Doc orders weight-loss surgery: Will workers’ comp cover it?

http://www.safetynewsalert....urgery-in-two-cases/

Imagine this: An employee, who happens to be morbidly obese, is injured at work. Doctors say, before he has surgery to correct the workplace injury, he needs weight-loss surgery.

And, in two separate cases, courts rule that comp must cover the weight-loss surgery!

First, the case of Adam Childers. While working at Boston’s Gourmet Pizza in Indiana, he was struck by a freezer door, injuring his lower back. At the time, Childers was six feet tall and weighed 340 pounds.

A doctor said before Childers could have back fusion surgery, he needed lap-band surgery to lose weight.

A workers’ comp panel awarded him benefits to have the weight-loss surgery. His employer appealed, arguing that Childers suffered from a pre-existing health condition of morbid obesity.

However, the court said the restaurant couldn’t prove that Childers had a weight problem that impaired his health and/or required medical intervention. Case closed, he gets the surgery paid for by comp.

In the second case, Edward Sprague injured his knee at work in 1976 and reinjured it in 1999.

During that time span, Sprague’s weight went from 225 to 350 pounds.

Doctors told Sprague his weight would prevent successful treatment of the knee condition, so he sought workers’ comp benefits for weight-loss surgery.

His insurance carrier argued that the claim wasn’t compensable because the obesity wasn’t caused by his 1976 accident.

Last year a state court ruled Sprague’s bypass surgery should be paid for by workers’ comp. The court said the injury was more than a minor cause of Sprague’s need for gastric surgery.

Now, the Oregon Supreme Court has issued the last word in this case. It agrees that comp should cover the weight-loss surgery.
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Not knowing any more than the article gives on the specifics of either case, if I was the employer, I'm thinking I'd be trying to have the SCOTUS hear arguements on both of these cases.

Ron

I don't know how it is in the states, but here in Canada, companies pay into the WSIB fund which pays out these kinds of claims. Companies are refunded premiums if they over pay and lower accident rates than average in the industry are rewarded with lower premiums. In the end, the company pays for this...I'd be surprised if this passed appeal.

if the weight loss surgery is required to do the surgery that is needed - there really isnt any question

lesson: dont hire fatties
they are an endless source of problems, especially health issues

but, I fully understand the quest to punish the fatties for being fatties

Just one of the many things wrong with health care. People want to engage in risky lifestyles and behavior and have someone else pay for it when it comes around to bite them on their big fat butts. Somehow, it was the employer and his coverage's fault the emlployee stuffed his face everyday like a hog before slaughter. Since it didn't expound too much, it would be just a guess that their big fat carcass was the underlying cause of their accidents. Not being able to get out of the way of a door raises questions. Carrying an extra 150 pounds around just because you can't turn down a 2nd double cheesburger is not good for one's knees either.

quote Originally posted by Pyrthian: lesson: dont hire fatties they are an endless source of problems, especially health issues

Sooner or later, obesity will be the subject of anti-discrimination laws. As America gets fatter and fatter, the growing number of land whales will start pushing for protected status.

So, I am a "land whale"... At 6'4 1/2" tall, and 340 lbs, I am a "fatty"... The words used above are as good a description of me as I guess I can get.
Don't worry about feelings in this case. Fat people and Land Whales don't have feelings I guess. We aren't human.

A large part of my weight issues are caused by two key factors...

The first: I was hit by a car in 1994, which resulted in knee, hip and back injuries that limit my capabilities to exercise for long periods of time. Dieting is not effective without exercise.

The second: I work in IT, which usually results in a large part of my time being spent in a chair working on computer issues. This, combined with my previous injury does not help me maintain weight.

Do I feel that weight loss surgery should be a worker's comp claim? No, not really. If I am injured on the job, and the only way to help repair/correct that injury is through rapid weight loss in order to help me get on my feet again, I will gladly pay for the surgery out of my own pocket if I must...

