Benefits denied for bariatric surgery, granted for family therapy
Case name: Mercy Hospital Iowa City v. Goodner, No. 2-933/12-0186 (Iowa Ct. App. 01/09/13).
Ruling: The Iowa Court of Appeals held that a physician's mononucleosis and chronic fatigue syndrome was compensable, but she was not entitled to reimbursement for the cost of bariatric surgery.
What it means: In Iowa, an employer is not required to pay for unauthorized care unless the worker shows that the care was reasonable and beneficial.
Summary: A family practice physician treated patients with mononucleosis, and one patient vomited on her hands during the examination. Later, the physician was diagnosed with mononucleosis. She also developed chronic fatigue syndrome. Her employer accepted her workers' compensation claim and provided benefits. During the course of her illness, the physician gained weight, so she underwent bariatric surgery and lost 70 pounds. The physician also had family therapy sessions. She sought benefits for the surgery and therapy. The Iowa Court of Appeals held that she was not entitled to benefits for the surgery but ordered the employer to pay half of the cost of the therapy sessions.
The court found that the physician was permanently and totally disabled under the odd-lot doctrine. The work that she could perform for one to four hours each day was so limited that a reasonably stable market for them did not exist. She tried to find a job in the medical profession for eight years that would allow her to get sufficient rest, but no jobs could accommodate her. The employer did not show that suitable employment was available.
The court could not conclude that the bariatric surgery was reasonable and beneficial. No evidence showed that any doctor recommended weight loss surgery to treat her chronic fatigue syndrome. Approximately half of the weight she lost was preinjury and not causally related to the work injury. Following surgery, she did not make a successful return to the labor market and was permanently and totally disabled.
The employer asserted that it was not required to pay for family therapy because it was only required to pay medical care for the physician, not her family. Family therapy was recommended by her doctors. A doctor explained that the therapy was reasonable and necessary because there was a profound impact on the family due to the loss of her wage and the family had to learn to cope with a long-term illness. The court ordered the employer to pay half the cost of the therapy.
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April 15, 2013
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