IN THE MATTER OF THE CLAIM OF: AMRITPAL SINGH, Claimant,
MKBS LLC D/B/A METRO TAXI, Employer,
PINNACOL ASSURANCE, Insurer, Respondents.
W.C. No. 5-101-459-005
Colorado Workers Compensation
Industrial Claim Appeals Office
June 4, 2021
RUEGSEGGER SIMONS & STERN LLC, Attn:
THOMAS M STERN, (For Respondents)
self-represented (pro se) claimant seeks review of an order
of Administrative Law Judge Kabler (ALJ) dated December 8,
2020, that determined the following: (1) the respondents
overcame the opinion of the Division-sponsored independent
medical examination (DIME) physician on mental impairment;
(2) the respondents overcame the opinion of the DIME
physician on permanent impairment of the cervical spine; (3)
the claimant failed to overcome the opinion of the DIME
physician on maximum medical improvement (MMI); (4) the
claimant failed to overcome the opinion of the DIME physician
on no permanent impairment for the lumbar and thoracic spine;
(5) the claimant is not entitled to temporary total
disability (TTD) benefits after November 15, 2019; (6) the
claimant failed to establish he is entitled to permanent
total disability (PTD) benefits (7) the claimant failed to
establish he is entitled to a general award of medical
benefits; and 8 the claimant failed to establish he is
entitled to post-MMI maintenance medical benefits
(Grover medical benefits). We affirm.
claimant worked as a taxi driver for the respondent employer.
On March 3, 2019, the claimant was involved in a work-related
motor vehicle accident while driving a taxi for the employer.
The claimant was transported from the scene of the accident
by ambulance to Rose Medical Center Emergency Department
where he was examined by Dr. Moon. The claimant complained of
left sided neck pain that was non-radiating. Dr. Moon found
left lateral paracervical neck tenderness. He specifically
noted no midline vertebral tenderness and no tenderness in
the cervical, thoracic or lumbar spine. Dr. Moon’s
clinical impression was neck muscle strain. His records
indicate no neurological deficits and no other signs of
serious injury. Dr. Moon prescribed medication and discharged
the claimant home.
claimant chose Rocky Mountain Medical Group (RMMG) as his
authorized treating provider (ATP) and began treating on
March 6, 2019, with Dr. Ramaswamy. The claimant reported a
dull pain in his chest, headaches, and hearing a clicking
sound when lifting his head while lying down. The claimant
also reported neck pain, upper back pain, “electrical
shocks” radiating from his neck to head, and mild lower
back pain. The claimant reported he had pre-existing neck
pain, and that a cervical fusion was recommended at some
point. Dr. Ramaswamy noted tenderness in the cervical spine
and mild tenderness in the thoracic spine with mild trigger
point activity. He diagnosed the claimant with a contusion of
unspecified front wall of thorax, strain of muscle, fascia,
and tendon at neck level, and strain of muscle and tendon of
the wall of the thorax.
claimant returned to Dr. Ramaswamy on March 20, 2019,
reporting numbness in his left hand, occasional dizziness,
nausea, and headaches, in addition to lower back and neck
pain. On examination, Dr. Ramaswamy noted tenderness in the
left trapezius with trigger point activity, tenderness in the
cervical spine, and tenderness in the lumbar spine. Dr.
Ramaswamy placed the claimant at modified duty and
recommended he not drive a taxi cab.
respondents filed a general admission of liability (GAL),
admitting for TTD benefits beginning on March 4, 2019.
April 10, 2019, five weeks from the date of his accident, the
claimant again saw Dr. Ramaswamy, reporting that he was
worsening, although he also reported being 10%-20% better.
