Doc orders weight-loss surgery: Will workers’ comp cover it?
September 4, 2009 by Fred HosierPosted in: Injuries, Special Report, What do you think?, Worker health, new court decision
Imagine this: An employee, who happens to be morbidly obese, is injured at work. Doctors say, before he has surgery to correct the workplace injury, he needs weight-loss surgery.
And, in two separate cases, courts rule that comp must cover the weight-loss surgery!
First, the case of Adam Childers. While working at Boston’s Gourmet Pizza in Indiana, he was struck by a freezer door, injuring his lower back. At the time, Childers was six feet tall and weighed 340 pounds.
A doctor said before Childers could have back fusion surgery, he needed lap-band surgery to lose weight.
A workers’ comp panel awarded him benefits to have the weight-loss surgery. His employer appealed, arguing that Childers suffered from a pre-existing health condition of morbid obesity.
However, the court said the restaurant couldn’t prove that Childers had a weight problem that impaired his health and/or required medical intervention. Case closed, he gets the surgery paid for by comp.
In the second case, Edward Sprague injured his knee at work in 1976 and reinjured it in 1999.
During that time span, Sprague’s weight went from 225 to 350 pounds.
Doctors told Sprague his weight would prevent successful treatment of the knee condition, so he sought workers’ comp benefits for weight-loss surgery.
His insurance carrier argued that the claim wasn’t compensable because the obesity wasn’t caused by his 1976 accident.
Last year a state court ruled Sprague’s bypass surgery should be paid for by workers’ comp. The court said the injury was more than a minor cause of Sprague’s need for gastric surgery.
Now, the Oregon Supreme Court has issued the last word in this case. It agrees that comp should cover the weight-loss surgery.
Should state comp laws be amended to prohibit employees from getting workers’ comp benefits to pay for weight-loss surgery in cases like these? Let us know what you think in the Comments Box below.
Tags: lap-band surgery, morbid obesity, weight-loss surgery, Workers' comp, workplace injury
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September 8th, 2009 at 1:24 am
I think if one surgery can’t be done without the other, then both need to be paid for.
September 8th, 2009 at 10:10 am
The work injury requires treatment that includes weight loss. If the doctor says the surgery is required to lose the weight than it should be paid for.
September 8th, 2009 at 10:24 am
No WC should not be made to pay for weight loss surgery.
September 8th, 2009 at 11:13 am
NO WAY should comp be required to pay for these people! They chose to allow themselves to become obese so, they should have to pay for their own gastric bypass/band. Maybe, had they learned to “bypass” the chow a little bit more, they’d be in better shape.
In my opinion, the obese are becoming another “entitlement bound” section of the population.
September 8th, 2009 at 11:14 am
What is this country coming too? One more reason our private sector businesses are going to places like China and India for labor! Between OSHA, Organized Labor, and petty rubbish like this, our businesses are being strangled. I suppose we as safety professionals should start pushing health and wellness programs. But then, you can lead a horse to water, but you can’t make him drink!
September 8th, 2009 at 11:15 am
If an employee is injured at work, the company is responsable. If the employee is obese, is the employee responsability. The company can not control employees life style, but can help having a safe and healthy environment.
September 8th, 2009 at 1:20 pm
Once again business is being forced to delve into personal health (obesity) choices because of judical rulings. But you can’t ask health questions (pre-existing) so how can you take the chance on hiring anyone who is not 20 YOA, in apparent great health and single? Companies can’t order workers to lose weight or stop smoking because that would be discrimination and if you don’t push for it, you are ignoring workers safety (another hazard!) And people wonder why businesses aren’t hiring them when they show up for the interview with a super-sized EVM in one hand and a jumbo drink in the other and smelling of tobacco. We are moving toward an era of business not providing any health insurance for anyone (because of the cost) and trying to make ends meet as the work comp premiums go through the roof.
September 8th, 2009 at 1:36 pm
A persons weight loss should not be covered. They were the ones that could not control how heavy they got and the company should not have to pay. If weight loss is required for sugury, then the employee should take the loss untill they lose it then workmans comp should pay for the actual injury correction.
