JCC Awards Shoulder Replacement After Carrier Waives 120-Day Defense

In Timothy Sullivan v. O'Reilly Auto Parts/Liberty Mutual Insurance and Helmsman Mngt Services, OJCC Case No. 25-018466DAL, Judge Daniel A. Lewis addressed a claim for reverse left shoulder arthroplasty after the claimant felt a pop while lifting a car battery on April 2, 2025. The carrier initially accepted a left-shoulder strain, authorized treatment at Care Spot and with Dr. Paul Meli, and later authorized orthopedic surgeon Dr. Marc Ialenti to evaluate the claimant for shoulder-replacement surgery.

The JCC accepted Dr. Meli's and Dr. Ialenti's opinions that the claimant's massive rotator cuff tear and arthropathy were chronic and pre-existing, and that the requested reverse shoulder arthroplasty was not majorly caused by the work accident. That meant the claimant would ordinarily lose on medical causation, even though all doctors agreed the surgery was medically necessary and Dr. Andrew Ellowitz opined the accident caused the condition.

The claimant still won because the carrier never sent a timely 120-day pay-and-investigate letter after authorizing Dr. Ialenti's January 13, 2026 evaluation for the arthroplasty. Relying on section 440.20(4) and recent First DCA authority, the JCC held the carrier had waived its right to deny compensability of the chronic shoulder condition, granted the surgery, and awarded attorney's fees and taxable costs.

Source: Compensation Order