section 38-31-100 was ambiguous and hold that the unambiguous language of section 38-31-100 provides that Guaranty may offset all payments from all solvent insurers made to Brock as a result of this wreck. View "SC Property v. Brock" on Justia Law

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Delores Williams, the personal representative of the Estate of Edward Murry, and Matthew Whitaker, Jr., the personal representative of the Estate of Annie Mae Murry (PRs), brought a declaratory judgment action to determine whether a GEICO motor vehicle insurance policy issued to the Murrys provided $15,000 or $100,000 in liability proceeds for bodily injury for an accident in which both of the Murrys were killed. The circuit court concluded coverage was limited to the statutory minimum of $15,000 based on a family step-down provision in the policy that reduced coverage for bodily injury to family members from the stated policy coverage of $100,000 to the statutory minimum amount mandated by South Carolina law during the policy period. The PRs appealed, contending the step-down provision was ambiguous and/or violative of public policy. The Supreme Court affirmed in part and reversed in part. The Court agreed with the circuit court that GEICO's policy is not ambiguous, but concluded the family step-down provision, which reduced the coverage under the liability policy from the stated policy amount to the statutory minimum, was violative of public policy and was, therefore, void. "The provision not only conflicte[d] with the mandates set forth in section 38-77-142, but its enforcement would be injurious to the public welfare." View "Williams v. GEICO" on Justia Law

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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

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The issue in this case centered on a workers' compensation lump-sum award to a claimant who passed away while an appeal of her award was pending. At issue before the Supreme Court was a Court of Appeals opinion that refused to reach Respondents-Petitioners' argument that the award abated upon the beneficiary's death; granted the entire lump-sum award to beneficiary's dependent grandsons; reversed the grant of interest on the award; and affirmed the reinstatement of a ten-percent penalty. Upon review, the Supreme Court affirmed the Court of Appeals' decision with respect to the abatement issue and that court's holding that the ten-percent penalty should have been imposed in this case. The Supreme Court reversed the Court of Appeals decision requiring the entire lump-sum award be paid to the Grandsons, and reinstated the Estate's and Grandsons' settlement. The Court also reversed the Court of Appeals decision to remove the assessment of interest. The case was remanded for further proceedings on what sums were due pursuant to the Court's holding here. View "Hudson v. Lancaster Convalescent Center" on Justia Law

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The South Carolina Supreme Court answered certified two questions from the U.S. District Court for the District of South Carolina. The case concerned supplemental health insurance policies, which differ from ordinary health insurance policies in both purpose and operation. The questions were: (1) whether the definition of "actual charges" contained within S.C. Code Ann. 38-71-242 be applied to insurance contracts executed prior to the statute's effective date; and (2) whether the South Carolina Department of Insurance could mandate the application of "actual charges" to policies already inexistence on the statute's effective dates by prohibiting an insurance company from paying claims absent the application of that definition. The South Carolina Supreme Court answered both questions "no." View "Kirven v. Central States" on Justia Law

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The Standard Fire Insurance Company appealed a court of appeals' decision that reversed the trial court's grant of summary judgment in its favor, and finding respondents Thomas, Debra, and Christopher were entitled to stack underinsured motorist (UIM) coverage despite an exclusion in Standard Fire's policy purporting to limit an insured's ability to stack such coverage when the vehicles insured under the subject policy were not involved in the accident. After review of the trial and appellate court records, the Supreme Court found no reversible error and affirmed the appellate court's decision. View "Carter v. Standard Fire Insurance" on Justia Law

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Samuel W. Rhodes and Piedmont Promotions, Inc. sued Marion L. Eadon, (d/b/a C&B Fabrication), for damages arising out of the faulty construction of three outdoor advertising billboard signs after one of the signs fell across Interstate 77. A jury returned a verdict for actual and punitive damages in favor of Rhodes. At the time of the suit, Eadon's two corporations, C&B Fabrications, Inc. and Low Country Signs, Inc., were listed as named insureds under a commercial general liability policy issued by Auto-Owners Insurance Company. Eadon sought indemnification from Auto-Owners for the verdict. In response, Auto-Owners filed a declaratory judgment action to determine whether it had a duty to indemnify Eadon under the policy. Upon review, the Supreme Court concluded the Court of Appeals correctly affirmed the judge's denial of Auto-Owners' motion pursuant to Rule 60(b), SCRCP. Further, the Court held the declaratory judgment action was procedurally proper save for a ruling on issues regarding property damages as there are related questions of fact that must be decided by a jury on retrial.View "Auto-Owners v. Rhodes" on Justia Law

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Petitioner was injured in a car accident while riding as a passenger in a vehicle driven by a co-employee. The liability limits of the at-fault driver were tendered, and there was no underinsured motorist (UIM) coverage on the vehicle in which he was riding. Therefore, Petitioner submitted a claim for UIM benefits under a Progressive insurance policy, issued to Sarah Severn. At the time of the accident, Petitioner resided with Severn and their child. He described Severn as "his on again off again fiancé." Both Petitioner's and Severn's names appear on the Declarations Page of the Policy under the heading "Drivers and household residents." Under the heading "Additional information," Severn is listed as the "Named insured." Progressive denied UIM coverage to Petitioner under Part III of the Policy. According to the affidavit filed by Progressive's Claims Injury Operations Manager, "[t]he claim was denied because [Petitioner] did not fall within the terms, provisions and conditions of [the Policy] to qualify for benefits under the [UIM] provisions," as Petitioner "was only listed as a 'driver' on the policy and not a named insured, nor was he a resident relative of the named insured." The Supreme Court granted Bell's petition for review of the court of appeals' decision affirming the circuit court's grant of summary judgment in favor of Progressive Direct Insurance Company. Finding no reversible error, the Supreme Court affirmed. View "Bell v. Progressive Direct Insurance" on Justia Law