In re Claim of Serrano, 052721 COWC, 5-112-470-002

Docket NºW.C. 5-112-470-002
Case DateMay 27, 2021
W.C. No. 5-112-470-002
Colorado Workers Compensation
Industrial Claim Appeals Office
May 27, 2021
          RITSEMA LAW PC, Attn: KYLE L THACKER ESQ, (For Respondents)          FINAL ORDER          The claimant seeks review of an amended order of Administrative Law Judge Turnbow (ALJ) dated December 4, 2020, and issued on December 9, 2020, that determined claimant had failed to prove compensability of her claimed work-related injuries. Because of the compensability determination, the ALJ also denied medical treatment for the alleged injuries. We affirm.          The ALJ conducted an evidentiary hearing on September 1, 2020, on the issues of:
1. Whether claimant proved that she sustained compensable injuries to her left shoulder, left wrist, right shoulder, and left foot.
2. Whether claimant proved that her left shoulder surgery was reasonable, necessary, related, and authorized.
3. Whether claimant proved entitlement to temporary disability benefits.
4. Whether claimant proved entitlement to medical benefits after maximum medical improvement (MMI).
5. Whether respondents proved entitlement to an unemployment offset.
6. Whether respondents proved that claimant had a pre-existing condition.
         The ALJ established findings of fact, which are summarized below.          The claimant worked as a server for the employer. On June 9, 2019, claimant fell at her workplace. Security video captured the fall. Claimant reported the injury within an hour of its occurrence and the employer provided her with a designated medical provider list.          The claimant did not seek medical treatment until approximately one month later. She first presented at the North Suburban Medical Center ER (NSMC) on July 7, 2019. NSMC was not on the Designated Provider List. Claimant reported a pre-existing medical condition, scleroderma, which is a chronic connective tissue disease generally classified as an autoimmune rheumatic disease. Claimant’s main complaints were pain in the left wrist and right foot.          A designated provider, Dr. Miller, saw claimant on July 12, 2019. The claimant provided a history to Dr. Miller, which Dr. Miller recorded as follows:
[Claimant] was walking out from behind bar and foot slipped out. Right leg slipped out and her left side hit the bar top. Fell to knees. No head injury. Was able to get up. Talked to manager and filled out papers. Main complaint at the time was bruising on the chest wall and left knee. This resolved with time … Right foot started hurting about one week later. Was ‘tender.’ Noticed swelling. Took some Aleve. Kept working, but still having pain in right foot. Was also having pain in the left wrist. This started last weekend. (Emphasis in ALJ’s order)
         Dr. Miller diagnosed a sprain and strain of the right foot. The doctor also stated as follows:
… Causality is unclear. Her fall was notable for a blow to the left knee and chest wall. There was bruising and associated pain, but this resolved. A few weeks later she developed foot pain and then even later developed wrist and shoulder pain. I think it is possible she did something to the foot, but I would like to see the video of the event. Time course is a little unusual. Possible Morton’s neuroma, maybe stress fx? I think the left UE symptoms are unlikely to be work related. There does not seem to be a good MOI (mechanism of injury) to support an injury and the time course is not typical with symptoms starting a month later. (Emphasis in ALJ’s order)
         At the same time, Dr. Miller noted left sided scleroderma, with less muscle mass on the left as a result. The doctor released claimant to regular duty.          On July 18, 2019, claimant returned to Dr. Miller. The doctor reviewed the security video and notated:
We reviewed her injury again as well as the video of her fall. Her left foot slipped causing her to fall on her left upper chest wall. Her left shoulder and arm were still on the bar. Her shoulder was abducted to about 90 degrees and there was no appreciable force to the wrist/hand area. The ulnar aspect of the wrist was in contact with the bar throughout

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