Employer could be on the hook for unauthorized gastric bypass surgery
Verizon Business Network Services, Inc. f/k/a MCI Worldcom Network Services, Inc. d/b/a MCI Telecommunications Corp. v. McKenzie, No. 0-685/10-0256 (Iowa Ct. App. 11/24/10).
Ruling: The Iowa Court of Appeals held that an employer could be liable for unauthorized gastric bypass surgery. It sent the case back for a determination of whether the worker proved that the surgery was reasonable and beneficial.
What it means: In Iowa, an employer could be liable for medical benefits when the employee obtains unauthorized care to treat a work injury.
Summary: A worker slipped and fell on a wet floor while working. The next day, she sought medical treatment. Although only light-duty restrictions were imposed, she was unable to return to work. More than one physician advised her that losing weight would help combat her persistent pain. The worker was prescribed a narcotic pain medication, but she continued to suffer from pain. She underwent gastric bypass surgery, and eventually lost more than 200 pounds. The employer did not authorize the surgery and declined to pay for it. Her pain improved, but she had to take a higher dose of narcotics due to a malabsorption condition caused by the surgery. As a result, she remained unemployable. She sought an increase in compensation and reimbursement for the surgery. The Iowa Court of Appeals sent the case back for a determination of whether the worker met her burden of proving she was entitled to benefits.
The court mentioned that an employer can be liable for unauthorized medical care if it is reasonable and provides a more favorable outcome than would likely been achieved by the care authorized by the employer. The court stated that the workers' compensation commissioner determined that the worker's gastric bypass surgery was reasonable and necessary, but it did not address whether the surgery was beneficial to her work-related injury.
Read more at the WorkersComp Forum homepage.
January 20, 2011
Copyright 2011© LRP Publications