Is the argument that he had a pre-existing condition, or that fat people are bad? The real answer is to uncouple insurance from employment.
Meaning that the whole tax-paying base of the country will pay for his weight-loss surgery?
This isn’t “insurance” per say. It is mandated coverage by the government if you want to operate.
I don’t think you will ever uncouple this unless you find a way to deter employees from suing their employers when they lose a job because they got hurt doing said job.
If it will take greater health care costs off the table, the government should be happy to pay for it. It is like diabetes maintenance . If we keep them on insulin and help with maintaining, it will be a lot cheaper than saving a few bucks now and paying much, much more when they get the ravages of the untreated disease.
Should optical insurance pay for Laser surgery? Is it financially better than constantly buying glasses? If laser surgery is cheap enough, it would be easy to see the savings.
But we all think fat people are weak and should be treated as lepers.
Yes, in my view. The purpose of such payments is to restore the individual to a state where he or she can work again. The fat didn’t keep them from working, but the shoulder does - to fix the shoulder, gotta fix the fat.
Workers comp has nothing to do with one’s insurance through their employer. Often they are entirely different carriers. You can be uninsured and still you qualify for workers comp if hurt on the job.
You’ll have to clarify what you’re getting at.
You said that the doctors took his age into consideration when deciding treatment. Thus something like age, which would definitely fall under something pre-existing, was a factor. Why couldn’t weight be as well?
It means this is an economic matter, not a moral one.
That has nothing to do with strangers passing arbitrary judgements as to whether some guy in some story they read “deserves” to be covered or not. I’m not talking about pre-determined policy details that clients are aware of going in, I’m talking about the need to pass judgement so many who participate in these discussions seem to have.
Employers are responsible for work-related injuries on their workplace. If this happened in the normal course of work it’s covered. Employers accept that responsibility when they become employers. If the claim is honest and it is a work-related injury then the employer is responsible; that matter was settled long ago. Personal attitudes toward the weight of strangers are unimportant.
I can certainly see the court’s reasoning that the weight and circumstances surrounding the event are linked and therefore considered one incident for workman’s comp purposes. Using the weight issue as a “pre-existing condition” seems cheap and I think it’s incumbent upon the employer to pay for the surgery necessary to fix the employee’s back regardless of what factors may have contributed to it. Likewise with the case in Oregon and the knee surgery.
But that said, I also think the employer should NOT be obligated to pay for any weight loss surgery. In this regard, they’re separate events. Sure in both cases, they’ll be helpful in helping to keep the injury from worsening (and the doctors said that there MAY be a possibility that the weight loss itself will heal the person with the bad back though not so much with the guy with the bad knee). But, in general, these surgeries aren’t about healing the actual injury to which the worker’s comp is there for.
Kearsen asked "Suppose we have universal health care, who pays for weight loss surgery? "
That would be us, the taxpayer. And you know, I’d have no problem with that. For me, the issue isn’t who pays for the surgery. If the guy’s insurance will pay for weight loss, good on it. But if it’s a public plan and the taxpayer gets sent the bill to cover someone taking preventative action against further weight related issues then I’d have no problem. But we’re not talking about insurance here. We’re talking about workman’s comp and that’s an entirely different question.
I see six of one, half a dozen of the other. Not arguing the rationales for providing or denying him coverage, here’s what I see:
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if workman’s comp is required to cover weight-loss surgery for pre-existing obesity that influenced/exacerbated a work injury, employers will discriminate against the overweight and obese in hiring. San Francisco is the only jurisdiction I know of that outlaws discrimination based on weight.
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if workman’s comp is not required to cover weight-loss surgery for pre-existing obesity, then a number of overweight people who are injured on the job will not be able to resolve their injuries, may not be able to return to work, and may end up being declared disabled, thus making them eligible for SSDI.
I don’t have any interest in making things harder for the employers, but I would rather have the employees able to work.
The employers should pay. These jobs both require a certain amount of physical labor, and the employer should have known that a potential risk of hiring someone obese is that they may be more likely to be injured.
So you’re okay with employers discriminating against fat people?
It seems that the courts have said they can, because being overweight causes work place injuries and becomes a liability for employers.
There is a principle in law that criminals have to take their victims as they come. In other words, if I punch you in the face and you die because of a deficient skull, well that’s too bad for me (and you I guess). I think a similar principle should apply for workman’s comp. Employers must take their employees as they come. If an employee is injured on the job and a pre-existing condition needs to be cured in order to fix the injury, well thats just too bad for the employer. These people were fully functioning before being injured on the job, and need to be restored to that state.
