No Workers’ Comp When Your Cups Runneth Over

Business Insurance is reporting that an Australian woman has been denied a claim she says is related to an injury she suffered on the job. She claimed a work injury caused her to gain weight and as a result she is in need of breast reduction surgery to alleviate the pain she is experiencing. The surgery would have cost her employer $20,000.

An employee of the Australian Taxation Office, she has been receiving benefits for neck and shoulder pain caused by computer-related tasks. In addition, she claimed that her accepted workplace injury caused her weight to increase. As a result, her breast size increased from “a DD cup to a EE or F cup”. She believed that Comcare, Australia’s workers’ comp insurer, should pay for said surgical reduction. As an employee of a Taxation Office, this woman would plainly recognize a taxing issue when she, um, sees one. Or two.

Regular readers will certainly recognize that this is a story that I could not let go unrecognized. It is obviously a big issue that we should delve into. I am slightly annoyed, however, that Business Insurance has stolen a bit of my thunder. When talking about her weight related growth in the Breastal region, they stated that the gain “caused her breast size to balloon from a DD cup to a EE or F cup”. Obviously “balloon” would have been a word humorously deployed within this article, but BI has undercut its utilization here by wasting it as a relatively serious verb. What a shame.

Her claim for breast reduction surgery was denied by an Administrative Appeals Tribunal. They determined that the surgery requested would not be the breast solution for the woman in question. Instead, they apparently had the audacity to suggest her enlarged breast issue would be better remedied by weight loss. The decision said, “No doubt that there are numerous possible ways to lose weight, and the costs of a dietician, exercise program, or enrollment in an organization such as Jenny Craig or Weight Watchers would be considerably less costly than the approximately $20,000 cost.”

I say good for the Australian Tribunal. The concept of an employer needing to pay for various co-morbidity issues is not a foreign one to those of us in workers’ comp. We are increasingly seeing injured workers’ whose underlying injury cannot be addressed until other medically necessary treatments and procedures have been performed. Adding on another burden, making employers pay for breast reduction surgery, would literally be the unkindest cut of all. Seriously, what would be next? Are we to assume that this woman’s breasts were the only thing to gain weight? Why not a tummy tuck? A butt lift? Where (or when) does personal responsibility enter back into the equation?

How about we just buy her a gym membership and call it a day?

It is an unusual decision for the folks down under, as in recent years they have so liberalized their benefits system that literally anything, including sex in a motel roomand “stress from being underworked” is considered compensable by some. A dose of common sense coming from this Appeals Tribunal is good news, and something I am fairly certain is welcomed by employers in the country. It can honestly be said that this was the breast decision they had hoped for.

And it just goes to show that good fortune doesn’t always follow those whose cups runneth over.

This article was originally posted on Workerscompensation.com