Oregon Says Workers’ Comp Must Pay for Weight Loss

August 28, 2009

Weight-loss surgery can be covered by state workers’ compensation insurance, provided it is needed to treat a job-related injury, according to an Oregon court.

The Oregon Supreme Court ruled Thursday that SAIF Corp., the state chartered agency that handles compensation insurance, must pay for gastric-bypass surgery needed before an injured worker 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 while working in a bakery.

His doctor recommended to Sprague that he have the knee replaced, but said that first he must have weight-loss surgery to assure an optimal result.

When the bakery’s workers’ compensation plan rejected a claim Sprague filed, saying his arthritis was due to the previous injury, Sprague went after SAIF.

SAIF initially said that Sprague’s weight problem was a preexisting condition for which it was not liable.

But an appeals court, and now the Supreme Court, said SAIF must pay because his arthritis was due to his initial injury, and the weight-loss surgery was directly necessary for treatment of the arthritis.

Sprague’s lawyer, Christopher Moore of Eugene, told the Oregonian newspaper that he did not expect the ruling to result in a tide of workers’ compensation filings for weight-loss surgery.

Obesity such as Sprague’s is fairly rare, and the need for weight-loss surgery to treat an injury even rarer, he said.

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