Two treats in one! (Obese people and health care/workman's comp)

Great Debates
1

In 2007, Adam Childers was working as a cook for an Indiana restaurant when he suffered an injury to his back. At the time of the injury, he was 26 years old, six feet tall and weighed 340 pounds, and smoked a pack and a half of cigarettes per day.

The back injury involved a herniated disc, for which physical therapy was unhelpful. Childers wanted back fusion surgery, but his doctors refused, based on his age and weight. During the course of two months during which Childers was trying physical therapy, his weight increased to 380 pounds. His doctors recommended gastric bypass or lap band surgery, as it was necessary for him to lose significant weight; they opined that with weight loss, the back surgery might become unnecessary.

His employer balked at covering the lap band surgery as part of his workman’s compensation, saying that Childers’ weight was a pre-existing condition and they shouldn’t have to pay for it.

Indiana’s courts (warning: PDF) said no – that Childers’ condition was a “single injury” that resulted from a combination of his pre-existing weight and his back injury, and the restaurant was responsible for paying for both.

A similar case from Oregon: Edward Sprague suffered a knee injury while working for a bakery. Sprague weighed 350 pounds, and his doctors advised gastric bypass surgery to solve the weight issue before fixing the knee. Although his employer objected, the courts ruled that they had to pay for the weight loss surgery as a necessary step towards the knee rehabilitation.

Avoiding with great reluctance any comments about how weighty an issue this is, it seems to me fundamentally unfair to stick the employer with costs for conditions that (a) existed before the workplace injury, and (b) have traditionally been viewed as the responsibility of the individual.

I also think the intersection of these two subjects, both involving strongly held opinions on this forum, should produce some interesting and lively debate.

So: as a general principle, should a morbidly obese employee who suffers an OTJ injury be compensated for his medical expenses relating to weight loss as well as to the actual injury he suffered, if such weight loss is necessary or desirable in curing the OTJ injury?

2

Two questions? You really want your pound of flesh.

3

I’d lean towards forcing the employer to pay. My admittedly inexpert reasoning is this - before the debilitating injury, neither of these men had sufficient motivation to lose weight, as far as I am aware. They should’ve been trying, perhaps, but were getting along okay.

In other words, the injury necessitated the weight loss, so it becomes incumbent on the party responsible for the injury to take on the costs associated with the weight loss.

As a judge or policymaker, I would make exceptions to that general rule if there was proof that the person purposely induced the injury so as to get payment for the weight loss treatment; and possibly if it was determined that the person’s weight was a primary contributing factor to the injury. IE : His employer wasn’t really negligent, an injury of this type was inevitable with routine activity at his weight level.

4

Workman’s comp has nothing to do with employer negligence. If you are injured on the job, they pay; there’s no need to find that the emp[loyer was negligent first.

5

I wouldn’t think it should be included in the workers comp, unless the weigh gain came about as a result of the injury

6

If the doctors are saying “treatment is futile unless you lose weight”, then losing weight becomes part of the treatment. As a practical matter there just isn’t much choice. I do wonder however how culpable someone is when they are so overweight that even the smallest extra stress on their overloaded back and legs can produce injury.

7

I don’t like that the weight loss issue is part of workman’s comp because the employer has zero control over it. In any other circumstance the employer could be fined for not providing a safe environment, or the employee could be fired for not following safe practices.

To me, this verdict tells employers that they are as responsible for their employee’s weight loss as they are for hard-hat use. So the result would be that they can’t hire fat people, and they have to fire those that don’t lose weight.

8

You’re right, I was confusing the issue’s details. Still the same opinion, though.

9

This just shows how ridiculous tying insurance to employment is.

Thank you for a good argument in favor of a public option Bricker.

More like 250 of them. :wink:

Moral of the story? Don’t hire fat smokers.

10

Seems to provide extra incentive not to hire overweight folks.

11

There are plenty of overweight people who go to work every day and are productive employees. The determination that weight is the factor is arbitrary. There are a lot of factors. My son has a bad back and he has never been overweight. He exercises and is in great shape.
So the employee hurt his back. It is possible that weight was a contributing factor. To what degree? Should the employee pay a percentage? If so, how do you determine degree? You are asking to open up an ugly can of worms. Presumably ,if he got operated on ,he could become an even more productive employee. He would probably have a healthier life. I guess we can see why universal health care is a good idea.

