Justia Insurance Law Opinion Summaries

Employee-claimant Cathy Bone filed a workman's compensation claim for a work-related injury. The employer, U.S. Food Service, and its carrier Indemnity Insurance Co. of North America disputed the claim. The single commissioner and an Appellate Panel of the South Carolina Workers' Compensation Commission issued orders denying the claim. Under the procedure then in place, Bone appealed to the circuit court, which concluded the injury was compensable and remanded the matter to the Commission for further proceedings. The employer appealed the circuit court's order, and the Court of Appeals dismissed the appeal on the basis the order was not a "final judgment" and thus not immediately appealable because further proceedings were ordered before the administrative agency. The Supreme Court granted Petitioners' petition for a writ of certiorari to review the decision of the Court of Appeals, and the Supreme Court affirmed. The high court subsequently granted a petition for rehearing filed by the employer, and it additionally granted the following two motions: (1) Bone's motion to argue against precedent, and (2) the motion of the South Carolina Defense Trial Attorneys' Association to accept its Amicus Curiae Brief in support of Petitioners. After considering the record in this matter, as well as the briefs and arguments, the Court adhered to its original decision to affirm. View "Bone v. U.S. Food Service" on Justia Law

Petitioner Shannon Hutchinson was the beneficiary of a mortgage life insurance policy. She sued Liberty Life Insurance Company after it denied her benefits under a policy exclusion for injury resulting from the insured's being intoxicated. The insured-decedent was under the influence of methamphetamine at the time of his accidental death. The circuit court granted Petitioner summary judgment, finding methamphetamine was not a narcotic under the policy. The appellate court reversed, finding the plain meaning of "narcotic" was enough to qualify as a narcotic. Petitioner petitioned the Supreme Court; the Supreme Court reversed the appellate court, finding the appellate court ready the policy exclusion to deny coverage for injuries from unlawful use of intoxicating substances: "this reading rewrites rather than interprets the insurance policy's exclusionary clause." View "Hutchinson v. Liberty Life Insurance" on Justia Law

Alea London Limited (insurer) appealed a circuit court's denial of its motion to set aside an order of a special referee that granted Respondent Elisa Narruhn an assignment of rights in supplemental proceedings held in conjunction with another lawsuit. The underlying suit was filed after Respondent was shot while attending a nightclub in Myrtle Beach. A special referee was appointed to conduct supplemental proceedings to determine whether the club had any assets to satisfy Respondent's judgment. The referee granted Respondent an assignment of any and all rights, including any claims, the club might have had against the Insurer (which issued the club a liability insurance policy). Respondent subsequently sued the Insurer seeking damages for failing to pay or defend a claim. Upon review, the Supreme Court modified the circuit court's order, but affirmed. View "Narruhn v. Alea London Limited" on Justia Law

Palmetto Hardwood, Inc., employed Petitioner Clifton Sparks as a saw operator. Petitioner suffered three work-related injuries during this employment, the first two of which injured Petitioner's lower back. In the third incident, Petitioner was required to remove a piece of metal from under a gang saw. In the process, the metal exploded and a three- to four-inch cubic piece struck him in the head. Petitioner subsequently sought workers' compensation for his injuries. At the hearing, Petitioner testified to substantial head pain, loss of cognitive ability, and other brain-function-related symptoms, including inability to read without severe headache, loss of his mathematical abilities, inability to balance while standing or to walk without a cane, hand tremors, anxiety, and more. Petitioner argued on appeal to the Supreme Court that the Court of Appeals erred when it applied an improper definition of "physical brain damage" within the meaning of section 42-9-10(C). The Supreme Court disagreed. Because "physical brain damage" as contemplated in S.C. Code Ann. 42-9-10 required "severe and permanent physical brain damage as a result of a compensable injury" and the Workers' Compensation Commission's finding that Petitioner did not suffer such brain damage was supported by substantial evidence in the record, the Court affirmed the Court of Appeals. View "Sparks v. Palmetto Hardwood" on Justia Law

"At its most basic level, this case presents a policy dispute: whose policy choice concerning health insurance premiums for State employees controls—the General Assembly's or the Budget and Control Board's?" The issue before the Supreme Court centered on "maintaining and enforcing the constitutional and statutory framework through which such issues must be resolved. " Upon review of the arguments of the parties and the applicable case law, the Supreme Court found that the General Assembly had and exercised the power to determine the contribution rates of enrollees for the State's health insurance plan in 2013. The Court held that the Budget and Control Board violated the separation of powers provision by substituting its own policy for that of the General Assembly, entered judgment for the petitioners, and directed the Board to use the appropriated funds for premium increases and return the premium increases previously collected from enrollees. View "Hampton v. Haley" on Justia Law

