Iowa: Court Finds Evidence Does Not Support Requiring Employer to Bear Expense of Gastric Bypass Surgery

Because an injured worker offered no evidence, other than her own testimony, that her gastric bypass surgery had been beneficial to her work-related injury, it was error to find the employer responsible for the expense of the surgery, held an Iowa appellate court recently in Verizon Bus. Network Servs., Inc. v. McKenzie, 2012 Iowa App. LEXIS 855 (Oct. 17, 2012). The injured worker underwent the surgery some six years after a slip and fall injury that left her unable to return to work. Prior to her surgery, it was determined that the worker had suffered a 25 percent industrial disability. The employer refused to authorize or approve the procedure, although a number of physicians indicated that weight loss would likely lessen her pain and discomfort. She went ahead with the surgery and then managed to lose 241 pounds. She sought to reopen her claim on odd-lot grounds and to recover the costs of the surgery, contending that in spite of the beneficial aspects of the surgery, she was totally and permanently disabled.

The appellate court agreed that the surgery and subsequent weight loss was undoubtedly beneficial to her overall health, but indicated that such an improved overall health status was not the standard to be used in determining whether the cost of a specific medical expense should be borne by the employer or carrier. The court said the surgery must have been beneficial to the worker’s employment-related injury. The court continued that while the gastric bypass surgery corrected her non-work-related morbid obesity, it did not provide a more favorable medical outcome for the work injury than would likely have been achieved by the care offered by the employer and accepted by the worker both before and after the weight-loss surgery. Accordingly, the court disagreed with the district court and the commissioner that the gastric bypass surgery was beneficial to the worker and reversed as to this issue.

Practitioners should be cautious with this case. The holding seems limited to the facts of the case. Had the worker shown by appropriate medical evidence that the surgery benefited her work-related injury, she would have prevailed.