WCPanelIQ
PanelQMEMed-legalDenied

Coleby Quartemont — ADJ13508500

COLEBY QUARTEMONT, Applicant vs. CITY OF VACAVILLE, Permissibly Self-Insured, adjusted by INNOVATIVE CLAIMS SOLUTIONS, Defendants

ADJ number
ADJ13508500
Decision date
Jun 17, 2021
District office
Sacramento
WCJ
Michael Geller
Claim administrator
Innovative Claims Solutions (TPA for City of Vacaville, Permissibly Self-Insured)
Commissioners
—

Injury / body parts: psyche

LC §3208.3LC §4063LC §4600CCR §10109

Summary

Applicant Coleby Quartemont, a maintenance mechanic for the City of Vacaville, suffered a psychiatric injury on December 12, 2019, after striking a power line while jackhammering and becoming frightened. The PQME, Dr. Mark Kimmel, found an adjustment disorder with mixed anxiety and depressed mood with PTSD elements, using the ICD-10 and finding the industrial event the predominant cause. Defendant denied the claim and continued to deny after the report, arguing the PQME report was not substantial evidence because the doctor did not review all childhood treatment records and did not use DSM terminology. The WCJ found injury AOE/COE, and the WCAB denied reconsideration, holding defendant failed its regulatory duty to conduct a reasonable, good-faith investigation and could not unilaterally reject an unambiguous medical opinion without seeking to clarify it.

Issues

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Holding

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Analysis

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Applicant takeaway

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Defense takeaway

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Provider takeaway

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