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State high court says bariatric surgery not compensable

bariatric surgery

The North Carolina Supreme Court ruled Friday that a lower appellate court erred in determining that a preschool and its insurer were responsible for paying for weight-loss surgery for an injured employee.

The state high court reversed a North Carolina Court of Appeals decision that had affirmed an Industrial Commission finding that bariatric surgery was compensable in a workers compensation claim initiated by Robin Kluttz-Ellison, who worked for Noah’s Playloft Preschool.

Ms. Kluttz-Ellison filed two workers compensation claims against the preschool for injuries she suffered in falling off a ladder and in tripping over a sleeping cot.

Prior to the workplace incidents, Ms. Kluttz-Ellison had unrelated knee surgery and struggled with body weight issues for years, the high court ruling states.

After the filing of the workers comp claims, Ms. Kluttz-Ellison’s physicians determined she needed additional knee surgery and a gastric bypass, a form of bariatric weight loss surgery.

The appeals court found that while the weight loss issue was not directly related to the workplace injuries, the need for bariatric surgery was directly related to the case because Ms. Kluttz-Ellison couldn’t undergo compensable knee surgery before losing weight.

In overturning and remanding the case, the state supreme court said the appeals court erred because it was improper to force an employer to pay for treatment of a preexisting general health condition that was unrelated to a work incident.