September 8th, 2009 at 3:13 pm
Intersting case. If a pre-exsisting condition causes the injury such as fainting due to low blood pressuer or diabetis, the employer should not have to pay. Now if the accident was caused in the work environment then the employer does pay. That includes any cost needed.
Could this lead to not hiring employees with pre-existing medical issues?
some of my college course, delt with figuring out the return on investment for programs such as smoking cessation, lowering cholesteral, blood pressue managment and weight management. Will employeers forgo these cost and discriminate aginst potential future work comp. cost. I believe we need to start discussing how we are going to deal with an aging work force.
September 8th, 2009 at 3:18 pm
I have a hard time going along with the gentleman with the knee injury getting the weight reduction surgery paid for by comp. According to the article, the weight gain came between the time he injured his knee in 1976 and when he reinjured the knee in 1999. A company is not allowed to terminate him due to the weight gain so why should that same company be liable to pay for the surgery to get the weight off. The weight gain was due to either a lifestyle choice which he should be responsible for or a medical condition which his health insurance should pay for. And people wonder why employers are closing their operations or moving outside of the US.
September 8th, 2009 at 3:25 pm
I agree with Rhonda, wholeheartedly. Tort reform before healthcare reform.
September 8th, 2009 at 3:36 pm
What if these people had other health related issues that made surgery impossible like high blood pressure, high cholesterol, severe diabeties, or anything else? Would WC be responsible to treat these pre-existing conditions as well? This can really open a can of worms.
September 8th, 2009 at 4:25 pm
TO all Employers
WC should not pay for weight loss surgery and if you hire an employee who has a weight proplem you should make them sign a disclamer prior to starting work for your company to protect assists.
September 8th, 2009 at 5:07 pm
I would like to say obesity is just like cancer. People always blame the person and some times its not how much we eat. It not just pushing away from the table like everbody thinks. I’m glad that WC is pushing the surgery. It will change the way these people fill and they will do more at work. It will change there lives….
September 8th, 2009 at 5:23 pm
Bad idea. Just one more reason for companies to be prejudice about hiring obese people. I think the judge could have taken into consideration the injured person could diet to loose weight.
September 8th, 2009 at 5:48 pm
I want to address the fact that 50% of obese people are not obese because they “chose” to be. Many reasons for obesity has NOTHING to do with eating too much. We, as commenters can’t
ass-u-me that either one of these two cases of obesity were caused by neglegence. For example, if someones thyroid goes out they could easily gain or lose 50 lbs in less than one months time. How sad that bigotry shows up in so many “flavors”. So ALL obese people should not be covered by workers comp. for an injury if bypass is needed before corrective surgery? Pretty narrow minded to say so. I think it should still be a case by case decision.
September 8th, 2009 at 6:02 pm
Responsibility is a value that is in the consciousness of the person, which allows him/her to reflect, manage, guide and assess the consequences of their actions. If the natural act of being responsible is passed from the individual to the courts, then we end up with a conscious by committee with assigned responsibility to an entity, as in this the case, the employer.
September 8th, 2009 at 6:33 pm
This is insane. Socialism here we come. How about the WC board award the employee to take leadership classes on self responsibility and the employee pays for it.
The funny part is that in many cases if an injury occurred at work while an employee was walking down normal and compliant stairs and fell because the employee weighed 400 lbs, the company would be liable.
September 8th, 2009 at 6:34 pm
Worker’s Comp shouldn’t have to pay for weight loss surgery. What if someone couldn’t have surgery due to bad blood pressure, high blood sugar, or high cholesterol; would worker’s comp have to pay for blood pressure, diabetes, or cholesterol pills? The weight issue is not employment related its lifestyle and/or genetics. The surgery should be covered by the employee’s health insurance, the employee, or medicaid benefits. I would think that other options would have to be tried first before surgery such as diet, exercise, and perhaps medicine to help lose weight. I wonder how an employee’s lack of compliance with the physicians and therapists directives effect worker’s compensation. People have to work at getting healthy themselves and a “magic” surgery without any work on the part of the patient or employee is rarely the answer.
