An appeals court in North Carolina has ordered a workers compensation insurer to cover bariatric surgery for a preschool owner and operator who needed a knee replacement surgery related to a workplace injury, but was told she needed to lose a significant amount of weight in order for the surgery to be successful.

Robin Kluttz-Ellison suffered two injuries while working at Noah’s Playloft Preschool Inc. in Salisbury, North Carolina: once in 2013 while on a ladder changing a light bulb and another time in 2015 while tripping over a student’s sleeping cot. Both injuries were found to be compensable, one of which aggravated an existing injury that called for a knee replacement surgery, according to documents in Robin Kluttz-Ellison v. Noah’s Playloft Preschool and Erie Insurance Group, filed in the Court of Appeals of North Carolina in Raleigh on Tuesday.

After first being denied the bariatric surgery by the insurer, a deputy commissioner with the state’s Industrial Commission and the full Commission both ruled in the insurer’s favor. On review, however, in 2021 the commission issued an amended award, “concluding that bariatric surgery was medically necessary” calling for the insurer to cover payment of medical expenses related to her gastric bypass surgery, which she had in 2018.

The appeals court affirmed, writing “there is a direct line connecting the dots” between the original compensable injury and the bariatric surgery. “For Plaintiff to undergo knee surgery, she had to lose weight” and according to her doctor she “could not lose weight fast enough due to her physical limitations for the knee surgery to be conducted safely and optimally without undergoing weight loss surgery.

“By connecting the dots, we can conclude that but for Plaintiff’s need to have right knee surgery to treat her compensable injury, she would not have needed to undergo bariatric surgery. Therefore, while the existence of Plaintiff’s weight problem was not directly related to the… 2013 accident, the need for bariatric surgery is directly related.”