Comp nixed for worker's gastric bypass surgery

In Iowa, a worker can be entitled to reimbursement for unauthorized medical care if it provides a more favorable medical outcome than would likely been achieved by the employer.

Case name: Verizon Business Network Services, Inc. v. McKenzie, No. 2-394/11-1845 (Iowa Ct. App. 10/17/12).

Ruling: The Iowa Court of Appeals held that a worker was not entitled to reimbursement for her unauthorized gastric bypass surgery.

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What it means: In Iowa, a worker can be entitled to reimbursement for unauthorized medical care if it provides a more favorable medical outcome than would likely been achieved by the employer.

Summary: A worker slipped and fell while working. She sought medical treatment the next day, complaining of lower back and leg pain. Her condition did not improve with conservative treatment. She was not able to return to work. More than one physician advised her that losing weight would help improve her pain. A workers' compensation commissioner determined that she suffered a 25 percent industrial disability. She underwent gastric bypass surgery. She lost more than 200 pounds after the surgery. The employer refused to authorize the surgery and declined to pay for it. After surgery, her pain improved, but she had to take a larger dose of narcotic pain medication due to a malabsorption condition caused by the surgery. She remained unemployable. She sought an increase in compensation and reimbursement for the gastric bypass surgery. The Iowa Court of Appeals held that the worker was not entitled to reimbursement for her surgery.

The employer argued that the worker did not show that the weight loss surgery was a beneficial treatment for her work-related injury. In denying reimbursement, the court pointed out that the worker did not undergo surgery as an alternative to the care being offered by the employer, but obtained the unauthorized care in addition to the care offered by the employer. The worker offered no evidence beside her own testimony that the surgery was beneficial to the work-related injury. At the same time, she claimed that the surgery justified a finding increasing her previous industrial disability award from 25 percent to an award of permanent total disability. The court found that the surgery, which corrected her nonwork-related morbid obesity, did not provide a more favorable medical outcome for the work injury than would likely have been achieved by the care offered by the employer.

The court remanded the worker's claim to reopen her claim. The court said that if the workers' compensation commissioner determined that the worker was entitled to additional weekly benefits, the benefits would begin on the date she filed her reopening petition.

Read more at the WorkersComp Forum homepage.

January 3, 2013

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