12

The employer should not be forced to pay for weight loss surgery in any scenario. The person’s weight should have no bearing on the injury and respective treatment. If the man requires treatment that can only come about after the weight loss, insurance companies should cut a check for the actual treatment prescribed sans the weight loss. It should still allow for personal responsibility on the weight loss.
If the person wants to take the money and get weight loss surgery instead, oh well.

This kind of taking away of personal responsibility and then placing it on someone, ANYONE else, is irresponsible.

13

Suppose we have universal health care, who pays for weight loss surgery?

14

Maybe the men didn’t have sufficient motivation to lose weight before the injury- but maybe they wouldn’t have been injured so severely ( or at all ) if they had been closer to normal weight. If a non-obese employee had a similar injury and required the same surgery, he or she wouldn’t have needed to lose weight first. I think perhaps the fact that these cases involve back and knee injuries confuses things a bit , because weight can contribute to back and knee injuries. Let’s say one of them injured his shoulder and required surgery, but surgeons won’t operate until he loses weight (because the surgery is more risky with a morbidly obese patient). Or they won’t perform the back surgery until the patient quits smoking. Should worker’s comp have to pay for treatment of all conditions which must be treated prior to the surgery?

15

If I were running things, I’d implement a hefty (pun intended) “fat tax” on all junk foods, sufficient to cover the medical expenses they cause later on down the road.

I’d also ensure that all cigarette tax money was earmarked for smoking related illness.

16

I think it’s wrong to force the employer to pay for these weight-reduction surgeries. The employer had nothing to do with the employee’s weight gain. To the extent that the weight contributes to the injury, it’s a shame that the employer even has to pay for that (but they should).

And, if I were an employer, it would make me decidedly less eager to hire obese people. They’re going to increase my insurance costs as it is; now I’m liable to be on the hook for their weight reduction surgery also?

Finally, forcing the employer to pay increases insurance premium costs for everyone else in the plan – if I were a coworker I would be unpleased.

17

Apparently it does, regardless of how you think things should be.

Insurance has to do with diluting costs for all involved. It has nothing to do with responsibility or blame.

18

I see what you did there… :dubious:

In the first case, nobody seemed to notice that the doctor said the determination for treatment stems from both Childers’ age and weight. We could replace all the weight references with age references for those who are against the employer paying and the arguments would be identical, except age is a protected class and weight is not. Should there be such a difference? And more importantly, in the context of the case, as age is also a preexisting condition, should it matter?

Looking at it that way, I’d have to say no. Childers’ age, weight, race, nationality, gender, etc is irrelevent. He was, I assume, given health insurance by his employer at the time of hiring which stipulated that in the case of an on-job injury, his employer would pay. Whether or not any preexisting condition, which doesn’t seem to have been excluded beforehand at the point of hiring, affects that is irrelevent. Of course I will take back my statements if the employer had made allowances to deal with the weight issue before or at hiring and Childers somehow failed to do so

Also, the doctor said that with weight loss the surgery might be unnecessary, so it seems that while the goal is to get his back into shape, Childers’ employer only wants one method (back surgery) of fixing it while the doctor posits another. I wouldn’t want my employer determining what kind of treatment I’ll get if I get injured (the cheapest and fastest, they’ll say).

In case 2 I would have the same opinion; treatment is necessary and the method of treatment should be based on his doctor’s recommendation, not his employers.

19

What does this mean?

An insurance company may decline to offer a life insurance policy to a skydiver, or a stunt pilot, under the very reasonable rationale that their risks of meeting an untimely death are greater than the average person’s. By setting standards on who they insure, an insurance company can manage their costs.

The general concept of workman’s compensation is that it places automatic liability onto the employer for any injury suffered on the job. So a group insurance policy for workman’s comp offered to a firm of accountants will probably be less expensive than a policy offered to a company employing stevedores and forklift operators.

Whether such a policy has to cover injuries that are created or exacerbated by pre-existing conditions is obviously going to factor into cost. And whether such pre-existing conditions can be viewed as the responsibility of an individual is obviously a key inquiry.

So it seems to me that, to this extent, anyway, ‘responsibility’ and ‘blame’ are very much factors.

20

He’s 26.