October 6, 2025

Kelley Kronenberg Defeats Shoulder Surgery Authorization in Workers’ Compensation Trial

Kelley Kronenberg Partner/Business Unit Leader Elizabeth Yohe secured a favorable ruling for Brentwood Nursery and Accredited Surety & Casualty in the Orlando District Office of the Judge of Compensation Claims, successfully defeating a claim for shoulder surgery authorization with potential exposure of approximately $60,000.00. 

The case involved a 74-year-old plant nursery worker who was struck by a Bobcat loader on January 10, 2024, sustaining various injuries. The compensability of the accident was not disputed. The claimant sought authorization for arthroscopic rotator cuff repair surgery as recommended by the authorized treating physician, Dr. Randy Schwartzberg. 

Elizabeth’s defense succeeded on the decisive strategy of medical necessity. The claimant had retained his own independent medical examiner, Dr. Omar Hussamy, who agreed the shoulder injury was work-related but disagreed with the type of surgery needed. Dr. Hussamy testified that the claimant required a reverse total shoulder replacement rather than the arthroscopic procedure requested in the petition. 

During the final hearing before Judge Wilbur W. Anderson, Elizabeth strategically highlighted this critical inconsistency. While the claimant proved the shoulder condition was compensable, he failed to prove the specific surgery he claimed—the arthroscopic procedure recommended by Dr. Schwartzberg—was medically necessary. 

Judge Anderson ruled in favor of the employer and carrier, finding that while the shoulder condition was compensable, the claim for the specifically requested arthroscopic surgery must be denied.  

Critically, the judge noted that the petition sought “Authorization of left shoulder surgery as requested by Dr. Schwartzberg,” not authorization for a reverse total shoulder replacement. This precise focus on the specific relief requested proved dispositive. 

This victory demonstrates the importance of careful attention to the specific claims made in workers’ compensation petitions and the strategic value of using a claimant’s own medical evidence to defeat a requested benefit. For employers and carriers, this case reinforces that even when compensability is established, specific treatment requests must still meet the medical necessity standard based on objective medical evidence.