Know if Workmans Comp Covers Obesity, Indemnity, and Pre-Existing Conditions

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Robert Golan

Because of the recent decision by American Medical Association (AMA) to classify obesity as a medical condition, questions have arisen vis-à-vis whether a claim of obesity can affect work comp.

Prior to the AMA’s decision, obesity was considered by insurance companies to be the result of poor dietary choices. Carriers regard matters of choice such as these as controllable by the insured; and therefore will not cover health conditions that arise from them.

On occasion, an insurance company will allocate indemnity payments for disability claims adjusted to include a prior condition. In fact, disclosure is encouraged, for concealment of such can result in a loss of payments altogether.

A third of all work comp claimants suffer from obesity. The shrinking of second injury funds is bad news for these claimants, who would be able to cite the AMA’s decision when applying for reimbursements if such funds were available. The good news is that New York law now makes it possible for carriers to grant apportionment to claimants with prior conditions. Furthermore, the law now recognizes morbid obesity as a pre-existing condition from which the patient is subject to recover if granted second injury funds. Needless to say, comp claims in the future will see serious debate over this issue.

Concealment is also subject to debate. So-called “obvious” conditions such as amputations are virtually impossible to conceal. One would imagine obesity must fall into this category as well. The truth is that a claimant with obesity in his or her past, even if the condition was successfully treated, must disclose the illness, or otherwise face concealment charges. Former suffers of obesity may not want authorities prying into what they consider to be a sensitive and private matter in their personal history, should there be an investigation.

Suffolk County workmans comp lawyer, Robert Golan PC, can provide you with a free consultation for your case.

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