But, for those of you people in shape, or just generally "skinny", using terms such as "fatty" and "land whales" is just as derogatory as calling an African American a n***er.

You really show a high level of respect for your fellow humans when you use those terms.

[This message has been edited by Synthesis (edited 09-08-2009).]

quote Originally posted by Synthesis: ..... But, for those of you people in shape, or just generally "skinny", using terms such as "fatty" and "land whales" is just as derogatory as calling an African American a n***er. ....

stuff for another thread, if you like
but - the obvious difference is: negros are born black, will stay black, and will die black (except white boy Mikey Jackson?)
tho I fully understand the judgeing based on visual input only

quote Originally posted by Pyrthian: if the weight loss surgery is required to do the surgery that is needed - there really isnt any question lesson: dont hire fatties they are an endless source of problems, especially health issues but, I fully understand the quest to punish the fatties for being fatties

While I don't necessarily agree with your first statement, I wholeheartedly agree with your second.

I fall into the group that needs to lose weight. I understand why some employers would not want to hire us fatties.

Ron

[This message has been edited by blackrams (edited 09-08-2009).]

quote Originally posted by Synthesis: So, I am a "land whale"... At 6'4 1/2" tall, and 340 lbs, I am a "fatty"... The words used above are as good a description of me as I guess I can get. Don't worry about feelings in this case. Fat people and Land Whales don't have feelings I guess. We aren't human. A large part of my weight issues are caused by two key factors... The first: I was hit by a car in 1994, which resulted in knee, hip and back injuries that limit my capabilities to exercise for long periods of time. Dieting is not effective without exercise. The second: I work in IT, which usually results in a large part of my time being spent in a chair working on computer issues. This, combined with my previous injury does not help me maintain weight. Do I feel that weight loss surgery should be a worker's comp claim? No, not really. If I am injured on the job, and the only way to help repair/correct that injury is through rapid weight loss in order to help me get on my feet again, I will gladly pay for the surgery out of my own pocket if I must... But, for those of you people in shape, or just generally "skinny", using terms such as "fatty" and "land whales" is just as derogatory as calling an African American a n***er. You really show me a high level of respect for your fellow humans when you use those terms.

Years back, my own laziness and poor eating habits resulted in my weight topping 300 pounds. I'm 6 feet, so 300 pounds meant I was incredibly fat. I couldn't climb stairs w/o pausing to catch my breath, I could feel my heart pound, my knees and ankles were always in pain, I looked terrible and I felt terrible. I made all sorts of excuses for my problem, and just kept on buying bigger and bigger clothes. I never got on a scale, and would do everything I could to avoid having my picture taken so I wouldn't have to look at how fat I was. I was a fatty, I was a land whale. And it was my fault.

I'm now 185 pounds, and have maintained that weight within 2 or 3 pounds for over 10 years. I still eat the things I like, just not as often and in moderation. I watch what I'm eating, and try to balance things out. I'm not on any strict form of dieting, I just use common sense. I don't exercise as much as I should, but I don't sit around all day either. Even on a busy day, I'll get out and walk for 5 to 10 minutes.

The point is, I got tired of making excuses for myself and hiding behind the indignation of being called a fatty. You're making excuses for your weight, and it doesn't sound like you're trying to do anything about it. Yes, it's hard to lose weight. It requires a lot of commitment and willpower, and it takes time. It's not fun. Exercise? Like I said, even walking 5-10 minutes a day is better than doing nothing. You have injuries, and that can make it hard, but consult a doctor. Chances are he/she can help you devise a regimen that you can do. It's going to hurt, that's just the nature of exercise. It can be done, the question is how badly do you want it?

Do you want to lose weight or do you want to continue to make bad choices and excuses? I've been on both sides of the fence, and I know where you're coming from. Are you mad at me for using the term "land whale", or are you mad at yourself for becoming one? The choice is yours.