It’s not discrimination if the demands of the job are such that some level of physical fitness is required. If the employer chooses to ignore that requirment and hire the person anyway, then that’s the employer’s fault. They should have to pay for whatever job-related injuries are sustained, even if that means paying for that pre-existing condition.
The situation would be different if the job was sitting behind a desk all day and the employee hurt his back by tripping over a trashcan.
I didn’t say health insurance, I said insurance. The problem is that small companies can get screwed if one of their employees has a big claim. Having a single risk pool would fix that problem.
But doesn’t this mean the employer is taking a huge risk with each new employee? If you place that burden of care on an employer, it seams to me that the employer would then have to take steps to protect themselves.
So can an employer now require a full medical and background evaluation as terms of employment? Can they now discriminate based on the potential for them to have to cover the cost of all your pre-existing conditions that might become a problem?
Worker’s comp is notoriously crooked, at least here in Texas. Generally speaking, the cases have to go to arbitration or something like that with the state’s worker’s comp commission.
Problem is, the comp commission case officers and arbitrators are heavily slanted toward the plaintiff- the assumption is that the big mean company is trying to fuck the hard working poor guy, when in fact, typically 80% or more of the cases are fraudulent ones where the guy is being treated by chiropractors instead of real doctors or occupational medical clinics.
My wife used to be an insurance defense comp attorney; she was routinely frustrated with the amount of fraud and bullshit that went on in the system- there were dozens of cases where the insurance company was getting hosed by jerks who were working the system.
This fat dickhead in Indiana’s case sounds like the system is similar up there.
Worker’s comp is not really like health insurance; it’s more like liability insurance (although it pays regardless of who’s at fault). So of course it has to be purchased by the employer.
Lots of stuff to address here…
As a general principle, it depends entirely on the wording of the statute. If surgery to correct underlying medical conditions in order to treat a work-related injury is compensable, well, that’s a cost of doing business in your state. Fairness doesn’t come into it. In so saying, if the weight loss is desirable, rather than medically necessary, it’s the worker’s problem, not yours.
Under the wording of most comp statutes, weight management programs or bariatric/gastric bypass procedures are compensable if the injured worker’s obesity prevents medically necessary treatment for a work related injury. Similarly, cardiac surgery or other care necessary to treat underlying conditions is also generally compensable - if your worker can’t have knee surgery because he is at risk of heart failure, then not only are you on the hook for the cost of his ACL repair, or whatever, you’re paying for cardiac stent emplacement too.
There are any number of superficially unfair provisions of workers’ compensation systems in general. For one, workers’ compensation claimants are rarely wealthy, so if an employee with unrealistic expectations or an overly litigious claimant’s attorney pushes a bad case and loses, the employer/carrier’s prospects for recovering its costs are miniscule at best. At best, maybe they end up with a lien against the worker’s home - in which case the worker simply abandons the mortgage, and the carrier gets nothing, since the mortgage issuer gets first claim.
Add to this the fact that the carrier pays the injured workers’ attorney- at the least, a ~15% fee on benefits secured, and much more in the event that the claim goes to trial.
It’s not the employer that gets stuck with the cost, it’s the WC insurance carrier, FTR.
Criminal law is not a no-fault system. Workers’ compensation is, which means employers and carriers have significant latitude in terms of how much exposure they can have for a given injury.
Anyway, there’s no guarantee that “these people” were fully functioning before being injured. There is a small but significant group of people (called “professional claimants” in the industry) who drift between labor pools, faking work-related accidents (or milking a real but non-injurious accident) using the same injury- generally, a back injury- over and over again in order to obtain indemnity benefits. They may have been assigned permanent work restrictions, but if they don’t tell the new employer it’s virtually impossible to prove fraud. You can prove that the condition is pre-existing, but all that means is that they get a smaller settlement.
Doesn’t work that way, at least not in most states; workers’ compensation premiums are generally based on the absolute number of industrial injuries for a given employer and industry, not on the amount paid out for a given employer (other than being adjusted on a per capita basis).
Employers have always been able to require full medical evaluations as a term of employment. Apart from anything else, in many situations they have to make sure you can physically handle the job requirements.
Not arbitration, mediation - no-fault insurance (which workers’ compensation is) generally involves alternative dispute resolution. If the worker or the employer doesn’t want to settle, they go to trial in an administrative court.
This is a very interesting take (especially the latter point) but not really true. Very, very few employers are self-insured- and the ones that are are invariably huge corporations- so they won’t see a measurable difference in their costs based on whether or not their insurance carrier has to cover weight-loss surgery. As noted above, WC premiums are not based on coverage costs, but on the absolute number of compensable injuries.
In any case, most SSDI claims are denied. Claims predicated on an injury which could be corrected via surgery but has not been are certain to be denied, regardless of whether the claimant can afford the surgery or not.