ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum - View Single Post

bridgetgirl · 06-12-2008, 08:06 PM

I can tell you in California when I was a work comp coordinator I helped 2 people get WLS through their work comp carrier. Again, this was in CA and benefits vary from state to state. If you require surgery to repair your back due to a work related injury, and a surgeon WILL NOT perform the surgery as a result of your weight your emplyer has the obligation to get you to that weight to deem you suitable for surgery. Rapid weightloss is the quickest way to get you ready for surgery to repair your back and settle your claim. Do not let anyone tell you differently. It does not matter how thin, how heavy, how old you are when you have the injury. Your employer has a responsibilty to get you back to your pre-injury capacity.

first of all you need a staement from your Primary work comp Dr stating that you need the surgery, that he cannot perform the surgery due to your weight and the he recommending you have gastric bypass to have rapid weightloss to get you healthy for surgery. Then the person that does the auth's submits that to the WC carrier. If they deny it (Im not sure the timeline to deny, accept or delay for more info) then you take it to your attorney to take in front of the Work Comp appeals board for a judge to rule on it. Again, you had this injury at work, your employer hired you "as is" and they are responsible for your healthcare, and getting you back to pre injury capacity.... or as much as possible to return you to that capacity.

I can help you with this, like I said I got this approved for 2 people in Cali. Also, I got weight watchers and Jenny Craig approved for people who had gained weight as a result of limited physical capacity as a result of their injury.

Youre gonna have to fight, so is your lawyer. Unless there is a law stating otherwise you are entitled. One of the people that I got approved I referred to Dr C, the other lived in Imperial Valley and used a Dr there.

Good luck pal, let me know how I can help!!!

If you had the same injury and were thin, and in the lab workout discovered you were diabetic or had hypertension they would have to get that under control. If you were 65 and had the same injury, but you had arthritis and degenerative chages to your spine due to your age, they would still have to do the surgery. When they settle the claim thats where it all comes out in the wash determing how much was because of the injury and how much was due to prexisting conditions.