Gastric bypass is one type of weight loss surgery
Obesity is a disease that affects Americans in many ways.
Workers’ compensation is affected by obesity as well. A work injury or disease, coupled with chronic obesity, frequently becomes much more difficult to deal with. The usual methods of treatment may not be possible for an injured worker living with chronic obesity.
Thomas A. Robinson, a noted expert on workers’ compensation, recently posted a great discussion on obesity treatment. The well-written article discusses how various state workers’ compensation systems deal with these problems. The short answer is some states award benefits for treating obesity as part of the work injury, and some don’t. Nebraska and Iowa have cases denying gastric bypass surgery based on factual findings that it was not necessary to treat the work injury, but leaving to door open with more proof of medical necessity.
Our firm has had at least one case where gastric bypass surgery was paid voluntarily when it was apparent the surgery was necessary to enable proper treatment of a serious work injury. A workers’ compensation trial award was entered in early January awarding gastric bypass surgery as necessary to reduce weight so a back surgery could be performed safely. This award reinforces that with proof of medical necessity to treat a work injury, weight loss treatment and surgery may be covered by workers’ compensation in Nebraska.
Today’s post comes from respected colleague Jon Gelman from Jon Gelman, LLC – Attorney at Law in New Jersey. Mr. Gelman addresses how an injured worker’s treatment rapidly gets more expensive when other health issues are present. And sometimes the workers’ compensation situation causes those other issues, which is important to share with your lawyer. Working with an attorney can help folks sort out the complications of how a workers’ compensation claim interacts with other conditions to make sure the worker gets the best care and coverage possible in each individual situation.
Employers and their insurance companies are responsible for the treatment of all medical conditions that arise from an industrial accident or exposure. A recent study published by The National Council on Compensation Insurance (NCCI) concludes that costs are soaring as medical conditions become more complicated by other conditions known as comorbidity diagnoses. These conditions are frequently: obesity, hypertension, drug abuse, chronic pulmonary conditions, and diabetes.
“While the average medical cost for a workers’ compensation claim is approximately $6,000, the medical cost of an individual claim can be a few hundred dollars or millions of dollars. In 2010, an NCCI study found that claims with an obesity comorbidity diagnosis incurred significantly higher medical costs than comparable claims without such a comorbidity diagnosis. Relative to that study, this study expands the number of comorbidities examined and provides additional information on both the types of claimants receiving comorbidity diagnoses and the types of providers submitting comorbidity diagnoses.”
- The share of workers’ compensation claims with a comorbidity diagnosis nearly tripled from Accident Year 2000 to Accident Year 2009, growing from a share of 2.4% to 6.6%. Claims with a comorbidity diagnosis have about twice the medical costs of otherwise comparable claims.
- Comorbidity diagnoses for hypertension are the most prevalent of those investigated.
- The initial comorbidity diagnosis tends to occur early in the life of a claim.
- Hospital and physician visits account for a majority of visits resulting in a recorded comorbidity diagnosis.
- Only a small portion of visits result in the recording of a comorbidity diagnosis.
View complete report: Comorbidities in Workers Compensation