The claimant again reported neck pain, lower back pain, left
hand numbness and tingling, and right chest wall pain. The
claimant also reported shortness of breath due to pain and
reported he was unable to work in any capacity. Dr. Ramaswamy
noted that the claimant “is set up for delayed recovery
based on his past history” (10 year recovery from prior
motor vehicle accident). Dr. Ramaswamy stated there was a
significant history of chronic pre-existing pain with prior
lumbar and cervical pathology. He recommended a cervical MRI
based on the claimant’s complaints of neck pain and
left hand numbness, which the claimant characterized as new
since the March 3, 2019, accident.
claimant previously was involved in a motor vehicle accident
on December 11, 2007, while driving a taxi. The
claimant’s ATP at that time diagnosed the claimant with
traumatic headaches, chest wall rib sprain/strain, traumatic
vertigo, bilateral hand and forearm abrasions, chronic
cervical and thoracic sprain/strain with spasms, lumbar
sprain/strain with spasm, cervical disc derangement,
insomnia, anxiety, depression, and esophageal discomfort with
spasm. On December 22, 2008, the claimant’s ATP opined
that the claimant had a 1% whole person impairment rating for
chronic pain, and released the claimant from care at MMI.
many years after being placed at MMI for his 2007 work
injury, the claimant continued to receive medical treatment.
On January 8, 2019, the claimant saw his ATP for a follow up
appointment where the claimant complained of neck pain. His
ATP noted he had discussed with the claimant a C4-5 and C5-6
April 20, 2019, the claimant underwent an MRI for his March
3, 2019, work injury as recommended by Dr. Ramaswamy. When
compared to his prior MRI of December 8, 2018, it showed a
new C5-6 left paracentral disc extrusion and possible free
disc fragment with mild indentation of the left side of the
claimant returned to Dr. Ramaswamy on May 9, 2019. At that
time, the claimant reported his condition was worsening. Dr.
Ramaswamy opined that the claimant was presenting with
diffuse pain and quite a bit of symptomatology with some
somatic complaints. He believed pain behavior was present.
While Dr. Ramaswamy noted that the cervical spine MRI
revealed a new disc protrusion at the left C5-6 interspace,
he also noted that some of the claimant’s subjective
complaints outweighed objective findings. Dr. Ramaswamy
referred the claimant to Dr. Lesnak for a physiatry consult.
examination, Dr. Lesnak noted that the claimant provided
submaximal effort during his evaluation and frequently
limited his activities because of pain/fear of pain. Dr.
Lesnak noted that “it seems quite clear that there is a
significant amount of psychosocial factors that are currently
affecting his symptoms, his recovery, as well as his overall
presentation and perceived functional status.” Dr.
Lesnak opined that “there is a likely presence of an
underlying symptom somatic disorder/somatoform
disorder” and noted that the claimant exhibited a
significant amount of anxiety.
claimant subsequently returned to Dr. Ramaswamy. The claimant
reported no change in his condition, with ongoing neck and
lower back pain, left lower extremity numbness and tingling,
left arm numbness and tingling, and right leg pain. He also
reported dizziness, chest wall discomfort, and shortness of
breath. The claimant reported he was 30% worse concerning
neck pain, lower back pain, and left arm and leg symptoms.
Dr. Ramaswamy referred the claimant for a psychological
consult with Dr. Reilly, noting that the claimant had a
history of anxiety and had stated that if he stopped his
medication, he would be in the emergency room. Dr. Ramaswamy
noted that “[s]trains typically resolve by now and [the
claimant] is presented with delayed recovery.”
Reilly performed neuro-psychometric testing and conducted a
clinical interview. He opined that the claimant’s
neuro-psychometric testing results could not be considered
valid because of symptom magnification, exaggerated symptoms
reporting, and negative response bias. Dr. Reilly concluded
that the claimant’s “clinical presentation is
strongly suggestive of a somatic symptoms disorder/chronic
pain condition.” He diagnosed the claimant with somatic
symptom disorder with predominant pain.
Lesnak performed EMG testing which did not show any evidence
of pathology. Dr. Lesnak did not recommend any further
diagnostic or interventional treatments and indicated the
claimant was medically safe to return to work as a cab driver
claimant saw Dr. Ramaswamy on June 25, 2019, and reported he
was no better and he was disabled. Dr. Ramaswamy noted that
the MRI showed a...