Allen ex rel. Doe v. S.C. Pub. Emp. Benefit Auth.

• Decision Date: 04 March 2015
• Docket Number: No. 27504.,27504.
• Citation: 411 S.C. 611,769 S.E.2d 666
• Parties: Jeffrey D. ALLEN, on behalf of Jane Doe, Appellant, v. SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY, Employee Insurance Program, Respondents. Appellate Case No. 2012–212988.
• Court: South Carolina Supreme Court

411 S.C. 611

769 S.E.2d 666

Jeffrey D. ALLEN, on behalf of Jane Doe, Appellant

v. SOUTH CAROLINA PUBLIC EMPLOYEE BENEFIT AUTHORITY, Employee Insurance Program, Respondents.Appellate Case No. 2012–212988.

No. 27504.

Supreme Court of South Carolina.

Heard Dec. 5, 2013.

Decided March 4, 2015.

Terry E. Richardson, Jr., of Richardson, Patrick, Westbrook & Brickman, LLC, of Barnwell, and John A. Massalon, of Wills Massalon & Allen, LLC, of Charleston, for Appellant.

Theodore D. Willard, Jr., of Montgomery Willard, LLC, and Stephen Van Camp, both of Columbia, for Respondent.

Opinion

Chief Justice TOAL.

Jeffrey D. Allen (Appellant), on behalf of his daughter, appeals the Administrative Law Court's (ALC) order affirming the Appeals Committee of the South Carolina Budget and Control Board Employee Insurance Program's (EIP Appeals Committee) decision to deny Appellant's insurance claim for his daughter's diabetes educational training session. We reverse.

Facts/Procedural Background

Appellant, a South Carolina public school district employee, is insured under the Group Health Benefits Plan of the Employees of the State of South Carolina, the public school districts, and participating entities (the State Health Plan).¹ The State Health Plan is offered through EIP.²

In November 2007, Appellant's daughter was diagnosed with Type 1 diabetes at the age of two years old.³ Appellant's daughter's doctor prescribed her an insulin pump to regulate her insulin levels. In August 2008—two weeks prior to attaching the pump to Appellant's daughter's body—her family and two school nurses attended a two-hour training session at the Medical University of South Carolina, during which a diabetic educator taught the caregivers how to operate the insulin pump.

Appellant submitted a $560 claim for the educational training session.⁴ Blue Cross Blue Shield of South Carolina (Blue Cross) denied the claim on the grounds that the “benefit plan does not cover education and/or training for this condition.”⁵ Appellant appealed the denial through Blue Cross's appeals process. Ultimately, Blue Cross's Appeals Review Committee upheld the denial of benefits on the basis that diabetes educational training is excluded under the State Health Plan, and that section 38–71–46 of the South Carolina Code,⁶ which mandates coverage for diabetes educational training in certain health insurance policies, does not apply to the State Health Plan.

Appellant appealed to the EIP Appeals Committee. The EIP Appeals Committee denied Appellant's claim, concluding that Appellant's State Health Plan policy expressly excluded diabetes educational training and that section 38–71–46 did not apply to the State Health Plan.

Appellant appealed to the ALC. In the ALC, Appellant argued that diabetes educational training is covered under the State Health Plan,⁷ and in the alternative, the State Health Plan should be reformed to comply with section 38–71–46. Additionally, Appellant requested that the ALC allow the matter to proceed as a class action lawsuit. On August 13, 2012, the ALC issued an order affirming the EIP Appeals Committee's decision that the terms of the State Health Plan do not cover diabetes educational training because the State Health Plan does not qualify as “health insurance coverage” as defined by the South Carolina Code.⁸ In light of the ALC's disposition of the case, the ALC declined to address whether it had the authority to permit the case to proceed as a class action.

Appellant appealed the ALC's order to the court of appeals. This Court certified the appeal pursuant to Rule 204(b), SCACR.

Issues

I. Whether the ALC erred in concluding that section 38–71–46 does not apply to the State Health Plan?

II. Whether the ALC erred in failing to address the availability of class action relief?

Standard of Review

A party who has exhausted all administrative remedies available within an agency and who is aggrieved by an ALC's final decision is entitled to judicial review.

S.C.Code Ann. § 1–23–380 (Supp.2012). In an appeal from a decision by the ALC, the Administrative Procedures Act (APA) provides the appropriate standard of review. See S.C.Code Ann. § 1–23–610(B) (Supp.2012). Under the APA, this Court will reverse an ALC's decision if it is:

(a) in violation of constitutional or statutory provisions;

(b) in excess of the statutory authority of the agency;

(c) made upon unlawful procedure;

(d) affected by other error of law;(e) clearly erroneous in view of the reliable, probative, and substantial evidence on the whole record; or

(f) arbitrary or capricious or characterized by an abuse of discretion or clearly unwarranted exercise of discretion.

