In re Claim of Nelson, 070519 COWC, 5-022-155-04

Docket Nº:W.C. 5-022-155-04
Case Date:July 05, 2019
PINNACOL ASSURANCE, Insurer, Respondents.
W.C. No. 5-022-155-04
Colorado Workers Compensation
Industrial Claim Appeals Office
July 5, 2019
          FINAL ORDER          The claimant seeks review of an order of Administrative Law Judge Felter (ALJ) dated May 30, 2018, that denied the claimant’s petition to reopen and determined that the claimant had failed to overcome the Division sponsored independent medical examination (DIME) regarding maximum medical improvement (MMI) and zero percent permanent medical impairment. We affirm.          An evidentiary hearing took place over three sessions on November 8, 2017; January 19, 2018; and April 6, 2018. Both parties appeared and participated with counsel.[1] The ALJ’s findings of fact are summarized below.          On July 18, 2016, the claimant walked into a handle of a floor safe which poked into the claimant’s right knee below the kneecap. She did not fall or injure any other part of her body at that time. The injury was immediately reported and the claimant was designated an authorized treating physician (ATP), Dr. Updike. Dr. Updike evaluated the claimant on July 19, 2016, noting no visible sign of injury. On September 8, 2016, Dr. Updike’s exam findings documented no warmth, redness, or swelling; diffuse nonfocal tenderness, and questionable effort.          On November 4, 2016, Dr. Ogin—a pain management specialist—noted a possible somatization disorder and the claimant’s physical exam was benign other than hypersensitivity. On November 8, 2016, Dr. Updike placed the claimant at MMI, reporting symptom magnification and delayed recovery concerns.          The claimant returned to Dr. Ogin for a maintenance care evaluation on February 22, 2017. Claimant reported allodynia and altered sensation diffusely throughout her right leg anteriorly and posteriorly into her calf, foot, and ankle. Dr. Ogin’s impression was possible neuropathic pain/CRPS (chronic regional pain syndrome) with minimal objective findings of anything, and possible somatization disorder. Dr. Ogin suggested moving ahead with autonomic testing to fully rule out CRPS. He further indicated that he suspected the testing would be normal. He postulated that even if the testing was normal, the claimant would be resistant to the suggestion that her pain is nonphysical.          A DIME physician, Dr. Winslow, evaluated the claimant on March 21, 2017. He noted that although the claimant was complaining of severe pain, there were no objective findings, no swelling, no redness, no skin color changes, no palpable temperature changes, and full range of motion. The doctor commented that the claimant seems to magnify her symptoms and reactions to her injuries. Dr. Winslow’s ultimate opinion was that the claimant did not have CRPS. Rather, she had at most a right knee contusion. The doctor concluded that the claimant was at MMI as of November 8, 2016, with no impairment, and no work restrictions. A corresponding Final Admission of Liability was filed on July 10, 2017.          Although maintenance care was admitted, the claimant did not follow-up with either Dr. Updike or Dr. Ogin. Instead, the claimant sought evaluation and treatment outside of the WC system. At hearing, the claimant admitted that she did not provide any of her new physicians with any of her WC claim related medical records. On September 20, 2017, Dr. Oh evaluated the claimant. He did not render a definitive diagnosis. He referred the claimant to a pain specialist unaware that the claimant had already been under the care of Dr. Ogin, who is a pain specialist. On November 27, 2017, the claimant returned to Dr. Ogin for a maintenance visit. Dr. Ogin indicated that there was a remote possibility that the claimant had a neuropathic component to her pain. He indicated that autonomic testing and thermography were warranted and reasonable, but that if the testing was negative, he would not have further recommendations.          The respondents obtained a physician advisory review, through Dr. Raschbacher, of the request for autonomic testing. He...

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