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Saturday, March 20, 2010

Workers Compensation Insurance Company Ordered to Pay For Gastric Bypass

Treating medical conditions that are necessary to relieve and cure a medical condition is the responsibility generally of workers' compensation programs throughout the United States. Now a Court has ordered that an insurance company must treat a persons obesity as an extension of its medical benefits so that weight reduction can occur and the underlying work related condition can be addressed.

"Claimant slipped and fell at work in 2002, and his ensuing workers' compensation claim presently encompasses, among other things, injuries to his head, neck, back and knees. His morbid obesity has contributed to his knee and back problems and, in an effort to combat those problems and counter a broader threat to his survival, claimant sought authorization to undergo gastric bypass surgery. The Workers' Compensation Law Judge granted his request. Upon review, the Workers' Compensation Board affirmed, holding that the surgery was causally related to the compensable injuries. 

In affirming the decision the Supreme Court, Appellate Division, Third Department, New York held:

"The employer is obliged to pay for claimant's medical care “for such period as the nature of the injury or the process of recovery may require” (Workers' Compensation Law § 13[a]; see Matter of Spyhalsky v. Cross Constr., 294 A.D.2d 23, 25-26 [2002] ). There is evidence in the record that claimant has gained a substantial amount of weight since 2002 due to the sedentary lifestyle imposed by the compensable injuries. Claimant's treating orthopedic surgeon opined that claimant's back and knee pain was exacerbated by his obesity and that such could be alleviated by weight loss. An independent medical examiner agreed, opining that weight loss would “certainly” help those conditions. While material in the record before us could support a different result, substantial evidence exists for the Board's determination that claimant's weight gain was caused by his compensable injuries and that gastric bypass surgery “would assist in [his] recovery” ( Matter of Bolds v. Precision Health, Inc., 16 A.D.3d 1007, 1009 [2005]; see Workers' Compensation Law § 13[a]; Matter of Spyhalsky v. Cross Constr., 294 A.D.2d at 25-26, 743 N.Y.S.2d 212).
Laezzo v. New York State Thruway Authority, --- N.Y.S.2d ----, 2010 WL 812862, N.Y.A.D. 3 Dept., 2010, March 11, 2010.