South Carolina Court Holds that PIP Benefits May Be Reduced by Amount Paid for Insured’s Medical Expenses by Workers’ Compensation Carrier

Sometimes, a personal injury or wrongful death case involves only two parties and one theory of liability. For example, when one motorist’s negligence harms another driver in a South Carolina car accident, the injured driver may only need to file a simple negligence claim against the careless motorist who caused the crash.

However, many cases are not so simple, and sorting out how who is liable and whose insurance company must pay for which damages can be a complex endeavor indeed. For example, what happens when a car accident injures someone who is on the job? Who is responsible for the injured person’s medical expenses – the workers’ compensation carrier or the injured person’s personal injury protection automobile accident insurer?

Facts of the Case

In a recent appellate case originating in the Spartanburg County Circuit Court, the plaintiff was a woman who (joined by her husband) filed a lawsuit against the defendant automobile insurance company, alleging that the company had breached an insurance contract, as well as the duty of good faith and fair dealing conferred upon it under South Carolina law. The accident giving rise to the claim happened in April 2015 and resulted in medical expenses exceeding $5,000. The defendant paid a portion of the female plaintiff’s lost wages but denied payment of the remaining personal injury protection (PIP) coverage because the plaintiff’s medical expenses had been paid through workers’ compensation. The plaintiffs averred that this provision violated South Carolina Code § 38-77-144 and that, accordingly, they should recover the PIP benefits in addition to the workers’ compensation benefits. The trial court granted summary judgment in favor of the plaintiffs, and the defendant appealed.

Decision of the Court

The South Carolina Court of Appeals reversed, holding that the circuit court’s grant of summary judgment in the plaintiffs’ favor was in error. According to the court, neither § 38-77-144 nor the general public policy of South Carolina prohibited the type of exclusion at issue. Thus, the court found that the parties were free to include it in the policy of insurance sold to the plaintiffs by the defendant.

In so holding, the court noted that the legislature could have mandated that PIP coverage be included with all automobile policies, but it had chosen not to do so. There was likewise nothing in the relevant statutes to indicate that the legislature intended to favor workers’ compensation carriers at the expense of automobile insurance companies, such as the defendant herein. Thus, there was nothing to prohibit a policy exclusion that reduced PIP benefits by the amount that an insured such as the female plaintiff in the current case recovered under workers’ compensation law.

An Experienced South Carolina Personal Injury Attorney

Cases involving car crashes and other accidents in and around Spartanburg or Greenville can be complex. This is especially true when there are multiple defendants, claims, and insurance companies involved. The Patrick E. Knie Law Offices can help you sort through the details of your case in order to help maximize the monetary recovery that you receive for your injuries or your loved one’s wrongful death. For a free, no-obligation case evaluation, call us at 864-582-5118 and ask for an appointment to discuss your case. Most cases are handled on a contingency fee contract, so you do not have to wait until you are able to pay attorney fees up front in order to get the legal assistance you need and deserve.

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