JCC Rejects Misrepresentation Defense and Awards Shoulder Surgery and Benefits

In Anthony Sparks v. Ellis Roofing & Sheet Metal LLC/Summit and Bridgefield Casualty Insurance Company, OJCC Case No. 25-014581JEJ, Judge Jill E. Jacobs addressed whether the carrier could suspend all benefits based on an alleged misrepresentation about prior right-shoulder problems after a June 10, 2025 skylight fall. The claimant sought reinstatement of compensability, follow-up care with Dr. James Bryan, right-shoulder surgery, temporary disability benefits, and continued physical therapy.

The JCC found the carrier failed to prove fraud or misrepresentation. Judge Jacobs credited the claimant's explanation that he had prior aches and treatment for sleep-related discomfort but no prior right-shoulder or right-elbow injury, and accepted Dr. Bryan's testimony that a 2013 trapezius strain, deltoid injections, and therapy notes did not establish a preexisting rotator-cuff injury. The order also found the claimant testified honestly and that the record showed no prior diagnostic testing or longstanding treatment for the right shoulder or elbow.

The order rescinds the January 28, 2026 notice of denial, grants compensability, awards continued authorization and follow-up with Dr. Bryan, authorizes the recommended right-shoulder surgery, reinstates TPD beginning January 28, 2026, requires payment of any TTD due after that date, and restores physical therapy. The JCC also awarded claimant's attorney's fees and costs and denied the carrier's fraud and misrepresentation defense with prejudice.

Source: Compensation Order