Id. A question of statutory interpretation is one of law for this Court to decide. CFRE, L.L.C. v. Greenville Cnty. Assessor, 395 S.C. 67, 74, 716 S.E.2d 877, 881 (2011) (“Questions of statutory interpretation are questions of law, which we are free to decide without any deference to the court below.” (citing City of Rock Hill v. Harris, 391 S.C. 149, 152, 705 S.E.2d 53, 54 (2011) )).

Law/Analysis

I. Applicability of Section 38–71–46 to the State Health Plan

Appellant argues that the ALC erred in concluding that section 38–71–46 of the South Carolina Code does not apply to the State Health Plan. We agree.

“All rules of statutory construction are subservient to the one that the legislative intent must prevail if it can be reasonably discovered in the language used, and that language must be construed in the light of the intended purpose of the statute.” Kiriakides v. United Artists Commc'ns, Inc., 312 S.C. 271, 275, 440 S.E.2d 364, 366 (1994) (citing Bohlen v. Allen, 228 S.C. 135, 141, 89 S.E.2d 99, 102 (1955) ). “ ‘What a legislature says in the text of a statute is considered the best evidence of the legislative intent or will.’ ” Hodges v. Rainey, 341 S.C. 79, 86, 533 S.E.2d 578, 581 (2000) (quoting Norman J. Singer, Sutherland Statutory Construction § 46.03 at 94 (5th ed.1992)). When interpreting a statute, the Court must read the language in a sense which harmonizes with its subject matter and accords with its general purpose. Eagle Container Co., L.L.C. v. Cnty. of Newberry, 379 S.C. 564, 570, 666 S.E.2d 892, 896 (2008) (quoting Hitachi Data Sys. Corp. v. Leatherman, 309 S.C. 174, 178, 420 S.E.2d 843, 846 (1992) ).

Section 38–71–46 of the South Carolina Code mandates coverage for diabetes education in “every health maintenance organization, individual and group health insurance policy, or contract issued or renewed in this State....”

S.C.Code Ann. § 38–71–46(A) (emphasis added). For purposes of the mandate, group policy “health insurance coverage” is defined as:

benefits consisting of medical care provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care under any hospital or medical service policy or certificate, hospital or medical service plan contract, or health maintenance organization contract offered by a health insurance issuer....

S.C.Code Ann. § 38–71–840(14) (2002) (emphasis added).⁹

We do not read “health care issuer” as modifying all preceding clauses in subsection (14). Benefits need not be provided by a “health care issuer” to qualify as “health insurance coverage” under section 38–71–840(14). Therefore, based on the plain language of section 38–71–840(14), the ALC erred in finding that the State Health Plan does not provide “health insurance coverage.”

Instead, the words “and including” in section 38–71–840(14) indicate that the General Assembly intended the statute's definition to be read in two parts, notwithstanding the list of exclusions. The first part of the definition provides that health insurance coverage is defined as benefits consisting of medical care provided: (1) directly through insurance; (2) directly through reimbursement; or (3) provided otherwise. S.C.Code Ann. § 38–71–840(14). After “and included,” the definition is expanded to include “items and services paid for as medical care under:” (1) any hospital or medical service policy or certificate; (2) any hospital or medical service plan contract; or (3) any health maintenance contract offered by a health insurance issuer. Id. Therefore, the plain language of the statute does not require health insurance coverage to be offered by a “health insurance issuer.” To conclude otherwise results in a tortured and illogical reading of the statute. See Browning v. Hartvigsen, 307 S.C. 122, 125, 414 S.E.2d 115, 117 (1992) (“A statute as a whole must receive a practical, reasonable, and fair interpretation consonant with the purpose, design, and policy of the lawmakers.”).

Section 38–71–46 is entitled “Diabetes Mellitus coverage in health insurance policies; diabetes education.” We find that the General Assembly's choice of title and use of the word “every” in section 38–71–46(A) indicates that, indeed, it intended to mandate coverage for “every health maintenance organization, individual and group health insurance policy, or contract issued or renewed in this State....” See S.C.Code Ann. § 38–71–46(A) (emphasis added). Nowhere in the plain language of section 38–71–46 does the General Assembly exclude—explicitly or implicitly—the State Health Plan from the mandate provided for by this statute.¹⁰

Moreover, we must read the language of section 38–71–46 in accordance with the statute's general purpose. See Eagle Container Co., 379 S.C. at 570, 666 S.E.2d at 896. South Carolina is cursed by diabetes. According to the South Carolina Department of Health and Environmental Control's most recently published statistics, South Carolina ranks seventh highest in the nation for the percentage of its adult population with diabetes. S.C Dep't of Health & Envtl. Control, Fact Sheet: Diabetes in South Carolina, SCDHEC.gov, 1 (Nov. 1, 2013), available at http://www.scdhec.gov/administration/library/ML–025328. pdf. Diabetes particularly plagues our state's African–American population, as one in seven African–Americans in South...