September 8th, 2009 at 6:34 pm
Yet another example of judges not judging. The rules seem to have become more important than the game. Put their lawyer in the cooler for a couple of days for contempt and dismiss the claim. Any self respecting, self sufficient citizen would be embarrassed to file such a claim against their employer’s insurance.
September 8th, 2009 at 6:47 pm
Wow I am a food tester and i cant hold my weight down at all, I sure hope i dont get hurt at work or all the workmans comp i have paid in for the last 6 years will be for nothing. lets not get to judmental of the overweight population it may just be you someday.
September 8th, 2009 at 9:34 pm
i have no problem with either company being required to pay for these surgeries. Many companies have refused to assist there employees with health issues and stress management, yet when they become ill for these reasons, its the employees fault. i started work for one agency over 15 years ago and the one outlet for stress i see within my work environment is food yet my agency has not until recently begun addressing stress relief or healthier living.
as for the cop outs who say this why the companies move out of the us, my response is bs. the companies move for one reason only. GREED!
September 9th, 2009 at 8:58 am
Well Said Paul!
September 9th, 2009 at 9:27 am
Unfortunately the courts are losing all common sense. The employee should have to pay for their own bypass surgery then workers comp kicks in to pay for the injury. These kinds of court rulings will only make it harder for the obese to get jobs as they will be seen as a liability by prospective employers.
September 9th, 2009 at 9:30 am
No I do not think WC should pay for a condition that did not arise out of and in the course of performing a job function. Is the weight a contributors factor yes but not a result of the job. Companies are going to be nailed either way. In another article WC was held compensible for a company sposoring or contibuting to a Wellness program where an employee got hurt in a gym off hours. If healthcare reform is to have any chance then the legislators need to stop this “I don’t take responsibliity for myself” attitude.
September 9th, 2009 at 9:33 am
If workmans comp is going to be expected to pay for weight reduction in these cases where it is not a direct result of employment, it won’t be long before insurance carriers will be looking at employee’s weight as factor in setting premiums. Then we as employers may start looking at weight as condition of employment…. who knows where this slippery slope leads to.
Let’s not open this can of worms. We all have to take some personal responsibility for something, and employers need to be held responsible for their actions. Having employers paying for things they have little or no authority to control is not right.
I also believe that if I am injured at work because of personal health issues IIIIIII should be held responsible.
September 9th, 2009 at 9:55 am
I have a better idea – don’t hire the fat people to begin with. Reduces their health insurance costs as well as preventing WC costs like the story above.
In case you say I’m discriminating – you’re right! We all make discriminating choices every day in all we do. In this case I’m discriminating to pick a “safer” and less “costly” choice for my employee. And I challenge anyone to file an EEO case against me.
September 9th, 2009 at 10:00 am
To Katie:
Signing a waiver will not protect anything. If someone getss hurt at your company, your company will be liable to cover damages.
To those stating that being overweight is not a choice:
I agree to some extent, however the docs in these cases are pushing for the stomach reduction surgery, not looking to fix chemical or hormonal problems, and that leads me to believe that overweight problems in these cases can be linked to overeating.
I think that this is leading to a very slippery slope, how much of people’s previous lives is WC going to have to cover?!?
September 9th, 2009 at 10:31 am
WC is for work related injuries, period, not HEALTH related issues. As Linda stated above, a thyroid problem can cause obesity, so not all obese people are from eating too much. However, a thyroid problem is not a work related injury, it is a health problem. Therefore, that should be covered under the person’s health insurance, not WC.
My comments on the cases above:
First case: “The court said the restaurant couldn’t prove that Childers had a weight problem that impaired his health and/or required medical intervention”. Of course they could prove it. The doc said they couldn’t do the surgery until he lost weight, so he was evidently a health risk for surgery due to his weight. Once again, a health concern and not a work related injury. WC shouldn’t pay, health insurance should. WC pays for back surgery, health insurance pays for lapban. Case solved.
