The North Carolina Court of Appeals recently decided whether workers' compensation covered the replacement of a woman's breast implants after she was involved in a work-related car accident.
In the case, a certified nursing assistant was working for Maxim Healthcare/Allegis Group when she was involved in a car accident while driving to pick up food for a client for whom she was caring.
The woman experienced swelling in her face and right knee as a result of the accident. She also sustained injuries to her chest. She said she began experiencing a decrease in the size of her breast implants, which she had gotten 5 years earlier, as well as a rippling of the breasts almost immediately after the motor vehicle accident.
She eventually had her breast implants replaced and sought workers' compensation benefits for the replacement and other treatment she received while recovering from the accident.
The employer and the insurer denied liability. However, the North Carolina Industrial Commission ruled in favor of the woman and granted an award. The employer and insurer appealed the decision
In its decision, the North Carolina Court of Appeals noted that while it had never addressed the issue of compensability of damage to breast implants before, it has affirmed workers' compensation awards for cosmetic surgery.
The court said that breast implants are covered under the Workers' Compensation Act because it believes "that the weight of authority supports a determination that breast implants satisfy the statutory requirement as a compensable prosthetic device that functions as part of the body."
However, the court said the commission had erred in granting workers' compensation benefits for replacement of both breast implants. The court said that the woman was entitled to compensation for her right breast implant only.
"The commission found that replacement of the left breast implant was necessary 'because the replacements would have to be symmetrical and evenly matched. Replacement of one implant required replacement of both,'" the court wrote. "Dr. Bowers (a board certified specialist in plastic surgery), however, never testified to this effect. Instead, he stated unequivocally that the rippling in the left breast most likely was due to the original implant's being underfilled and that the rippling was not caused or aggravated by the accident."
The court sent the case back to the commission to decide the appropriate amount of compensation for replacement of the right breast implant.
Source: North Carolina Court of Appeals