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Does workers’ comp cover weight-loss program so employee can have back surgery?

An employee injured her back at work. A neurosurgeon recommended back surgery but told the worker she had to lose 90 pounds before he’d operate. Does workers’ comp have to cover a weight-loss program? 

Shela Lybyer worked as a custodian for the Springdale School District in Arkansas. She suffered an injury to her lower back while helping to move wrestling mats in a school gym.

Lybyer returned to work on “very light duty” with a lifting restriction of ten pounds.

Conservative treatment for the back injury didn’t improve Lybyer’s condition, so a neurosurgeon recommended back surgery. However, the surgeon refused to operate because of the risks associated with Lybyer’s obesity and told her she had to lose 90 pounds first. She started to see another doctor for help losing weight.

Six months after her injury, Lybyer was accused of trying to cover surveillance cameras in a hallway where she worked. She admitted attempting to cover one camera with tape and signed a resignation letter.

After leaving her job, Lybyer applied for temporary total disability (TTD). An administrative law judge denied the TTD benefits but said she was entitled to medical benefits including a weight-loss program so she could have back surgery. The Arkansas Workers’ Compensation Commission affirmed the ALJ’s decision.

Both sides appealed. The school district said its workers’ comp insurance shouldn’t have to pay for a weight-loss program for Lybyer. She appealed the denial of TTD benefits.

Lybyer admitted she voluntarily signed the letter of resignation because she didn’t want to get a bad evaluation. A state appeals court noted that an employee isn’t eligible for TTD benefits after voluntarily resigning from a job. The court upheld the Commission’s decision to deny TTD benefits.

The school district argued there wasn’t enough evidence to support the claim that Lybyer’s weight gain was caused or exacerbated by her workplace injury. The district also argued there was no evidence to show Lybyer could reach the weight requirement for the back surgery.

The appeals court agreed with the Commission about the weight-loss program. It found Lybyer’s efforts to lose weight so she could have back surgery were foiled by her workplace injury and financial issues. Lybyer’s testimony and medical records showed that under a doctor’s guidance she had been able to lose about 100 pounds previously.

The appeals court found, “The Commission’s decision to award a conservative weight-loss program is supported by substantial evidence.” The district’s workers’ comp insurance was ordered to pay for a weight-loss program for Lybyer.

(Shela Lybyer v. Springdale School DistrictArkansas Court of Appeals, No. CV-18-682, 2/13/19)

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