Employee Entitled to Benefits for Weight Loss Surgery to Treat Work Injury

September 11, 2009 (PLANSPONSOR.com) - The Indiana Court of Appeals has agreed with the state's Worker's Compensation Board that an employee who sustained a work-related injury is entitled to short-term disability and medical benefits for weight loss surgery as a precursor to back surgery to treat his work-related injury.

In its opinion, the court said the existence of pre-existing conditions is no bar to recovery under Indiana law. “When a claimant’s physical condition combines with an accident at work to produce a single injury, the Board may find that the injury arose out of that claimant’s employment within the meaning of the Worker’s Compensation Act,” the opinion said.

The court found that Adam Childers’ physical condition – his weight and his inability to lose weight without surgery – combined with an injury that arose out of his employment to produce a single injury. “[Childers]’s weight surgery is a pre-cursor for the safety of [Childers]’s back surgery in ways that are legally indistinguishable from the requirements of other types of surgical preparation – anesthesia, securing a sanitary surgical environment, providing the availability of proper surgical instruments, etc. – for his back surgery,” according to the court.

The court said it was within the Board’s purview to find that Childers’ initial weight made him “more susceptible to” an injury that would immobilize him, as did the blow to his back by a freezer door at Boston’s Gourmet Pizza, thereby causing him to gain weight such that the necessary treatment for his work-related lower back injury included the lap band procedure. Childers weighed around 340 pounds at the time of the accident, but gained 40 more pounds after his injury and before doctors recommended back surgery.

In addition, the court ruled that Boston’s Gourmet Pizza did not prove that prior to his injury, Childers had a weight problem that impaired his health and/or required medical intervention.

The court ordered the pizza shop to continue to pay temporary total disability benefits to Childers while he is preparing for, undergoing, and recovering from weight loss surgery, and while he is preparing for, undergoing and recovering from lower back surgery.

“[Childers] is entitled to receive temporary total disability and all such other benefits as he may be entitled while preparing for, undergoing and recovering from both his secondary and primary surgeries to treat his work-related injury, until such time as [Childers]’s injury shall become quiescent and be determined to be in a state of maximum medical improvement,” the court said.

The court opinion is here .