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Workers’ compensation can cover weight-loss surgery

On Behalf of | May 20, 2022 | Workers' Compensation |

Many people in North Carolina and elsewhere struggle with their weight. However, some people suffer from genetic and metabolic conditions that cause them to gain considerable weight despite their best efforts at keeping it off. In fact, for some obese people, weight-loss surgery is the only option. Although not always covered by private insurers, weight-loss surgery may now be compensable through the state’s workers’ compensation in certain situations, particularly when the surgery is necessary in order to proceed with an additional compensable surgery to treat a work-related injury.

Case and appeals ruling

A day-care owner in Salisbury had full-knee replacement surgery in 2010, and then she fell at her facility in 2013, injuring both of her knees to the extent they required surgery. The woman also reportedly suffers from severe obesity. The woman had apparently tried to lose weight unsuccessfully until her doctors told her gastric bypass was the only option. What’s more, her doctors told her she needed to lose a significant amount of weight before they could even operate on her knees.

The North Carolina Industrial Commission awarded the woman workers’ compensation benefits for the gastric-bypass operation; however, the program’s insurance provider denied the claim. They testified that her obesity was a pre-existing condition, further asserting that the weight-loss surgery was unrelated to the compensable knee-injury claim. The woman appealed, and the North Carolina Court of Appeals agreed, ruling against the insurer.

Right to compensation

Work-related injuries can come in many forms and happen in all work environments for a variety of reasons. Additionally, some compensable injuries may only be able to be treated after another underlying condition is taken care of first. Instead of being summarily dismissed, these special circumstances deserve further scrutiny. An experienced workers’ compensation attorney will carefully analyze all aspects of a client’s claims and work aggressively to help him or her obtain compensation for all necessary medical procedures stemming from the workplace accident.