On July 30, 2008, the Oregon Court of Appeals used a lot of ink to reach an inconclusive result. The case is a good example of just how complicated the workers’ compensation law has become in the last decade. In SAIF v. Sprague, the court decided that the Workers’ Compensation Board was correct to hold SAIF Corporation responsible to cover the cost of gastric stapling surgery for a gentleman who had injured his knee in 1976 (when he weighed 225 pounds). Eventually the knee injury resulted in arthritis in the knee. Doctors wanted to do a total knee replacement, but by then Mr. Sprague weighed well over 300 pounds and the doctors said he must lose weight before a knee replacement could be done successfully.
This case took years to wind through all the levels of appeal. The gastric surgery was performed in 2001. Mr. Sprague asked SAIF to pay for it as part of “compensable” medical services in his knee claim. When SAIF wouldn’t pay, the matter went into litigation. It first reached the Court of Appeals in 2005 when the court reversed the Workers’ Compensation Board and sent the case back to the board to reconsider. Then the court issued another opinion to further explain itself. The first time the board had decided that SAIF did not have to pay. In 2007, after reconsidering it according to the court’s instructions, the board ruled in Mr. Sprague’s favor.
The case involved the meaning of an Oregon statute (a law passed by the Oregon legislature). The old version of the statute was less complicated. In an earlier case under the old version of the law, the court had held that a worker who injured her knee at work was entitled to have a weight loss program paid by the workers’ compensation carrier as part of the medical treatment to help her recover from the work injury and to possibly avoid more knee surgery. Van Blokland v. OHSU, 87 Or App 694 (1987).
Under the current version, the case was complicated by questions of “consequential” and “combined” medical conditions and different medical coverage depending on how the medical condition was classified. Mr. Sprague’s arthritis was a consequential condition. His obesity was not. The court held that the gastric stapling should be paid for in order to treat the current knee condition. However, one of the three judges thought that the court made a mistake in its 2005 decisions but did not think it should start over now. After the court has written three opinions in the Sprague case, it still is questionable whether the meaning of the statute is clearer now or not.
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