By Jeffrey R. Smith (email@example.com)
Drawing up policies for benefits such as disability coverage can provide clear definitions of what is and isn’t covered, but sometimes gray areas can pop up that make things more complicated than expected.
Disability benefits, both short- and long-term, are essential for any workers who find themselves unable to work because of illness or injury. Workers are insulated, in a way, from losing their income if something unfortunate befalls them. Indeed, our society tries in most cases to protect the unfortunate, and disability benefits is a form of this protection.
But how far should this protection extend? There’s no doubt someone who gets injured in an accident or falls ill deserves measures to prevent them from falling into poverty, debt or other financial problems. But what if the worker can’t work as the result of a conscious choice to do something unnecessary, such as cosmetic surgery?
A recent Ontario case saw a hospital worker in North Bay, Ont., apply for two weeks of short-term disability because she had to stay in bed for after an operation to recover. However, the surgery was not to fix a serious health problem or save her life. It was elective cosmetic surgery to eliminate excess skin the worker had after losing a significant amount of weight.
The woman’s employer denied her the short-term disability benefits because it said it fell under the category of “self-inflicted injury,” which made it ineligible for benefits. It also said because she booked the time off before the operations, which happened during the leave, she didn’t have a temporary disability at the time she applied for the benefits.
The arbitrator agreed with the employee that classifying the surgery as self-inflicted opened the door to calling any kind of surgery the same and in this case, it was necessary to improve the employee’s self-esteem and quality of life.
Given the circumstances of this particular case, the arbitrator’s decision is understandable. However, it raises the question of what should be done in other situations where the employee makes a conscious decision to do something that will make her unable to work for a while. If an employee decides have a face lift, nose job or breast augmentation and complications or recovery demands she can’t work for a little while, is that considered a disability that warrants disability benefits? What if the cosmetic surgery isn’t simply for vanity but for quality of life reasons, such as the case above? Where is the line drawn between the two instances of cosmetic surgery?
Another gray area could be if the employee injures herself doing something where injury could be reasonably expected. Can this be excluded from coverage in a benefits policy? And how far should the distinction go?