Nearly two out of three adult Americans are overweight, and more than one out of four are obese. So, it’s no surprise that the issue of whether weight-related injuries are covered by workers’ compensation has been raised.
Should an employer have to pay the costs – an estimated $30,000 – for a worker’s gastric bypass surgery, in which a rubber band is used to shrink the size of the stomach and reduce weight gain? Also, what other types of weight-reduction surgeries, if any, should be covered as part of workers’ compensation laws?
It’s a hot topic, since obesity affects millions of children and adults, accounts for more than 100,000 American deaths each year, and results in nearly $150 billion in medical costs annually.
Workers’ Compensation Coverage
Most, but not all, work-related injuries are covered by workers' compensation coverage. The system is designed to provide benefits to injured workers, even if an injury is caused by the negligence or carelessness of the employer and/or the employee.
In cases where an injured worker is intoxicated or under the influence of illegal drugs, the injuries suffered generally are not covered. Also, self-inflicted injuries, those sustained during the commission of a crime or while the employee was not on the job, or during activities which are in violation of company policies also generally fall outside the protections of workers’ compensation.
Gastric Bypass Surgery as Workers’ Compensation
Candidates for gastric bypass surgery are at least 100 pounds overweight. They eat up a large share of medical treatment expenses through the treatment of diabetes and other weight-related medical conditions.
Some courts have held that weight-reduction surgeries are covered by workers’ compensation programs and ordered employers to shoulder the costs of helping their injured workers lose weight.
Boston’s Gourmet Pizza v. Childers
The Court of Appeals of
Childers was 25 years old, six feet tall, and weighed about 340 pounds in 2007 when he was working as a cook at Boston’s and was struck in the back by a refrigerator door, suffering a back injury.
On the advice of his doctor, Childers underwent gastric-bypass surgery and filed a claim for reimbursement for the cost of the surgery under his state’s workers’ compensation program. The doctor was of the opinion that Childers would continue to suffer back pain from the refrigerator door incident if he did not lose 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.”
The board further determined that Childers should receive 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.”
With obesity rates on the rise and millions more working Americans being overweight and at risk of becoming obese, the question of whether gastric-bypass surgeries and other weight-management medical procedures are covered by workers’ compensation is not likely to go away anytime soon. State courts across the
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