What Do You Think: Was Preschool Owner's Bariatric Surgery Compensable?

Charlotte, NC (WorkersCompensation.com) –  Losing weight is sometimes required before someone can undergo surgery, but does that mean it’s compensable if the necessary surgery is work-related?

That’s the question a North Carolina court recently faced in considering whether workers’ compensation covered a worker’s bariatric surgery.

The owner and director of a preschool experienced an injury to her left and right knees and left shoulder after falling off a ladder while changing a light bulb at the school. She claimed workers’ compensation benefits for her injuries, but the school consented only to pay for a one-time evaluation of the owner’s right knee.

Later, the owner tripped and fell over a child’s sleep cot, and again experienced injuries. She sought compensation benefits for her right elbow, hand, and lower arm as well as both knees. Her claims were consolidated. As part of her claim, the owner contended that her condition and need for knee surgery required her to lose weight, and thus her need for bariatric surgery was compensable.

After initially denying her claim, on reconsideration, the Workers’ Compensation Commission concluded that bariatric surgery was medically necessary for the owner to under knee surgery, and thus the commission awarded her payment of medical expenses related to her gastric bypass procedure.

The school appealed the commission’s ruling to court.

Under North Carolina law, to be compensable, medical treatment must be “directly related” to the original compensable injury.

Was the owner’s gastric bypass procedure compensable?

A. Yes. There was a connection between the owner’s injury at work and need for bariatric surgery.

B. No. The owner’s weight problems were not caused by and did not directly result from the accident she experienced at work.

If you picked A, you agreed with the court in Kluttz-Ellison v. Noah’s Playloft Preschool, No. COA21-356 (N.C. Ct. App. 05/03/22), which held that while the owner’s weight problem was related to the workplace accident, her need for bariatric surgery was.

The court reasoned that, due to her physical limitations, the owner could not lose weight fast enough for her knee surgery to be conducted safely and optimally.

“But for [the owner’s] need to have right knee surgery to treat her compensable injury, she would not have needed to undergo bariatric surgery,” the court wrote.

Finding that the only way for the owner to lose the weight needed to undergo right knee surgery was to undergo bariatric surgery first, the court ruled in the owner’s favor in finding that the procedure was compensable.

This feature does not provide legal advice.

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