The growing waist line of America is not only having an impact on our health, but on workers’ compensation programs. This impact can increase the costs of common work injuries.
An All Too Common Hypothetical
John McNeely is your average American who works for Hard Hat Construction Company as a specialized laborer. Although he is a hard working individual, he enjoys his time off on the weekends. This has resulted in him being “a few pounds overweight.”
One day he suffers a compensable injury to his knee in the nature of a right medial meniscus and ACL tear. As a result of the injury, he receives a standard course of medical care and treatment, which includes surgical repair and post-operative physical therapy. Unfortunately, Mr. McNeely continues to have issues with his right knee and he is eventually referred for a right knee arthroplasty. Due to his underlying condition of obesity, it is recommended he undergo a weight loss program prior to surgery. A request for payment is submitted to the workers’ compensation insurer, which is denied. Is the obesity care compensable?
Current Status of the Law
Each state’s workers’ compensation law governs the compensability of medical care and treatment. While every law is different, there is a growing trend across the United States of courts requiring workers’ compensation insurers to pay for treatment such as weight loss programs or surgery. These forms of additional medical care and treatment are costly and place added burdens on the system.
In examining these issues, courts have concentrated on the specific state’s statutes and case law interpretations as to what is “reasonable and necessary” to cure and relieve the effects of the work injury. When engaging in this analysis, they often note that the employee’s obesity, while not work related, is reasonable and required to promote resolution of thework injury. In such cases as injuries to backs (especially the lower back), lower extremities and weight bearing joints, weight loss programs and surgeries are being found to be compensable.
Meeting the Challenges of Obesity
Workers’ compensation claims that involve an obese employee create many challenges. Here are several suggestions for meeting these demands:
- Every workers’ compensation claim is dependent on the statutory framework of their controlling law and case law interpretations. Every case is also dependent on the facts of the case. There is no “cookie cutter” approach to handling these claims.
- Defense attorneys should carefully question their medical experts regarding obesity-related care. Special caution should also be given to the expert’s opinion regarding what symptomology, if any, is related to the underlying obesity diagnosis, and the effect the pre-existing condition has on the progression of the work injury.
- Numerous studies indicate obese employees are more likely to file a workers’ compensation claims. Employers should scrutinize their work environment for dangers and take proactive steps to prevent injury. Paying attention to workplace ergonomics is essential.
- The longer an injured worker is off work, the greater chance they will decondition. Getting injured workers back to work in some capacity is better than no work at all. Contrary to popular belief, disabled workers want to get back into the workplace and be active in the labor market. Do not assume a case is hopeless.
- Use medical experts who understand these issues and pay special caution to the employee’s symptomology, if any, and its relation to the underlying diagnosis.
- Promote employee wellness programs within the work place and implement programs that follow best practices. Studies show that effective and well-implemented wellness programs reduce costs and promote a positive work environment.
Author Michael B. Stack, CPA, Principal, 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. http://reduceyourworkerscomp.com/about/. Contact: email@example.com.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.