Weight loss surgery covered by state, court rules


In a ruling likely to be thinly applied, the Oregon Supreme Court has decided that weight loss surgery is covered by state workers' compensation insurance in limited situations. The unanimous ruling Thursday affirmed an Oregon Court of Appeals decision ordering SAIF Corp. to pay for the surgery, but on different grounds. Edward Sprague developed arthritis in a knee he injured on the job in 1976.

His doctor recommended gastric bypass surgery to help Sprague lose weight before his knee replacement surgery to ensure the operation would be effective.

Sprague weighed 320 pounds before he underwent the gastric bypass surgery in 2000. He filed a claim for compensation that was initially rejected by the state Workers' Compensation Board.

But after the Oregon Court of Appeals ordered the board to reconsider, it allowed the claim, which SAIF then denied.

The appeals court rejected the SAIF appeal, ruling that Sprague's knee injury "was a material cause of his need for gastric bypass surgery."

The Supreme Court used different reasoning to reach the same conclusion, ruling the weight loss surgery was necessary for effective treatment of the arthritic knee.

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Weight loss surgery covered by state, court rules