Harman v. Aetna Life Insurance Co. While the Supreme Court has ruled that equitable estoppel may be applied to claims brought under ERISA, the plaintiff must demonstrate detrimental reliance on a plan before the court will intervene.Read More »
Burnette v. City of GreenvilleIt appears that the interpretation of the claimant’s 2008 MRI as showing “only a ‘minimal’ protrusion with no nerve root displacement or impingement, and comparatively, no greater pathology of any significance (if any) than the MRI of 2004 …” is the medical opinion, not of any physician, but of the single commissioner, adopted by the Workers’ Compensation Commission.
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Swilling v. Pride Masonry of Gaffney Although claimant had only worked for eight weeks before his injury, he continued to work light duty thereafter, receiving $21 per hour for 40 hours per week ($840 per week). Nevertheless, on its Form 20, the employer calculated his average weekly wage at only $742.14. The Workers’ Compensation Commission cited S.C. Code Ann. § 42-1-40 in finding that exceptional reasons existed to deviate from the Form 20 and to set claimant’s average weekly wage at $840.
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Watson v. Xtra Mile Driver Training, Inc. Based on the claimant’s testimony as to her experience in sedentary occupations and the testimony of her doctor and her vocational evaluator that she could return to work within her restrictions, we find the claimant failed to show she has lost her capacity to earn wages.Read More »
Workers’ Compensation – Disability – Back Injury — Phlebotomist/CNA – Job Search – Constructive Refusal of Light Duty – None Offered
Johnson v. Rent-A-Center, Inc. After plaintiff suffered a compensable back injury, and after the defendant-employer refused to allow her to return to work without a full medical release with no restrictions, she obtained certifications as a certified nurse assistant and phlebotomist. However, plaintiff’s doctor said work was a CNA not within her restrictions, and plaintiff has been unable to find work solely as a phlebotomist.Read More »
Insurance – Disability – Additional Policies – Different Terms – Time Limitations – Mental Disorders – ECT – Tort/Negligence
Doe v. Northwestern Mutual Life Insurance Co. Where neither plaintiff nor her insurance agent can remember what the agent said when, in 2002 and 2003, plaintiff purchased two additional disability policies pursuant to an additional purchase benefit (APB) rider in her 1996 disability policy, plaintiff cannot make out a claim for negligent misrepresentation.Read More »
Insurance – Life – Waiver of Premium – Disability – ‘Any Work’ – Administrative Review – Unreasonable
Davis v. Hartford Life & Accident Insurance Co. In concluding that plaintiff was not disabled, the defendant-plan administrator relied on the internally inconsistent report of a doctor who never examined plaintiff, reviewed her medical records, and cherry-picked information that supported the administrator’s position while ignoring the bulk of plaintiff’s medical records.Read More »
Dinkins v. Lowe’s Home Centers, Inc. Although claimant suffered successive compensable injuries and is now unable to find work within his restrictions, since his restrictions arise from just one of his injuries (a back injury), claimant is not entitled to total disability benefits; instead, he is limited to the scheduled benefits for the partial disability of his back. We affirm the limitation of benefits to those under S.C. Code Ann. § 42-9-30.Read More »
Skinner v. Westinghouse Electric Corp. Even though claimant suffers from the occupational disease asbestosis, his asbestosis is not compensable because it has not affected his wage-earning capacity; in fact, claimant is earning more now than he did when he worked for defendant. We reverse the Workers’ Compensation Commission’s award under the scheduled loss provisions of S.C. Code Ann. § 42-9-30.Read More »
Workers’ Compensation – Insurance Coverage – Independent Contractor — Agency – Payroll Services – Estoppel – Disability
Langdale v. Harris Carpets Even though the contract between the defendant-carpet company and the defendant-human resources services company said neither would act as the other’s agent, defendants actually acted as each other’s agents, including when 10 percent was deducted from the earnings of the plaintiff-independent contractor for the purpose of paying workers’ compensation insurance premiums for him. We affirm the rulings of the Appellate Panel of the Workers’ Compensation Commission that the human resources services company, Gevity/Staff Leasing, is obligated to provide workers’ compensation coverage for plaintiff, and that plaintiff is temporarily totally disabled.Read More »