An appeals court in North Carolina has ordered an occupational injury insurer to cover obesity 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 surgery to succeed.
Robin Kluttz-Ellison suffered two injuries while working at Noah’s Playloft Preschool Inc. in Salisbury, North Carolina: once in 2013 when he was on a ladder changing a light bulb and another time in 2015 when he tripped over a student’s bed. Both injuries were found to be compensable, one of which aggravated an existing injury that required a knee replacement operation, according to documents in Robin Kluttz-Ellison v. Noah̵7;s Playloft Preschool and Erie Insurance Group, filed in the North Carolina Court of Appeals in Raleigh on Tuesday.
After first being denied bariatric surgery by the insurer, a deputy commissioner at the State Industry Commission and the entire commission ruled both in favor of the insurer. Upon review, however, in 2021 the Commission issued an amended award, “concluding that bariatric surgery was medically necessary” and urging the insurer to cover the payment of medical expenses related to her gastric bypass surgery, which she underwent in 2018.
The Court of Appeal confirmed and wrote “there is a direct line connecting the dots” between the original compensable injury and bariatric surgery. “In order for the 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 performed safely and optimally without undergoing a weight loss surgery.
By linking the points, we can conclude that if the Plaintiff’s need to have surgery on her right knee to treat her compensable injury, she would not have had to undergo bariatric surgery. Therefore, even if the occurrence of the Plaintiff’s weight problems was not directly related to … the 2013 accident, the need for bariatric surgery is directly related. “