A “Shot” at Surgery: GLP-1 Medications and Surgical Clearance in Workers’ Compensation Claims 

By William Anthony 

An increasingly common medical-management issue in workers’ compensation cases arises when treatment of an accepted injury reaches an obstacle that is not the accepted condition itself. An authorized surgeon recommends a knee replacement or other procedure but will not proceed until the injured worker loses weight, lowers a body-mass index, improves an A1C level, or satisfies another preoperative target. A second provider then prescribes Wegovy, Zepbound, or another GLP-1 medication. The question is whether that prescription is sufficiently connected to the compensable injury and proposed surgery to fall within the employer and insurer’s medical responsibility. 

In January, the Workers Compensation Research Institute published a 28-state study examining these weight-loss therapies in workers’ compensation, including GLP-1 medications used to manage obesity as a comorbidity that can affect recovery. 

Georgia Authority 

Georgia law supplies a framework but not a GLP-1-specific answer. O.C.G.A. § 34-9-200(a) requires employers and insurers to furnish medical care and other treatment the State Board of Workers’ Compensation finds reasonably required and likely to effect a cure, give relief, or restore the employee to suitable employment. Board Rule 205 likewise requires treatment prescribed by the authorized treating physician to relate to the on-the-job injury and be reasonably necessary for one of those treatment purposes. 

Georgia’s ancillary-care cases show why the analysis cannot stop at whether the requested treatment directly addresses the injured body part. In Berry College v. Storey, the Georgia Court of Appeals held that physician-prescribed household services could be compensable when they directly relieved a knee injury while limiting responsibility to services that actually benefited the employee and relieved the work injury. Jarallah v. Pickett Suite Hotel applied the same reasoning to family and marital counseling recommended as part of psychiatric treatment. Together, those decisions recognize that treatment can have broader personal benefits while still requiring the work-related purpose and extent of the service to be identified. 

Two Georgia decisions involving weight-loss treatment are also instructive, although neither establishes a controlling appellate rule. In Harris v. Eastman Youth Development Center, an administrative law judge ordered continued payment for a weight-loss program intended to support an approved knee replacement. The Court of Appeals later decided other issues without reviewing the compensability of that program. Lee Fabricators v. Cook involved a physician-prescribed diet program after the physician concluded that the work injury had exacerbated the claimant’s weight problem. The administrative law judge ordered payment, but the Board later denied the program based on noncooperation. The appellate opinion addressed authorization of treatment rather than announcing a general rule on weight-loss care. 

Persuasive Authority from Other States 

Other states have addressed similar requests more directly but not uniformly. In State ex rel. Miller v. Industrial Commission, the Ohio Supreme Court held that obesity did not have to become a separately allowed condition before a supervised weight-loss program could be considered for reimbursement. The court directed consideration of whether the services were reasonably related to the accepted injury, reasonably necessary for treatment, and medically reasonable in cost. 

The Oregon Supreme Court took a broader approach in SAIF Corp. v. Sprague, where gastric bypass was compensable because it was a necessary prerequisite to effective treatment of an accepted knee condition. The North Carolina Supreme Court drew a narrower line in Kluttz-Ellison v. Noah’s Playloft Preschool, holding that compensability depended on the causal relationship between the work injury and the condition receiving treatment, not merely on whether the treatment was necessary before compensable surgery could proceed. 

Those decisions arise under different statutory schemes and do not supply a Georgia rule, but they illustrate competing ways of characterizing treatment directed at a condition that stands between the claimant and treatment of the accepted injury. 

Claims-Handling Considerations 

In the example above where a knee replacement was recommended, the analysis by any claims handler should begin with the proposed surgery rather than the weight-loss medication. The medical record should establish whether surgery has actually been recommended, whether weight loss or another medical target is an express condition of proceeding, who imposed the requirement, the target itself, and the medical reason for it. A general instruction to lose weight presents a materially different record from a surgeon documenting that a particular procedure will proceed once a defined threshold is reached. 

The prescribing record should explain why a GLP-1 medication was selected and how it is expected to advance that surgical objective. Relevant questions include whether reasonable alternatives were considered; how progress will be measured; how long treatment is expected to continue; and whether the authorized treating physician, surgeon and prescribing provider are working from the same treatment plan. If injury-related restrictions or reduced mobility contributed to post-accident weight gain, that history may also bear on the relationship between the prescription and the claim. 

Duration also matters. Wegovy and Zepbound are approved for chronic weight management while a request in a workers’ compensation claim may be justified by the narrower purpose of obtaining surgical clearance. The file should address what happens when the target is reached, surgery occurs, the procedure is abandoned or the medication is no longer advancing the treatment plan. Cost, medication risks, available alternatives and the likelihood of achieving the stated objective may also bear on whether the requested course is medically reasonable. 

Absent direct Georgia appellate authority, these requests remain fact specific. The quality of the medical record – particularly the documented relationship between the requested medication, surgical requirement and treatment of the compensable injury – will often matter more than the medication label itself. 

Key Takeaways 

• Georgia appellate courts have not squarely decided whether a GLP-1 prescription used to obtain surgical clearance is compensable. 

• Existing Georgia authority permits consideration of treatment extending beyond the injured body part, but the work-related function and scope of that treatment still must be established. 

• The claims analysis should define the surgical prerequisite, prescribing rationale, available alternatives, expected duration and point for reassessment. 

William Anthony, an associate attorney at law firm Swift Currie, represents employers, insurers and servicing agents in workers’ compensation claims. He can be reached at william.anthony@swiftcurrie.com. 

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