ORDERS:
ORDER OF DISMISSAL
This
matter is before the Administrative Law Court (“ALC”) pursuant to a Notice of
Appeal filed by Leonard O. Henry (“Henry”) on April 17, 2008. Henry appeals
the decision of the South Carolina Budget and Control Board, Employee Insurance
Program (“EIP”) closing his claim for basic long-term disability (“BLTD”)
benefits under the State of South Carolina’s Basic Long Term Disability Income
Benefit Plan (“Plan”). By letter dated March 19, 2008, EIP’s Long Term
Disability Appeals Committee (“Appeals Committee”) informed Henry that he no
longer qualified for continued disability income benefits under the terms and
conditions of the Plan.
On
appeal, Henry raises three issues, but they all relate to the Supplemental Long
Term Disability Plan (“SLTD Plan”), not the BLTD
Plan. On August 6, 2008, EIP filed a motion to dismiss this appeal based on
the fact that the ALC does not have subject matter jurisdiction over Henry’s
appeal. Upon consideration of the parties’ filings and the Record on Appeal,
the court finds that this appeal should be dismissed.
The
ALC, like other administrative agencies, is a creature of statute and, as such,
possesses only the authority and jurisdiction expressly provided to it by
constitutional and statutory provisions. See S.C. Code Ann. § 1-23-500 et
seq. (2005 & Supp. 2007); see also Mungo v. Smith,
289 S.C. 560, 564, 347 S.E.2d 514, 517 (Ct. App. 1986); Calhoun Life Ins.
Co. v. Gambrell, 245 S.C. 406, 140 S.E.2d 774 (1965). S.C.
Code Ann. § 1-11-710(C) provides:
Notwithstanding
Sections 1-23-310 and 1-23-320 or any other provision of law, claims for
benefits under any self-insured plan of insurance offered by the State
to state and public school district employees and other eligible individuals
must be resolved by procedures established by the board, which shall constitute
the exclusive remedy for these claims, subject only to appellate judicial
review consistent with the standards provided in Section 1-23-380.
S.C. Code Ann. §
1-11-710(C) (emphasis added). This provision, along with § 1-23-600(D) (as
amended by 2008 S.C. Act No. 334), provides for
judicial review of claims involving self-insured plans by the ALC in its
appellate capacity. However, there is no authority granting the ALC appellate
jurisdiction over claims arising from plans that are not insured by the State
of South Carolina.
In
the present appeal, there is no dispute that the BLTD Plan is a
state-sponsored, self-insured plan that is administered by Standard Insurance
Company. EIP argues, however, that the SLTD Plan, while state-sponsored, is
not funded by the state and, therefore, any challenges to this plan are not
properly before the ALC.
The
Record on Appeal shows that the SLTD Plan is underwritten by Standard Insurance
Company and is not funded by the State of South Carolina. (R. at 00077; compare R. at 00050 (SLTD Policy) with R. at 00002 (BLTD Policy)). Moreover,
the terms of the SLTD Plan contain a procedure for claims review which states
that a claimant may request review by Standard of a denial within sixty days
after receipt of the denial. (See R. at 00050, 00070, 00072.) No other
review procedures are provided for under the SLTD Plan. In contrast, the BLTD
Plan states that a claimant may request review within six months after
receiving notice of the denial from the claims administrator and further
provides that, upon receipt of that decision, a claimant may request a final
review from EIP. (See R. at 00020.)
In
the instant appeal, Henry raises issues relating solely to the SLTD Plan. The
SLTD Plan is not a “self-insured plan” subject to § 1-11-710(C). Therefore, this
court does not have jurisdiction to review the issues raised in Henry’s appeal.
It is therefore
ORDERED that this appeal is DISMISSED.
IT IS SO ORDERED.
PAIGE
J. GOSSETT
Administrative Law Judge
September 25,
2008
Columbia, South
Carolina
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