In SAIF Corp. v. Sprague, the Oregon Court of Appeals ruled earlier this week that an obese employee’s gastric bypass surgery was coverd by workers’ compensation. For the full opinion, click here.
The employee in Sprague suffered an on-the-job knee injury in in 1976. He weighed 225 pounds at the time of the injury. The employee began gaining weight after his 1976 injury, and by 2001, he weighed 350 pounds. He then had gastric bypass surgery to reduce his weight, and filed a workers’ compensation claim for the surgery, claiming it was necessary to allow his knee to heal.
SAIF, the workers’ compensation carrier, took the position that the surgery was not compensable because the employee’s obesity was not caused by the 1976 knee injury. The Court of Appeals disagreed, holding that because the record showed the gastric bypass surgery was performed to control the employee’s obesity in order to allow the on-the-job knee injury to heal, it was compensable through workers’ compensation.
This decision does not likely mean that all or even most gastric bypass surgeries or other elective procedures will be covered by workers’ compensation. It does mean, however, that some medical treatment that is indirectly related to a compensable injury may be covered, if the treatment is necessary to treat the compensable injury. Claims like this one will likely be decided on a case-by-case basis.