United Benefit Advisors Insight and Analysis Blog

An Uptick in Obesity Disability Claims

By Josie Martinez, Senior Partner and General Counsel at EBS Capstone
a UBA Partner Firm

  Aug 26, 2013 9:41:00 AM

medical symbolBy Josie Martinez, Senior Partner and Legal Counsel
EBS Capstone, A UBA Partner Firm

The American Medical Association (AMA) recently categorized obesity as a "disease" rather than a condition. While it's commendable that the AMA is attempting to tackle the widespread obesity issue, the fallout of this determination is that employers may see more disability claims. Previously, it was thought that "normal" obesity was not protected under the Americans with Disabilities Act. However, this new re-classification complicates matters.  Now, obese employees may have additional protections in the workplace. Employers may need to consider reasonable accommodations for those with a body mass index of 30 or over. We may see more employees qualify for short-term disability benefits as a result of this new determination.  This could be costly across the board when you consider that according to the Centers for Disease Control and Prevention, the obesity rate has jumped nearly 50 percent since 1997. Currently, one- third of American adults are classified as obese, in addition to one- third being overweight. The new determination by AMA makes it easier for an obese employee to argue that he/ she is disabled.

But, not so fast: An important nuance to remember is that most claims examiners look at medically supported restrictions/limitations with respect to the employee's job as a determinative factor when analyzing a claim's credibility. Carriers will look at such things as the diagnosis, treatment and duration as well as any limitations on the job before a claim is approved.  So, if an overweight employee can prove restrictions or limitations on the job as a result of obesity, he/she could substantiate disability under their plan. That being said, whether it is a disease, condition or illness, it is not in and of itself determinant of benefits. The determinant to the receipt of disability benefits is whether the condition/ disease is so impairing that it prevents the person from performing material duties of his/ her occupation, as demonstrated by medical evidence. Functional impairment, therefore, is critical to the claim's assessment.

At the end of the day, will there be an uptick in claims based on the AMA's new classification of obesity as a recognized “disease"?  Probably – but in most cases, such claims will likely not be approved based only on obesity as a "disease."  It will, however, likely mean increased demands on employers.

Topics: wellness, employee wellness, disability management, employee benefits, health care