Pre-Existing Conditions in Workers’ Compensation Cases in South Carolina

Pre-existing conditions do not prevent you from recovering workers’ compensation benefits in South Carolina.

The analysis may be a bit different than when we are talking about pre-existing injuries in the context of an auto accident or other personal injury case, though.

In a workers’ compensation case, liability is never an issue because workers’ comp is a no-fault system, and the benefits that are paid to an injured worker are determined by statute – South Carolina’s workers’ compensation laws. In this article, we will look at how pre-existing conditions can impact a workers’ compensation case, including:

• Pre-existing permanent physical impairment under SC Code § 42-9-400,
• Pre-existing conditions with a causal link to the current on-the-job injury, and
• Why Singleton v. Young Lumber Co.’s limitation of benefits to the cap for the scheduled member does not apply when there are pre-existing conditions under SC Code § 42-9-400.

Pre-Existing Conditions in Workers’ Compensation Cases

In most cases, permanent workers’ compensation benefits are limited to the amount specified in SC Code § 42-9-30 for the affected scheduled member (i.e., leg, arm, or other affected body part).

When there are pre-existing conditions, however, there are two situations where an injured worker’s benefits can be increased:

1. Pre-existing conditions with a causal link (the subsequent injury aggravated the pre-existing condition or vice-versa), and
2. Pre-existing permanent physical impairment from any cause or origin that results in a greater disability when combined with the new impairment.

Pre-Existing Conditions with a Causal Link

Under SC Code § 42-9-35, an injured worker with a pre-existing condition or permanent physical impairment can receive benefits for a previous injury if they can prove by a preponderance of the evidence that:

1. The new injury aggravated the pre-existing injury or physical impairment, or
2. The pre-existing condition or physical impairment aggravated the new injury.

The worker can be compensated for the disability caused by the aggravation of the pre-existing condition by the new injury (or vice-versa), but there must be a connection between the two injuries.

Permanent Physical Impairment from any Cause or Origin – No Causal Link

Under SC Code § 42-9-400, however, any permanent physical impairment from any cause or origin that, when combined with the effects of the new injury, results in a greater disability than the new injury alone, must be compensated:

(a) If an employee who has a permanent physical impairment from any cause or origin incurs a subsequent disability from injury by accident arising out of and in the course of his employment, resulting in compensation and medical payments liability or either, for disability that is substantially greater and is caused by aggravation of the preexisting impairment than that which would have resulted from the subsequent injury alone, the employer or his insurance carrier shall pay all awards of compensation and medical benefits provided by this title…

What is a permanent physical impairment?

(d) As used in this section, “permanent physical impairment” means any permanent condition, whether congenital or due to injury or disease, of such seriousness as to constitute a hindrance or obstacle to obtaining employment or to obtaining reemployment if the employee should become unemployed.

This means that a worker who has any pre-existing conditions, even if they are not job-related, that increase the worker’s disability when combined with the current injury, can be compensated for the combined effect of the current injury and the pre-existing condition, even if it means the worker is totally disabled.

Although any permanent physical impairment from any cause or origin will qualify, the statute provides that “there shall be a presumption that the condition is permanent and that a hindrance or obstacle to employment or reemployment exists when the condition is one of the following impairments

(1) Epilepsy;
(2) Diabetes;
(3) Cardiac disease;
(4) Amputated foot, leg, arm, or hand;
(5) Loss of sight of one or both eyes or partial loss of uncorrected vision of more than seventy-five percent bilateral;
(6) Residual disability from Poliomyelitis;
(7) Cerebral Palsy;
(8) Multiple Sclerosis;
(9) Parkinson’s disease;
(10) Cerebral vascular accident;
(11) Tuberculosis;
(12) Silicosis;
(13) Psychoneurotic disability following treatment in a recognized medical or mental institution;
(14) Hemophilia;
(15) Chronic Osteomyelitis;
(16) Ankylosis of joints;
(17) Hyperinsulinism;
(18) Muscular Dystrophy;
(19) Arteriosclerosis;
(20) Thrombophlebitis;
(21) Varicose veins;
(22) Heavy metal poisoning;
(23) Ionizing radiation injury;
(24) Compressed air sequelae;
(25) Ruptured intervertebral disc;
(26) Hodgkins disease;
(27) Brain damage;
(28) Deafness;
(29) Cancer;
(30) Sickle-Cell Anemia;
(31) Pulmonary disease; or
(32) Intellectual disability.”

Singleton v. Young Lumber Co. Limitations do not Apply When There are Pre-Existing Conditions

In Singleton v. Young Lumber Co., 236 S.C. 454, 114 S.E.2d 837 (1960), the SC Supreme Court held that an injured worker could not receive compensation for total disability (up to 500 weeks of benefits) when the only injury was to his leg. Instead, the worker is limited to the amount specified in SC Code § 42-9-30 for the affected scheduled member.

In Ellison v. Frigidaire Home, however, the Court clarified that Singleton’s holding “stands simply for the proposition that impairment involving only a scheduled member is compensated under the scheduled injury statute and not the general disability statute.”

When, under SC Code § 42-9-400, a worker has a permanent physical impairment from any cause or origin that, combined with the effect of a new injury, prevents the employee from working, the employee can receive total disability benefits and is not limited to compensation under the scheduled injury statute. It is not necessary to prove a causal connection between the pre-existing condition and the new injury.

So, in Singleton, the employee’s only injury was to his leg. Although the commissioner found that the employee was totally disabled, the SC Supreme Court held that the employee was only permitted to recover benefits under the scheduled injury statute – limited to the cap for loss of a leg.

In Ellison, the employee’s injury was to his leg (fractured in a forklift accident on the job), but the employee also proved that he had “pre-existing physical conditions including hypertension, sleep apnea, prostate cancer, diabetes, and congestive cardiac disease which, in combination with his workplace injury, rendered him physically unable to return to work after his accident.”

Although the commissioner found that the employee had a 20% permanent disability rating for the leg, the commissioner found that the employee was permanently and totally disabled due to the combined effect of his pre-existing conditions and the leg injury, and the SC Supreme Court agreed that Singleton does not limit an employee to recovering benefits under the scheduled injury statute when there is a “permanent physical impairment from any cause or origin” under SC Code § 42-9-400.

And, isn’t this just taking the scenic, legal jargon route to reach the “eggshell plaintiff rule?”

Got Axelrod?

Your Myrtle Beach worker’s compensation lawyer on the Axelrod team will help you to file your claim, represent you before the workers’ compensation commission for any hearings and appeals, and litigate legal issues when the insurance company attempts to deny your valid claim.

Call now at 843-353-3449 or message us online to speak with a SC worker’s compensation lawyer today.