North Carolina Supreme Court Reverses Decision on Weight-Loss Surgery Compensation

The North Carolina Supreme Court has overturned a lower court’s ruling that would have required a preschool and its insurer to cover weight-loss surgery for an injured employee, Robin Kluttz-Ellison, under workers’ compensation. This decision reverses the North Carolina Court of Appeals’ affirmation of an Industrial Commission finding in favor of Kluttz-Ellison, who had filed workers’ compensation claims for injuries sustained from two separate incidents at Noah’s Playloft Preschool—falling off a ladder and tripping over a sleeping cot.

The Supreme Court’s decision hinged on the relationship between the employee’s need for weight-loss surgery and her workplace injuries. Kluttz-Ellison had a history of body weight challenges and had undergone knee surgery unrelated to her work prior to the incidents. Her physicians recommended additional knee surgery and a gastric bypass to address her weight issues, which they deemed necessary before the knee surgery could proceed. The appeals court had previously ruled that the need for weight-loss surgery was directly related to the compensable knee surgery.

However, the North Carolina Supreme Court found that compelling an employer to pay for treatment of a preexisting condition not caused by workplace injury was incorrect. This ruling emphasizes the separation of responsibility for preexisting conditions from those directly arising from workplace incidents, reshaping the landscape of workers’ compensation claims in the state.