Second case: I have two bad knees thanks to the military. Since leaving the military, I have put on some weight. Is it due to my knees? Yes and No. Yes because it makes it difficult for me to exercise and no because I should be watching what I shove in my mouth a little better. So should this guy. Just because you have a “disability” doesn’t mean you have to be obese. Dieting works to control weight also. WC issue, NO. Health issue, NO. Personal issue, YES. WC pays for the knee surgery, patient goes on a diet. Case solved.
September 9th, 2009 at 10:37 am
This is ridiculous. The obesity issues in both cases are personal issues that need to be addressed by the employee, not the employer. People need to take responsibility for themselves, and not push that responsibility onto others. If either case was an over eating problem the employees should have addressed it before it got to the point they were obese. Same line of thought applies to a pituitary problem. You would think that if someone put on 50 lbs. in one month they would consult a physician and address problem and try to fix it before they put on 150+ lbs. Either way the employee in both cases should have had to address the obesity issue outside the workers’ comp. system. 2 equally poor decisions that will more than likely cause problems for all of us down the road.
September 9th, 2009 at 11:15 am
This case worries me. Being overweight myself, but taking control of that now, I worry that cases like this will encourage companies to weed out prospective employees based on their weight. I think the injured employee should be encouraged to lose the weight without the lapband or bypass surgery. If it takes writing exclusions into state laws then so be it.
September 9th, 2009 at 2:26 pm
The problem with doing gastric bypass surgery is that it is risky, and takes quite some time to work. I think the doctors should have suggested to the patient that he lose weight by whichever way he chooses, then the doctor would do the surgery. I don’t know the severity of the back injury in either of these cases, but sometimes time will make the injury better in that the swelling on the bulging disc will go down, etc.
But the companies should not have to pay for any surgery that is not directly linked to the injury.
September 9th, 2009 at 3:48 pm
Weight-loss surgery as an elective, then no, let the person use their own medical insurance.
Since the weight-loss surgery is being called for in order to perform treatment for the work related injury, then yes, workman’s comp can pay for it.
Those saying “NO” must be employers. You can suck it up. If you don’t like it then institute a program to encourage healthy weight loss as a preventative measure. Hire a Wellness Counselor to assist in this. You not have had anything to do with people becoming obese, but at the same time you weren’t doing anything to discourage it within your company.
September 9th, 2009 at 5:16 pm
THe obesity is a personal health issue. Are employees going to file a claim for lap-band surgery (or other treatment) because they have a desk job and have gained 40# in five years? Do they have stress at work and band-aid it by eating too much and WC should pay for it? How far will our litigious society let this go? No one will be able to stay in business if we continue with this trend of irresponsibility and inaccountability. YES, the state WC regs must be changed to ensure employers aren’t faced with an onslaught of these unjust, innappropriate claims.
September 11th, 2009 at 6:34 am
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September 11th, 2009 at 9:50 am
I agree with Lori. Over eating to the point of being overweight is an individual choice that each person makes and should live with the consequences of that choice. If the person gets injured at work, let WC pay for the injury that the employee suffered but NOT for the surgery to lose weight – that is absured and ridiculous! Why is the employer going to be penalized for something he had no control of?!
Employers cannot discriminate against a person being
September 11th, 2009 at 1:18 pm
Some people take responsibilty for their physical condition and some do not; it is the world we live in.
I DO NOT ever believe WC should ever pay for anything that is the sole responsibilty of the individual; ever!
The problem is we live a cheating, lying, not my fault, it’s always someones elses fault, so on and so forth society and until the legal system regains its common sense this will never change.
Unfortunately; I agree with a prior comment that soon how a person takes care of themselves physically; which superficially and externally can be seen very easily, will be a criteria for hiring!
WC has become a crutch and scapegoat for many unnecessary things and the true impact will be higher insurance premiums and to a point, when the premiums get to high; a business drops its health care or goes out of business.
September 13th, 2009 at 9:07 am
in the case of the first guy it should not have been covered, his weight was a pre-existing condition that was not in any way caused by the injury, except maybe making him a little slower to react to the door. His condition was to caused by but maybe contributed to the severty. He should be heald responsible for the cost and not the employer.