[This message has been edited by GT86 (edited 09-08-2009).]

quote Originally posted by GT86: Years back, my own laziness and poor eating habits resulted in my weight topping 300 pounds. I'm 6 feet, so 300 pounds meant I was incredibly fat. I couldn't climb stairs w/o pausing to catch my breath, I could feel my heart pound, my knees and ankles were always in pain, I looked terrible and I felt terrible. I made all sorts of excuses for my problem, and just kept on buying bigger and bigger clothes. I never got on a scale, and would do everything I could to avoid having my picture taken so I wouldn't have to look at how fat I was. I was a fatty, I was a land whale. And it was my fault. I'm now 185 pounds, and have maintained that weight within 2 or 3 pounds for over 10 years. I still eat the things I like, just not as often and in moderation. I watch what I'm eating, and try to balance things out. I'm not on any strict form of dieting, I just use common sense. I don't exercise as much as I should, but I don't sit around all day either. Even on a busy day, I'll get out and walk for 5 to 10 minutes. The point is, I got tired of making excuses for myself and hiding behind the indignation of being called a fatty. You're making excuses for your weight, and it doesn't sound like you're trying to do anything about it. Yes, it's hard to lose weight. It requires a lot of commitment and willpower, and it takes time. It's not fun. Exercise? Like I said, even walking 5-10 minutes a day is better than doing nothing. You have injuries, and that can make it hard, but consult a doctor. Chances are he/she can help you devise a regimen that you can do. It's going to hurt, that's just the nature of exercise. It can be done, the question is how badly do you want it? Do you want to lose weight or do you want to continue to make bad choices and excuses? I've been on both sides of the fence, and I know where you're coming from. Are you mad at me for using the term "land whale", or are you mad at yourself for becoming one? The choice is yours.

The only issue I had until this post was that you used a derogatory term.
Now you tell me I am making excuses because of my injuries. At least, that is the way it is coming across to me.

I stop walking when my knee starts making a grinding noise and the pain becomes bad enough I can barely even stand. That is after two knee surgeries. It did that even before I gained the weight.
I am 30 years old, and have been told by three different doctors that the next step in getting a working knee, is a replacement. They have all said I am too young, and can't get one yet.
I am un-insured, not by choice, but by financial limitations. I make decent money, but at an out of pocket cost through my contracting firm of over 800 dollars a month for coverage for me and my three children, I can not afford it. So I go without the ability to see a doctor.

When I was hit in 1994, I was 220 lbs of muscle. I was moving furniture for a living working for a family member's moving company, and working out for football. I had less than 3% body fat. I know what being in shape is, I know how to exercise and lose weight.
My physical limitations due to the accident now prevent me from doing ENOUGH exercise, even with strictly controlled dieting to drop weight.

I am NOT a PC person. I do not believe in Political Correctness, and feel that people should take PC and shove it up their ass... But to be referred to as a "Land Whale" by someone is just a bit too far in my book. I am a person, a human being. My weight is not by choice. It is by medical factors that limit me.
I understand that many people out there DO stuff their faces, and don't care about themselves. I am not one of those people, and to be lumped together using a term such as the one you used... Well.. I will leave it there...

You are right, I do have a choice. As long as you choose to use bigoted terms, I will choose to consider you a bigot.

[This message has been edited by Synthesis (edited 09-08-2009).]

quote Originally posted by Synthesis: The first: I was hit by a car in 1994, which resulted in knee, hip and back injuries that limit my capabilities to exercise for long periods of time. Dieting is not effective without exercise.

Not trying to attack you here. So you're saying that if they forced a lap-band on you (or whatever the techniques are/is), that your weight wouldn't change because you can't exercise?

quote Dieting is not effective without exercise.

Yes it is, if you take in only what the body needs.

The body will not store fat, if the caloric and fat intake are insufficient to allow it to--it's simply not possible.

The problem is, in this country, we think we need huge servings--of everything, and it's the #1 reason obesity is the #2 health problem in this country. We eat way more than we should.

quote Originally posted by maryjane: We eat way more than we should.

Guilty as charged.

