THE OBLIGATION OF THE EMPLOYER TO PAY FOR PERSONAL HEALTH CONDITONS AFTER A WORK-RELATED INJURY.
Under the Kansas Workers Compensation Act (KWCA) the employer is generally responsible for all medical treatment prescribed by the authorized treating physician. The proposed medical treatment must be related to the work injury and be reasonable and necessary. The phrase “reasonable and necessary” has a very specific meaning under the KWCA. Not every proposed treatment is reasonable and necessary. The employer/ insurance carrier may not be responsible for an experimental treatment because it is not “reasonable” The employer would not be liable to purchase a new hot tub for the injured worker, when a membership at the YMCA would allow him to use their hot tub. The new hot tub would not be “necessary”.
What is reasonable and necessary is often an issue when the injured worker has a personal health condition that must be evaluated or treated for the work injury to be effectively treated. For example, a person may need to lose weight or stop smoking prior to surgery for a back injury. The person may need cardiac care or dental treatment before being cleared for a knee replacement.
Is the work compensation insurance carrier responsible for treatment of the personal health condition? The answer-many times- is yes. There is no requirement that medical treatment only benefits the work injuries and no other medical conditions.
In Trimble v. Goodyear Tire & Rubber Co., 2007 WL 1390703 (Kan. WCAB 2007), the claimant requested authorization of gastric bypass surgery. The claimant needed back surgery due to a work accident. However, the back surgery would not succeed unless the claimant lost substantial weight.
Respondent argued that the claimant’s obesity was a preexisting condition unrelated to the work accident. As such, they should not be responsible for the gastric surgery since this surgery would benefit his diabetes and weight problems as well as the back injury.
The Kansas Workers Compensation Appeal Board (Board) disagreed. Since the gastric bypass surgery is a reasonable and necessary medical treatment to cure or relieve the effects of claimant’s work injury, it does not matter that it will also benefit other co-morbid medical conditions. See also Radcliff v. Easyhome, Docket Number 1,057,822 (Kan. WCAB August, 2021) & Morris v. Creekstone Farms Premium Beef, 2011 WL 4011683 (Kan. WCAB 2011).
This same principal has been applied to testing and treatment of cardiac conditions. In Fisher v. Cessna Aircraft Co., 2007 WL 2586168 (Kan. WCAB 2007) the Board ordered the respondent to provide pre-surgery testing and treatment for a heart condition. The concurring opinion stated in part:
“ In Kansas, an employer takes an employee as it finds him. This claimant has a possible heart condition which puts him at risk for the procedures recommended by claimant’s treating physicians. The evaluation and treatment of that heart condition is compensable only because claimant is in need of treatment for the work-related injury.”
See also Horner v. U.S.D. No. 259 (Kan. WCAB 2009)
The same principal applies to purely palliative treatment. The Board has ruled that
the respondent is responsible for pain medications that are reasonable and necessary to cure or relieve the effects of a work injury. This is true even if the claimant was taking the same pain medications prior to the work accident for a personal health condition. See Harris v. Training & Enforcement Center of Hutchinson, 2020 WL 1140326 (Kan. WCAB 2020) & Helmer v. Sinclair Masonry, Inc., 2016 WL 5886184 (Kan. WCAB 2016).
If you need treatment for a personal health condition in order to “cure or relieve” the effects of a work accident don’t accept the work comp insurance carrier’s denial of authorization. We can help. Jan Fisher, McCullough, Wareheim & LaBunker.