Oregon Says Workers’ Comp Must Pay for Weight Loss Surgery

Weight-loss surgery can be covered in Oregon by workers’ compensation provided it is needed to treat a job-related injury.

The Oregon Supreme Court ruled that SAIF Corp., the state chartered agency, must pay for gastric-bypass surgery an injured worker need before he could undergo knee replacement.

Edward G. Sprague initially injured his knee while working as a mechanic in 1976. He filed a claim with SAIF, which compensated him and allowed him to have a surgical procedure. At the time, he weighed 225 pounds.

Over the years, he gained weight, growing to 320 pounds, and developed arthritis in the knee. Then, in 1999, he reinjured the knee working in a bakery. His doctor recommended that he have the knee replaced, but first he had to have weight-loss surgery to assure an optimal result. When the bakery’s insurer denied the claim, saying his arthritis was due to the previous injury, Sprague went after SAIF. SAIF said the weight problem was a preexisting condition. But the Supreme Court said SAIF must pay because his arthritis was due to his initial injury and the weight surgery was part of the treatment.

Topics Profit Loss Workers' Compensation