In conventional medicine, breast implants come in pairs: in most circumstances, you install (or replace) both at the same time. There is a compelling aesthetic symmetry in the process. In the idiosyncratic world of comp, however, symmetry is trumped by the "work-related" standard.
Penny Rumple Richardson was injured in an on-the-job car accident. Her breast implants were damaged. The North Carolina Industrial Commission determined that the damage was work-related and approved replacement of both implants. The insurance company appealed. Ms. Richardson's doctor, Greensboro plastic surgeon Dr. David Bowers, originally testified that the right implant had ruptured in the accident and the left implant showed signs of rippling, so he replaced both. But presumably when pressed by defense counsel, he conceded that the left implant most likely had rippling because it was under-filled. In other words, damage to one implant is clearly related to the accident, but damage to the other is not.
At the appeals court level, Judges Barbara Jackson and Sanford Steelman Jr. agreed that breast implants are covered in workers' compensation claims, because they are a "prosthetic device that functions as part of the body." However, they determined that only one implant was damaged as a result of the accident. They sided with the carrier in denying coverage for the "rippled" implant.
Judge James Wynn, Jr. dissented. He pointed out that Richardson needed both implants replaced to ensure that they were "symmetrical and evenly matched." Judge Wynn sought to expand comp coverage to include the rather obvious aesthetic considerations, but he failed to convince his colleagues on the bench.
The Draconian remedy, of course, would be to remove the uncompensable implant. Fortunately, that won't happen.
The case has been sent back to the workers comp commission for resolution. We hope Ms. Richardson has conventional health insurance and that it will cover half of Dr. Bowers's fee. If that doesn't work, Richardson herself will have to pay the price for maintaining essential symmetry.