The American Medical Association (AMA) has recently listed obesity as a medical condition, as opposed to it being a result of eating choices. Can this affect work comp claims?
Prior Medical Conditions Can Result in Loss of Future Indemnity
Yes. Prior medical conditions can, occasionally, be apportioned with disability in a later comp claim. And concealing a prior medical condition can result in loss of future indemnity payments. Neither of these can interact with a comp claim if the prior condition is seen only as the result of voluntary choices.
The consequences for claims would be larger if second injury funds were not vanishing, since obesity effects one third of all people with serious work comp claims, and would have resulted in far more successful applications by carrier for reimbursements.
Morbid Obesity Permits Recovery From Second Injury Fund
However, apportionment remains a possibility. Recent case law in New York expands apportionment of comp claims with prior conditions, even if they are not the subject of prior workers comp claims. And “morbid obesity” was permitted as a pre-existing condition which would permit recovery from second injury funds. So, obesity may become a new, major, issue in comp claims.
What about concealment of obesity? Concealment of significant conditions can result in loss of benefits. But concealment does not apply to obvious conditions, such as an amputated limb. And obesity is obvious and cannot be concealed, or so it would seem.
But prior obesity which has been treated can now be considered an illness which must be disclosed in a comp claim. And that can be an embarrassing intrusion if it becomes a new subject for claim investigations.
Could Be Similar Impact to Change in Substance Abuse
Prior substance abuse, alcohol and drugs, were also considered personal failings, rather than disease, until they began to be described as “obsessive-compulsive disorders”, often resulting in hospitalization at medical facilities. And sympathy for the conditions was far less than for obesity, even as substance abuse became the basis for successful reimbursement claims.
This is another change which, originally, seemed to have no effect on work comp. But the history of work comp is cluttered with unintended consequences.
Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. [email protected]
Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: [email protected].
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