The State Accident Fund v. SC Second Injury Fund,
388 S.C. 67; 693 S.E.2d 441
SIF Reimbursement Agreements
Claimant, who had preexisting degenerative disc disease, sustained an injury to his back. During surgery to treat his back, Claimant suffered a stroke that resulted in a permanent brain injury. SAF denied that Claimant’s stroke was causally related to his work accident. One month before the hearing on causation of the stroke, SAF and SIF entered into an agreement in which the SIF agreed to reimburse SAF “for the lumbar spine only.” The agreement was in full and complete satisfaction of any and all claims by SAF against SIF for Claimant’s accident. The agreement was approved by the Commission and neither party challenged the agreement. A month later, the Commission found Claimant’s stroke to be causally related to his work accident. Two years later, SAF requested reimbursement under the previous agreement for the stroke, which SAF asserted was causally connected to Claimant’s back injury. The SIF denied the request.
At the original hearing, the Hearing Commissioner denied SAF’s claim on the basis that the agreement’s language excluded injuries other than the lumbar spine. The Full Commission and Circuit Court affirmed. The SAF appealed to the Court of Appeals.
The Court of Appeals affirmed. The Court held that the term of the agreement clearly indicated that the parties did not contemplate extending its coverage to causally connected injuries that might have followed. Additionally, the Court noted that despite having knowledge of the stroke expenses and having ample opportunity to request their inclusion, SAF failed to seek inclusion of the stroke expenses in the terms of the agreement. SAF argued that the agreement should be void because no meeting of the minds occurred. SAF contended that it believed the agreement included all causally related expenses because the SIF’s practice was to pay causally related expenses after executing other similar agreements. The Court dismissed this argument after noting that there was no evidence that SAF was a party to any of these other agreements and that there was not evidence SIF ever represented to SAF that it would pay for Claimant’s stroke. The Court also dismissed SAF’s estoppel argument on the basis that SAF could not show that SIF made any representations to reimbursement for Claimant’s injuries other than those reflected in the agreement.
