Weight Loss Surgery Claim Paid 9 Years Late

Weight loss surgery is not typically eligible for coverage under worker’s compensation. But the Oregon Supreme Court recently ruled that the state’s worker’s comp plan must pay for one resident’s weight loss surgery — nine years after his operation.

overdue stampThe state of Oregon is set to foot the bill for one resident’s weight loss surgery…nine years after he had the procedure.

The state’s worker’s comp insurance has been ordered to pay for the bariatric surgery Edward Sprague received in 2000.

Sprague injured his knee on the job in 1976 and years later developed arthritis that would require knee replacement surgery. However, his doctor recommended he first get weight loss surgery, since Sprague weighed 320 pounds. He did, and filed a claim with the state’s worker’s comp insurance, which was initially denied.

But last month, the Oregon Supreme Court found in Sprague’s favor, ruling that weight loss surgery was a direct benefit to his knee problem, and is eligible for worker’s comp coverage.

Last week, we reported a similar story about an Indiana pizza shop employee who needed bariatric surgery to qualify for back surgery to address an injury he sustained on the job. Both surgeries were paid for by his employer.

Dallas health care attorney Michael Byrd noted that these types of rulings could have an impact on hiring decisions, and cause businesses to steer clear of overweight employees.

“Unfortunately, there is not a lot of federal law or state law that protects discrimination based upon weight,” he said. “I think it’s wise to conclude that the overall consequence of these decisions is that further discrimination will happen.”

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