Posted On: August 31, 2009 by Steven J. Malman

Court Says Workers’ Compensation Insurance Can Cover Weight-Loss Surgery if Injury is Job-Related

A state Supreme Court says that SAIF Corp, which handles workers’ compensation benefits, must cover a gastric bypass procedure that an injured worker had to undergo so that he could then get his knee replaced. The worker, Edward G. Sprague, hurt his knee in 1976 while working as a mechanic.

Sprague underwent surgery following the work accident and SAIF compensated him for his medical expenses. Sprague weighed 225 pounds at the time of the accident.

In the last three decades, Sprague’s weight has grown to 320 pounds. He also has arthritis in the knee that he injured. He hurt his knee again in 1999 in a work accident at a bakery.

His physician recommended knee replacement surgery. However, in order to obtain the best results possible, he said that Sprague would have to undergo gastric bypass surgery to get rid of his excess weight.

Sprague’s employer at the time rejected his workers’ compensation claim, citing that the arthritis he experienced was a result of the work injury in 1976. Sprague filed a claim against SAIF. The company had said that the worker’s weight issue was a preexisting condition and it therefore should not have to pay for the gastric bypass procedure.

An appeals court and now the Oregon Supreme Court disagreed with SAIF. The court found that the bypass procedure was related to the worker’s knee condition, which resulted from the 1976 work accident.

If you were injured in an Illinois work accident and your employer’s insurer is refusing to cover the expenses for services and procedures that you need to recover from your injuries, please do not despair. It may be a good idea, however, to retain the services of an experienced Chicago workers’ compensation lawyer who will know how to make sure that you get the work benefits that you are owed.

Gastric bypass to ensure success of second surgery compensable: Court, Business Insurance, August 28, 2009

Oregon Says Workers' Comp Must Pay for Weight Loss, Claims Journal, August 31, 2009

Related Web Resources:

Corporation v. Edward G. Sprague, Entry Form, May 18, 2009

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