Two recent workers compensation cases were settled this month that centered on whether or not weight loss surgery should be covered for work related injuries. In both cases, the state court decided that in certain circumstances weight loss surgery can be covered if it is needed to treat a job-related injury.
The two cases were separate and unrelated incidents, but in each instance the injured employee had gained weight following a work related injury and both had been instructed to lose weight before additional surgery could be performed for the specific injury. Doctors had recommended weight loss surgery to assist with weight loss.
The first court decision involved a 25 year old man in Indiana who was injured when he was accidentally hit in the back with a freezer door while at work in a pizza shop. He suffered from severe pain in his back that extended down into his legs. His doctor recommended back surgery, but only after he lost some excess weight. At the time of the injury he weighed 340 pounds, but had gained 40 pounds following his injury.
The trial court had initially ruled that both back surgery and the preceding Lap-Band Surgery should be covered as treatment for the “single injury” received on the job. The Indiana Court of Appeals affirmed the decision earlier this month. You can read more about this story at Courthouse News Service.
The second case involved an Oregon man with a knee injury. The initial injury had occurred in 1976 while he was working as a mechanic. Following this injury, knee surgery was covered by SAIF, the state charted agency that handles compensation insurance. Over the years, he developed arthritis in the knee and his weight went from 225 pounds to 320 pounds.
Then, in 1999, he reinjured his knee while working at a bakery. His doctor recommended knee replacement surgery, but said it was necessary for him to lose weight beforehand.
Following a lengthy court battle, the Oregon State Supreme Court ruled last week that the state compensation insurance agency must pay for the employees gastric bypass surgery. The decision was based on the findings that the arthritis resulted from the original injury and that weight loss surgery was needed before knee replacement surgery could be performed. You can read more about this story in the Insurance Journal.
The court findings in these two cases are based on specific circumstances and should not be considered a widespread coverage of weight loss surgery for work-related injuries. The similar decisions, however, do highlight the growing support of weight loss surgery as an effective weight loss treatment for obesity and the benefits it can provide for weight-associated health conditions.