Ron

quote Originally posted by blackrams: Guilty as charged. Ron

So am I, but I watch it. Up until last Aug (08) I had a full time job. I had donuts in the morning, either brought a lunch or went to a restraunt at noon, and ate supper at home that night. When I gave up my job, I changed how I ate. I do a lot around here, but it's nowhere near the activity I did when I worked full time. Now, I don't eat anything in the mornings. Occassionally, if I'm working out in the pastures, I'll eat a sandwich or 2 for lunch--maybe a banana to keep up my potassium. Then I'll eat a light supper at night. That's it. I don't eat any more than what I feel I can burn off during the same time period. I just don't. No snacks. And, I'm not hungry. I let my activities dictate my eating habits--not the other way around.

I have known hundreds of office types in my lifetime, and only occassionally have I seen any overweight. Not grossly overweight anyway, and the reason is, they just don't eat a lot. They eat what their body requires and they stop. That's the trick. Even if a person has a sedintary (sp) job, the body will still burn what fat & calories it needs just to keep breathing and little bit of walking that any job requires. Eat that much--and that much only, and you're good to go. Go over that, and it 's gonna show up somewhere.

[This message has been edited by maryjane (edited 09-08-2009).]

quote Originally posted by Synthesis: The only issue I had until this post was that you used a derogatory term. Now you tell me I am making excuses because of my injuries. At least, that is the way it is coming across to me. I stop walking when my knee starts making a grinding noise and the pain becomes bad enough I can barely even stand. That is after two knee surgeries. It did that even before I gained the weight. I am 30 years old, and have been told by three different doctors that the next step in getting a working knee, is a replacement. They have all said I am too young, and can't get one yet. I am un-insured, not by choice, but by financial limitations. I make decent money, but at an out of pocket cost through my contracting firm of over 800 dollars a month for coverage for me and my three children, I can not afford it. So I go without the ability to see a doctor. When I was hit in 1994, I was 220 lbs of muscle. I was moving furniture for a living working for a family member's moving company, and working out for football. I had less than 3% body fat. I know what being in shape is, I know how to exercise and lose weight. My physical limitations due to the accident now prevent me from doing ENOUGH exercise, even with strictly controlled dieting to drop weight. I am NOT a PC person. I do not believe in Political Correctness, and feel that people should take PC and shove it up their ass... But to be referred to as a "Land Whale" by someone is just a bit too far in my book. I am a person, a human being. My weight is not by choice. It is by medical factors that limit me. I understand that many people out there DO stuff their faces, and don't care about themselves. I am not one of those people, and to be lumped together using a term such as the one you used... Well.. I will leave it there... You are right, I do have a choice. As long as you choose to use bigoted terms, I will choose to consider you a bigot.

Call me a bigot if you wish, but that doesn't change what you're doing. From my point of view, you're simply making excuses for your weight. Instead of accepting that, you're hiding behind a false sense of indignation.

You're taking in more calories than you need, and you haven't bothered to find a type of exercise that you can do. I understand your injuries are limiting, but on the other hand I know a guy who has been confined to a wheelchair for over 30 years, which limits him far more than you. He's not overweight, and in fact has more upper body strength than people half his age. No secret what he does: he eats well and exercises. He can't go out and run a marathon, or go for a nice walk. But he's found things that he can do, and doesn't allow his lack of mobility to be an excuse. He doesn't make bad eating/activity choices, and then blame his condition for a weight problem that's caused by bad choices.

Other health issues aside, with your knee problem you have even more incentive to drop those pounds. Lose weight, or don't. But don't get mad at people for calling you fat (or other terms you find offensive), because your weight is a result of choices you made. Yes, your circumstances make it harder. But it's not about the hand you're dealt, it's about how you play that hand.

