Zurich just lost a workers' comp fight over a shoulder surgery it said wasn't its problem. A Louisiana appeals court ordered the carrier to pay.
In a decision dated May 20, 2026, the Louisiana Second Circuit Court of Appeal affirmed a ruling that orders Replacement Parts Inc. and its workers' compensation insurer, Zurich American Insurance Company, to cover the late Stevie Michael Holmes's left shoulder replacement and related care.
Holmes was a delivery driver for Bumper to Bumper (Replacement Parts). He was hurt in a work-related auto accident on April 28, 2023, and filed a disputed claim that July after the carrier refused to cover treatment recommended by his orthopedic surgeon.
The fight came down to a question claims handlers see all the time. Did the accident cause the surgery, or did a condition that pre-dated his hire?
Zurich leaned on records from Dr. Trettin, Holmes's treating orthopedist. Six days before Holmes started the job, Trettin wrote in an office note that Holmes would probably eventually need his shoulders replaced. In an August 23, 2023, report, Trettin tied the replacement to pre-existing problems, not the crash. For the defense, that closed the question.
The workers' compensation judge initially agreed. In October 2023, she approved treatment for Holmes's neck but not his shoulder. Holmes moved for reconsideration with a new report from Dr. Brown, dated December 18, 2023, which said the surgery was needed because of the accident. Brown had been treating Holmes for the related neck injury and based the opinion on a review of the medical records. The judge reversed.
Holmes died from liver cancer in August 2024. His wife and children were substituted as plaintiffs.
The appeals court walked through Louisiana's rule on aggravation of pre-existing conditions. A claimant can recover if the accident aggravated, accelerated or combined with a pre-existing condition to produce disability. The panel leaned on testimony from Holmes's supervisor, Greg Henry, who described Holmes as a strong worker able to lift and bag heavy items before the accident, and who saw Holmes at the scene complaining of neck and shoulder pain.
Zurich also argued the judge had relied too heavily on a lay witness to decide what is really a medical question. The panel was not persuaded. Citing Louisiana Supreme Court precedent, the court reaffirmed that causation is not strictly a medical conclusion. It is the ultimate fact for the court to determine based on all the credible evidence, lay and medical.
Dr. Brown's report also carried weight. He found that Holmes's left shoulder symptoms had dramatically increased after the collision, with marked inflammation in the biceps tendon, and concluded that the work accident had aggravated a pre-existing condition.
The defendants had previously agreed to pay $2,000 in penalties and $5,000 in attorney fees, and to start weekly indemnity benefits of $311.19 retroactive to September 24, 2023. The appeals court assessed costs of the appeal to Replacement Parts and Zurich.
For carriers, the message is direct. A clean pre-existing-condition note in a treating doctor's file will not end the inquiry. Louisiana courts will weigh supervisor testimony, lay witnesses and competing medical opinions, and they will defer to the workers' comp judge unless the ruling is plainly wrong.
