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SALEM, Ore.—An insurer must pay for the gastric bypass surgery doctors said a worker needed for a knee surgery to succeed, Oregon’s Supreme Court ruled Thursday.
The ruling in SAIF Corp. vs. Edward G. Sprague upholds an appeals court finding favoring the claimant, who weighed 350 pounds in 2000 when he underwent the gastric bypass surgery to treat his “severe morbid obesity,” court records state.
Mr. Sprague had suffered a work-related left knee injury in 1976, and nearly 25 years later the knee had deteriorated when he hurt it again while working. Doctors concluded his obesity needed treatment in order for knee surgery to succeed.
But SAIF, the insurer in the case, opposed paying for the bypass surgery. SAIF argued it should not compensate for the bypass surgery because the claimant had not proved his morbid obesity was caused by his compensable knee injury.
The Supreme Court disagreed. It said the bypass surgery was related to the claimant’s knee condition, which was caused in part by the 1976 injury.
Oregon statute “does not limit the compensability of medical services simply because those services also provide incidental benefits or help to treat other medical conditions that were not caused by the compensable injury,” the court said. “The fact that the gastric bypass also treated claimant’s morbid obesity as a necessary incident of effectively treating his knee condition does not affect the resolution of the compensability of his medical services claim.”