[This message has been edited by GT86 (edited 09-08-2009).]

quote Originally posted by GT86: Call me a bigot if you wish, but that doesn't change what you're doing. From my point of view, you're simply making excuses for your weight. Instead of accepting that, you're hiding behind a false sense of indignation. You're taking in more calories than you need, and you haven't bothered to find a type of exercise that you can do. I understand your injuries are limiting, but on the other hand I know a guy who has been confined to a wheelchair for over 30 years, which limits him far more than you. He's not overweight, and in fact has more upper body strength than people half his age. No secret what he does: he eats well and exercises. He can't go out and run a marathon, or go for a nice walk. But he's found things that he can do, and doesn't allow his lack of mobility to be an excuse. He doesn't make bad eating/activity choices, and then blame his condition for a weight problem that's caused by bad choices. Other health issues aside, with your knee problem you have even more incentive to drop those pounds. Lose weight, or don't. But don't get mad at people for calling you fat (or other terms you find offensive), because your weight is a result of choices you made. Yes, your circumstances make it harder. But it's not about the hand you're dealt, it's about how you play that hand.

I can appreciate the argument you make now as yes, I am the one who is responsible for my own weight. Yes, I am watching my caloric intake. As a matter of fact, for the last month I have been keeping a close eye on what I eat, and I have been walking the treadmill as much as possible, with ibuprofen of course.

My ENTIRE argument against you was simply the term you used. Regardless of my weight, I have a right to feel indignant about the term "land whale". A bit callous of you to use it. But of course, the internet breeds anonymity, so it is OK to be callous to people around you just because you don't like the way they look.

quote Originally posted by Synthesis: I can appreciate the argument you make now as yes, I am the one who is responsible for my own weight. Yes, I am watching my caloric intake. As a matter of fact, for the last month I have been keeping a close eye on what I eat, and I have been walking the treadmill as much as possible, with ibuprofen of course. My ENTIRE argument against you was simply the term you used. Regardless of my weight, I have a right to feel indignant about the term "land whale". A bit callous of you to use it. But of course, the internet breeds anonymity, so it is OK to be callous to people around you just because you don't like the way they look.

To be honest, that was the precise term that helped motivate me to lose weight all those years ago. A co-worker had grown tired of listening to me make excuses for my weight, and very bluntly told me I was a "self-indulgent land whale with no self control who won't take responsibility for the fact that he's fat". And yeah, I had the same reaction as you at first. I got very angry and defensive that someone could be so insensitive and callous. But it made me stop and think, and it made me honestly evaluate my situation.

And you know what, he was 100% correct. After my anger, embarrassment (and yes, even my hurt) had passed, I realized this person had done me a favor. I was so used to making excuses that I needed a big dose of blunt rudeness to pierce the layer of BS I had surrounded myself with. It made me realize I didn't have a special condition requiring sympathy, but rather that I was fat, that I brought it on myself, and that I was continuing to make bad choices. That guy, who I wanted to beat senseless, actually became one of my best friends.

There's no doubt it's a rude term, and I understand why you find it offensive. But I use it for a reason, as it tends to get attention. I'm not on a crusade to get people to lose weight, but I remember how well it cut through my excuse shield.

[This message has been edited by GT86 (edited 09-08-2009).]

Why would the employer object, he dont pay it, his insurance carrier does. Dont cost him anything either way....?

quote Originally posted by rogergarrison: Why would the employer object, he dont pay it, his insurance carrier does. Dont cost him anything either way....?

Insurance premiums will rise as his usage of claims goes up? Like car insurance? (asking not stating)

quote Originally posted by rogergarrison: Why would the employer object, he dont pay it, his insurance carrier does. Dont cost him anything either way....?

there is the implication that the person is "getting away" with something
he will now live a luxurious life, at the expense of others

Dude,

I am not against being called anything, Yea, I am fat because of my lifestyle choice, no I was not born that way. Well I was, but grew out of it lol, then back into it.

I am hurt though.