Petitioner Michael Crisp, Jr. worked for Employer SouthCo, Inc., seeding grass and performing odd construction jobs. In 2004, Petitioner and other workers were installing silt fencing to combat ground erosion. Petitioner held a pole while another worker operated the Bobcat. As Petitioner bent down to reach for a pole, the bucket of the Bobcat fell on Petitioner, covering him. Petitioner suffered injuries to his head and hands. At the emergency room, Petitioner was treated for abrasions and bruises to the back of the head and neck and a complex fracture in his right hand. There was no mention of a brain injury in Petitioner's hospital records. Nearly two years after his injury, Petitioner's doctor opined that Petitioner sustained physical brain injury as a result of his 2004 injury. Petitioner's eventual workers' compensation claim for the brain injury was denied, and he petitioned the Supreme Court for review of an appellate court's decision to reverse a circuit court's finding that he sustained a compensable brain injury. Upon review, the Supreme Court reversed the appellate court and remanded the case for further consideration of whether Petitioner sustained physical brain damage as contemplated under the Workers' Compensation Act which would entitle him to benefits for life. View "Crisp v. SouthCo." on Justia Law

Palmetto Hardwood, Inc. employed Petitioner Clifton Sparks as a saw operator. Petitioner suffered three work-related injuries during this employment, the first two of which injured Petitioner's lower back. In the third incident, Petitioner was required to remove a piece of metal from under a gang saw. In the process, the metal exploded and a three- to four-inch cubic piece struck him in the head. Petitioner subsequently sought workers' compensation for his injuries. Six doctors opined regarding whether Petitioner had suffered a physical brain injury. The Commission found that Petitioner had sustained a compensable injury to his head. It also found him to be totally and permanently disabled. The Commission ruled that Petitioner should receive only five hundred weeks of compensation as a result of his total and permanent disability and medical expenses causally related to the three compensable injuries. On appeal, the circuit court remanded to the Commission for it: (1) to explain whether the "physical brain injury" it found "border[ed] on the frivolous" was intended to be the same as or different from "physical brain damage" as used in section 42-9-10 (C); and (2) to reconcile the order's seemingly contradictory findings that Petitioner suffered a compensable injury to the head with its finding of no physical brain injury. On appeal, the circuit court affirmed the Commission's order. Petitioner subsequently appealed to the Court of Appeals, which affirmed in an unpublished opinion. On appeal to the Supreme Court, Petitioner argued that the Court of Appeals erred when it applied an improper definition of "physical brain damage" within the meaning of section 42-9-10(C). The Supreme Court disagreed and affirmed the circuit court. View "Sparks v. Palmetto Hardwood" on Justia Law

Shenandoah Life Insurance Company brought an action to void an insurance policy it issued on the life of Lorenzo Smallwood. The circuit court granted partial summary judgment to Shenandoah, and narrowed the issue for trial to whether Lorenzo intended to defraud the insurance company when he did not disclose information related to his medical history on the insurance application. At trial, the court granted Shenandoah's motion for a directed verdict. Lakeisha Smallwood appealed the directed verdict. Upon review, the Supreme Court held that a jury could reasonably conclude that Shenandoah failed to meet its burden of proving Lorenzo made the misrepresentations with the requisite fraudulent intent. The Court reversed and remanded the case for trial. View "Shenandoah Life v. Smallwood" on Justia Law

The Supreme Court accepted the petition of Harleysville Mutual Insurance Company (Petitioner) in its Original Jurisdiction to assess constitutional challenges to Act No. 26 of the South Carolina Acts and Joint Resolutions, which regulates coverage provided by commercial general liability (CGL) insurance policies for construction-related work. Upon review, the Supreme Court held that the retroactivity clause of Act No. 261 violated the Contract Clauses of the state and federal Constitutions, and that the statute may only apply prospectively to CGL insurance contracts executed on or after its effective date of May 17, 2011. View "Harleysville Mutual v. South Carolina" on Justia Law

Frank Hutson was working as a crane operator for the State Ports Authority when he suffered an injury to his lower back and legs while attempting to remove a container from a ship. He was diagnosed with a disc bulge for which he was treated with steroid injections, physical therapy, and used a back brace. After reaching maximum medical improvement, he filed a Form 50 with the workers' compensation commission for continued benefits alleging permanent and total disability pursuant to Sections 42-9-10 and 42-9-30 South Carolina Code (1976 & Supp. 2011) or, alternatively, a wage loss under Section 42-9-20. He also asked to receive the award in lump sum. Although the Ports Authority and its insurance carrier, the State Accident Fund (collectively, Respondents), admitted the accident and the back injury, they disputed the claims to his legs and argued he should receive only permanent partial disability benefits. They also objected to Hutson's request that his benefits be paid in a lump sum. The issue before the Supreme Court centered on whether speculative testimony by the claimant concerning his possible future work as a restaurateur qualified as substantial evidence to establish he did not sustain a wage loss pursuant to Section 42-9-20 of the South Carolina Code (1976). The Court held it did not, and therefore reversed and remanded the case for further proceedings. View "Hutson v. SC State Ports Authority" on Justia Law