The second one is not so black and white. Knee injuries decrease mobility which increases you weight gaining potential. I’ve recently injured my knee and in the short span of 4 mo I have gone up two clothing sizes with no changes in eating habbits, while aginst doctors orders I’m still trying to exercise, ammitedly at a much slower pace. He had a period of years, I can see that causing even more weight gain, which in itself will cause more damage to the weakened knee, which then turns around and further decreases mobility. Its a cycle, that will lead to further harsher health issues, which most likely lead to the second injury. This one needs more closely looked at. In many cases such as this yes it should be covered. The injury lead to secondary health issues, those should be covered.
September 14th, 2009 at 11:17 am
Common sense tells us that when you’re that over weight it’s not healthy. Companies shouldn’t have to hire a wellness counselor to encourage employees to be healthy. It’s just another way of saying it’s not my fault and pushing the responsibility on to someone else.
September 16th, 2009 at 4:49 pm
If the weight loss surgery will get the worker back to work sooner then pay for it, it may cost the insurance company less money in the long run just to pay for the surgery than it would be to pay the worker to be out of work, remember the worker is getting 67% of his pay for everyday he’s out and you may never get the worker back to work if they can’t do the surgery for the work related injury. With weight loss surgery the weight comes off faster which gets them to the operating table for the work related injury sooner, as well as a faster recovery time when your in better physical condition, the ultimate goal is to get the worker released to full duty as soon as possible.
September 23rd, 2009 at 11:26 pm
I would say that if you hire someone that is morbidly overweight and they are injured on the job and they need to have a surgery to repair the injury that happend at work then the weight loss surgery should be covered.
This is a prime example of why it is important to pre-screen and proves that as the employer you are responsible for the decisions that are made to hire and what job duties are being preformed.
If a person that was over mobidly weight knew it would be hard to get a job maybe then the US would not have such a problem with obesity.
September 24th, 2009 at 9:16 am
Wow are you suggesting we discriminate against over weight people? There are so many things wrong with that thought process that I don’t know where to begin. What exactly would a “safe” job be for an overweight person that could insure they wouldn’t hurt themselves? What if you hired a person or normal body weight and they gained weight while in your employement?
Your opinion is even more freightening then WC being charged for weight loss surgery.
October 7th, 2009 at 4:50 pm
The problem is that the bypass surgery will not fix whatever made the person overweight to begin with. We as a society tend to be “victims” and not take responsibility for ourselves. Yes, there are many ways to become overweight, some beyond the employee’s control but NONE caused by the employer. If thyroid is the cause, the employee’s thyroid was not injured at work, right? Also, after the surgery and any weight loss that may result, can the employer then require the employee to submit weekly meal plans and limit what he eats until after they are all done treating his work related injuries? This whole scenario is ridiculous. These types of cases are going to end up feeding into discrimination in the hiring process in time. If private health insurance would recognize the benefits of preventative programs and pay for things like nutritional consultations and exercise programs, we’d all be a lot better off and wouldn’t see cases like this come to court in the first place.
October 9th, 2009 at 12:54 pm
The overall rate of success of these weight loss programs which are perpetually contending with from each one other is more or less the one. And the most ridiculous part is that these programs all fail at the same hurdle in cattiness of doing really tall claims. This occurs because the body gets habituated to the hardship through which it is cast and aligns itself to the new routine and the metabolic process slows down. You have to be quicker than nature to be able to trick the body into falling back weight. Without pursuit this footprint then you will perpetually inquire why you cannot turn a loss exercising weight.
October 12th, 2009 at 2:46 pm
I think their obesity likely resulted in their poor safety habbits at work, which resulted in their initial work injuries, which resulted in a doctor requiring the bypass surgery in the work place. I don’t think employers should have to pay for any of the treatment as it can all be easily tied to pre-existing, non-work related issues.
Where is the personal accountability? Work DID NOT MAKE YOU OBESE!