Brad AKA Fats

It's really strange, that many of us will watch our pets' weight more than our own. If you feed an adult dog or cat all they can eat, they will quickly become overweight, unless they are outside animals and free to burn the excess off. Even outside animals tho, will get overweight in their older years if we continue to feed them the same amt as they recieved during their growing years. If we see our pets start to get fat, we cut their food ration back a bit, but we don't place the same doctrine on ourselves.

All living things can be viewed as an engine. It takes in fuel, and it burns this fuel energy in it's activities (work). Pour too much fuel to it, and it bogs down. To run at full rated load, it takes a lot of fuel. If it just sits at idle, it needs much less fuel. Same for us--we are engines as well--needing just the right amt of fuel (and the right kind) for optimum performance.

I am old-soon to be 60. I don't particularly like being called an old grey haired fart, but I know that in comparison, that I am old, so it doesn't bother me when someone refers to me by that moniker. It's just a fact of life--I'm old--that's fine, but I am not going to let myself become an old fat grey haired fart, and since I am nearly 60, and honestly can't do the physical activity I once could, my only other option is to cut back the fuel intake. I want it, but I don't need it, so I leave it alone.

I lost over 100 lbs last year. I went from 260 down to 158 lbs at 5 feet 7 inches. I know what it is to be a "fatty." It's not fun. But I was HOOKED on CHEAP CRAPPY food. I ate McD's like it was going out of style and sucked up copious quantities of other fast food as well. I ate candy and crisps (chips) by the bag full. This was MY fault and I remedied it. However, I would like to say that there are some fat people out there who cannot afford good, decent food. Perhaps what should be done is this: Congress forgets about this "health care reform" bill and reforms the FDA instead. Give them a mandate to ensure the food in this country is safe and healthy. STOP McDonalds from taking perfectly good beef and adding 30 percent LARD to it before making burger patties from it. Prohibit foods with trans fat from being sold.

Just some "food" for thought. Correct what's wrong with America's diet and you would clear up a lot of health care issues as well.

quote Originally posted by GT86: Sooner or later, obesity will be the subject of anti-discrimination laws. As America gets fatter and fatter, the growing number of land whales will start pushing for protected status.

But really, one of these days I'll be sued because i wont date a girl that is over a size 7.
And I have a fat gut that I should lose.

GT86 and Synthesis
you both already had pluses from me, but I would have given you one for the way you maintained a civil conversation.

[This message has been edited by buddycraigg (edited 09-10-2009).]

Brad,

I know you. You're not FAT. Could you stand to lose some weight? Sure. So could I. When I lost my eye I also had my jaw wired shut for two months. (lots of damage in the face). I ate nothing but liquid vitamins and protein supplements. Oh, they give you a little cookbook on how to make 11,000 different foods that all take like blended mush, which it is, and most of them would make me gag, so I didn't eat it. I went from 240 to 185 and then I actually started to GAIN WEIGHT back to 195 when they finally took the wires out. My metabolism had slowed so much I just didn't need many calories. Since then, I've never gotten back to 240. Right now I'm 220. When I was in college, I took a class called "PT" called physical training. Basically this amounted to brief periods of boot camp type running and workouts. I got down to 190 then and then bulked back up to 200 the next semester when I took a weight training class. That's as light as I've ever been in my adult life and IMHO, as light as I should be and maintain good health even though all the BMI sites tell me that's at least 20 pounds too heavy.

I could also obviously stand to lose 20 pounds or so, but I'm not going to worry about it. I am trying to cut out the soft drinks because I hate diet stuff but otherwise I eat pretty healthy. Not a lot of fast food unless I'm in the field and that's the only real quick thing to get. Usually I make myself a sandwich and take it with me.

I still contend that you're not FAT. Heavy, could stand to lose weight? Yes. FAT? No. If you could maintain without gaining any weight and quit smoking, you'd probably live longer than most.

John Stricker

quote Originally posted by twofatguys: Dude, I am not against being called anything, Yea, I am fat because of my lifestyle choice, no I was not born that way. Well I was, but grew out of it lol, then back into it. I am hurt though. Brad AKA Fats