JCC Awards Knee Replacement After Carrier Waives Knee Defenses

In Huey Wright v. Eagle Roofing Products Florida LLC/National Union Fire Insurance Co. of Pittsburgh, PA, Judge Mark A. Massey addressed a request for authorization and scheduling of a right total knee replacement after a January 6, 2025 workplace accident in which a large hopper bucket struck the claimant's knee.

The employer/carrier accepted the accident and authorized knee treatment, but later argued that pre-existing osteoarthritis, not the industrial accident, was the major contributing cause of the need for surgery. It also disputed whether the total knee replacement was reasonably and medically necessary.

The JCC found the knee replacement reasonable and medically necessary, and concluded that the carrier waived its medical-necessity defense by not timely responding to authorization requests. The order also found the employer/carrier was on notice of the pre-existing osteoarthritis but continued authorizing right-knee treatment without limitation and did not issue a 120-day pay-and-investigate letter or timely deny the condition.

Relying on the waiver analysis in Sullivan and Sierra, the JCC treated the osteoarthritis as part of the compensable injury by operation of law and rejected the major-contributing-cause defense. The claim for authorization and scheduling of the total knee replacement was granted, as were costs and attorney fees, with jurisdiction reserved on amount. OJCC Case No. 25-002639MAM.

Source: Compensation Order