Indiana Appeals Court Affirms Work Comp Coverage for Obesity Surgery

An Indiana appeals court has upheld the ruling of the state’s workers’ compensation board that an employee at a pizza restaurant is eligible for treatment for obesity under a workers’ compensation policy.

The ruling is similar to one recently handed down by the Oregon Supreme Court, which ruled that weight-loss surgery can be covered by state workers’ compensation insurance, provided it is needed to treat a job-related injury.

The Indiana appeals court, in Boston’s Gourmet Pizza vs. Adam Childers, agreed that because Childers massive weight gain was a result of an injury he sustained while working at Boston’s Gourmet Pizza, he is “entitled to receive a certain secondary medical treatment and the continued payment of temporary total disability benefits.”

Childers was 25 years old and a cook at the restaurant in March 2007 when he was injured when a freezer door hit him in the back while he was working. Childers was six feet tall, weighed 340 pounds and smoked around 30 cigarettes a day, according to court documents.

In the months following the accident, Childers’ back pain increased and underwent a number of treatments and examinations. He was determined to be a candidate for spinal fusion surgery, but by that time his weight increased to 380 pounds.

His doctor said because of Childers’ increased weight there was a high risk that the surgery would fail. He recommended lap band surgery “so that he will lose some substantial weight and potentially improve his back symptoms and possibly even avoid surgery,” the court wrote in its opinion.

The workers’ compensation board found that Childers was entitled to the lap band surgery for weight loss “as a pre-cursor to his primary entitlement to back surgery to directly repair the result of his work-related accident.”

The restaurant objected, saying Childers’ weight was a pre-existing condition and not covered under the policy.

The appeals court found that Childers work related injury, which did not respond to various non-surgical treatments, was partly the cause of Childers’ additional weight gain because he was unable to exercise subsequent to the injury. It also noted that the record “contains evidence that Childers’ efforts to lose weight by other means had been unsuccessful.”

Additionally, the court said no evidence had been presented “that Childers’ weight at the time of the injury precluded successful resolution of his pain, and there is evidence that after the weight gain, further treatment for his pain was ‘doomed to failure.'”

Source: Indiana Court of Appeals, www.in.gov/judiciary/opinions/