Safety and OSHA News

Will workers’ comp pay for operation to reverse a medication’s side effect?

Employees taking medication for work-related injuries may be eligible for additional workers’ comp benefits for side effects from the drugs. In this case, the unusual side effect was …

… gynecomastia which is the growth of abnormally large breasts in men.
A West Palm Beach, FL, police officer strained his quadriceps tendons while on duty. Workers’ comp paid for medical care for the injury, including anti-inflammatory medications and, to combat their side effects, Zantac, a drug that treats ulcers.

Two years after the injury, the officer filed for additional workers’ comp benefits for the treatment of his gynecomastia. The condition is due to the excess growth of breast tissue, not from being overweight.

The employer and its insurance carrier denied compensability for the gynecomastia following exams by two doctors.

The officer took his case to a judge of compensation claims (JCC) because he believed there was a disagreement in the two doctors’ medical opinions. The JCC agreed and appointed an expert medical advisor (EMA) to determine 1) whether the officer had gynecomastia, 2) the cause of the condition, and 3) what treatment is recommended.

Several months passed before a doctor willing and able to perform the evaluation could be found. The officer asked for one appointment to be rescheduled, but he didn’t appear on the new date. The appointment was rescheduled again for a month-and-a-half later.

A week before the next appointment, the officer filed a motion to submit medical records from a doctor who had already performed surgery to address the gynecomastia. The company filed to dismiss the officer’s claim because he decided on his own to undergo the surgery before he was able to be evaluated by the EMA.

The JCC found that, because the only treatment for gynecomastia was removal of breast tissue, the EMA would not be able to determine whether the officer actually had the condition. The officer’s claim was dismissed.

Surgery complicated matters, but …

The officer took his case to a state appeals court, which ruled that the officer and JCC had both acted a bit hastily:

“Certainly, Claimant’s decision to have the surgery complicates matters, and could ultimately result in the denial of some or all of his claims, but dismissal of his claims was not warranted at this juncture … “

The court reasoned that the situation should still be presented to an EMA because the officer didn’t willfully disobey an order by having the surgery before he was examined by the court-appointed expert. In other words, no one told him not to have surgery before seeing the medical expert appointed by the court.

The court reversed the JCC’s ruling and remanded the case so that an EMA could make an evaluation.

Whether or not the officer’s breast reduction surgery will be paid for by workers’ comp is still a matter to be determined, pending an EMA’s examination. But at the moment, it’s possible the surgery will be covered.

What do you think about the court’s decision? Has your company ever dealt with a workers’ comp case in which treatment for a work-related injury supposedly caused a secondary condition? Let us know in the comments below.

(Arlotta v. City of West Palm Beach, Dist. Crt. of Appeal First Dist., FL, No. 1D11-1877, 3/26/12)

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Comments

  1. Medication prescribed by the treating physician caused a reaction and hospitalization. Although this was different from the initial injury, it was directly a result of the meds prescribed for the injury; therefore, this was covered as part of the workers’ compensation claim.

  2. If it turns out the meds did cause the secondary condition, then yes it should be covered. But it hasn’t been proven so it shouldn’t be covered. The employee may have known he had this condition before his injury. Then decided to have the operation on his own before it could be proven it was indeed a condition before his injury.

  3. So we have to take the employee’s word that he developed gynecomastia from taking Zantac. Interesting that this is not listed as one of the side effects on Zantac’s webpage. The worker should have first proved that the condition developed because of his medication first, then make arrangements for the surgery.

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