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June/July 2022  Volume 32, Number 3        
 

bariatric surgery

Is Bariatric Surgery Covered by Workers Comp?

More than a third of U.S. adults are obese. Almost another third is overweight.

An increasingly popular procedure for people who suffer from obesity is bariatric surgery. According to Renew Bariatrics, a bariatric services provider, “bariatric surgery is considered one of the most effective ways to achieve sustainable results. Owing to the amazing weight loss results delivered by bariatric surgery, its popularity has been rising at a rapid pace.

According to a study, the global popularity of bariatrics as a weight-loss treatment procedure is projected to grow at a rate of 10% year-over-year.”

Indeed, the latest figures published by the American Society for Metabolic and Bariatric surgery say the total number of bariatric surgeries performed in the US in 2015 was 196,000, which is an almost 10 percent annual growth since the 158,000 they reported four years earlier.

But should an employer bear the cost of an employee’s bariatric surgery, such as a gastric bypass procedure, which costs approximately $30,000? Especially when being overweight had little or nothing to do with the cause of the injury?

Robin Kluttz-Ellison worked at Noah’s Playloft Preschool Inc. in Salisbury, NC. She fell and hurt her knee twice: first in 2013 changing a light bulb when she fell off a ladder; the second time was in 2015 when she tripped over someone’s sleeping bag. Her injuries were deemed compensable, and she was approved for knee surgery. However, to undergo knee surgery, she had to lose weight, which according to her doctor, she couldn’t do fast enough due to the physical limitations posed by her injured knee.

The insurer denied her bariatric surgery, but she appealed and won. The Court of Appeals of North Carolina said that “there is a direct line connecting the dots” between the original compensable injury and the bariatric surgery. “For Plaintiff to undergo knee surgery, she had to lose weight” and according to her doctor she “could not lose weight fast enough due to her physical limitations for the knee surgery to be conducted safely and optimally without undergoing weight loss surgery.

“By connecting the dots, we can conclude that but for Plaintiff’s need to have right knee surgery to treat her compensable injury, she would not have needed to undergo bariatric surgery. Therefore, while the existence of Plaintiff’s weight problem was not directly related to the… 2013 accident, the need for bariatric surgery is directly related.”

In a similar case in Indiana, a cook named Adam Childers who was six feet tall and weighed 340 pounds was struck by a refrigerator door as it swung open. His back injury would not likely go away, his doctor said, unless he also lost weight.

The Indiana Workers’ Compensation Board found that Childers was entitled to receive “secondary medical treatment, including surgery, for weight reduction as a precursor to his primary entitlement to back surgery to directly repair the result of his work-related accident.”

Childers was also awarded temporary total disability benefits “while preparing for, undergoing and recovering from both his secondary and primary surgeries to treat his work-related injury, until such time as [his] injury shall become quiescent and be determined to be in a state of maximum medical improvement.”

Although Childers’s employer appealed the ruling, the state appeals court upheld it.

These are only two cases involving weight reduction and workers comp, but they are illustrative. As obesity becomes a greater national problem each year, the issue of whether gastric-bypass surgery and similar medical procedures are covered by workers compensation will become more prominent.

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In this issue:

This Just In...

House Passes SECURE Act 2.0

How the Ukraine Crisis is Affecting the US Workforce

Is Bariatric Surgery Covered by Workers Comp?

Updates on Marijuana Legalization, PTSD Claims and Lump Sum Settlements

 


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