Even if your doctor has formally recommended a surgery, getting authorization from L&I can be challenging for injured workers in…
The questions and answers about Concentra below are stated in the sole opinion of Spencer D. Parr, co-founder of Washington Law Center and an experienced L&I litigator.
Is Concentra a Good Place for Injured Workers to Seek Occupational Health Treatment?
No. Concentra markets its occupational health services to employers. It cannot keep its business loyal to occupational medicine employee referrals and occupational health services like drug screening, pre-employment physicals, and DOT physicals if it fails to provide the outcomes employers want. Employer-favorable outcomes are often adverse to the interests of injured workers. This is a free market reality.
Employer-favored outcomes in workers’ compensation (L&I) claims include rapid “back to work” opinions from treating providers; conservative placement of few or no prophylactic restrictions; concentration of care on only those injuries and occupational diseases which are most obvious or have already been conceded under a given claim; referrals and then deference to IME physicians for critical medical analysis and causal-relationship positions, including with respect to permanency opinions; and also the frank limitation of advanced and extended medical care options.
For example, we hear too often from people whose medical care providers won’t advocate for a second course of physical therapy because they’ve told their patient that “L&I won’t approve it,” a proposition that is often false. We also hear too often that the only thing covered under an L&I claim is a strain or sprain, so the provider will not advocate for a surgery that was plainly never indicated in the time period leading up to an industrial injury or occupational disease. Some Concentra providers will at times advocate for their patients, but the reality is that a physician must choose to work at Concentra. In doing so they must find themselves to be like-minded with the Concentra corporate mission or move on—that’s a risk you don’t want to take.
Because employers and injured workers generally have opposite goals in the administration and outcome of complex workers’ compensation claims, severely injured workers should generally try to avoid commercial organizations that profit by marketing their services to the employer’s medical-legal needs. This conclusion is not difficult to reach. If you have an uncomplicated injury that needs very little care, Concentra is likely fine. If you need more serious care, explore other options with your attorney.
If My Employer Refers Me to Concentra, Do I Have to Go?
No. RCW 51.36.010 provides that injured workers are entitled to seek treatment with the medical provider of their choice, not their employer’s choice. If your employer referred you to Concentra, that should be a red flag to you, and you should strongly consider going to another medical care provider. Your employer knows the market and is likely directing you to get care in a place that is safe enough for them. Your employer knows where you seek medical care has a major influence on your workers’ compensation claim, more than you might like. As an injured worker, don’t put yourself in this position. Stay away from Concentra and similar corporations.
Can I Trust Referrals Made by Medical Providers at Concentra?
If a medical provider is beholden to any of their referral sources for a continuing stream of new patients, that medical provider should not be given your blanket trust. It’s likely that such a provider will adopt the same outcome goals as the referral source upon which their business depends financially. Geese of a feather flock together.
This then means you’ve never really broken free of the employer’s undue influence in both the administration and outcome of your workers’ compensation claim. No injured worker wants to be trapped within a network focused too much on meeting employer expectations regarding “objective” evidence, rather than on the provision of world-class medical care. This includes cases where the diagnosis and treatment needs are not screaming obvious from the most “objective” indicators.
Is it Correct For My Concentra Providers To Say They Cannot Help if They See No “Objective” Evidence?
Somebody that’s only a bit smarter than dumb once declared that “evidence-based” medicine is the only standard by which workers’ compensation patients should be treated. Coincidentally, that person was also responsible for paying all the bills. See the problem? Meanwhile, case law provides that objective evidence exists when the facts and evidence based on the circumstances of your claim point the qualified expert medical provider to a conclusion on a “more probable than not” basis, even though there might not be frank clinical signs or symptoms that manifestly confirm their impression.
The supposed requirement to show such evidence actually increases the injured worker’s burden of proof improperly from the “more probable than not” basis the law requires to something that looks like the elevated legal standard of proving a case through “clear, cogent and convincing” evidence. Our workers’ compensation does not require that level of confidence, so your provider is likely to be misleading you if they insist otherwise.
More About Objective Evidence and a Proper Diagnoses
A pain syndrome is thus allowed, and pain management treatment should be recommended by the attending physician where appropriate because the provider has diagnosed a pain syndrome based on the facts and circumstances present. A concussion syndrome is thus allowed and a closed head injury at work can therefore result in ongoing limitations from work even if the brain MRI doesn’t show any trauma-related evidence of tissue damage to account for symptoms such as severe headache or confusion or limited ability to concentrate as the day passes. An experienced neurologist knows that ongoing functional limitations can still be present even without MRI confirmation of structural damage. A complex carpal tunnel presentation can be authorized for surgery even though nerve conduction studies reveal no obvious entrapment neuropathy. A condition of depression or anxiety is thus allowed even though there is no objective way to confirm that a patient is depressed or anxious.
If you think about it, objective evidence may not even be possible without authorizing complex diagnostic procedures (an MRI with contrast after an MRI without contrast failed to document injury is one common example). Therefore, physicians shouldn’t rush to over-emphasize the need for objective evidence or standards until no additional diagnostic option remains and the patient’s complaints can be determined to be inconsistent with a valid medical diagnosis under the circumstances.
So, if your medical provider infuses legalistic-sounding fallacies about insufficient “objective” evidence, please direct them to just call an experienced attorney and get advice on how to properly advocate for their patient within such a context. If they believe that you are telling the truth about the nature and severity of your symptoms and limitations, they should advocate for you, not just throw their hands in the air and say there’s “nothing more they can do; go see an IME.”
How Do I Know I Can Trust My Medical Providers With My L&I Claim?
In workers’ compensation (L&I), the most important sign of a trustworthy medical provider is someone who listens carefully, documents present medical conditions both inside and outside of your workers’ compensation claim, and doesn’t defer causal relationship or need for treatment analysis to IME examiners. Instead, your provider does the analysis themselves or informs you when you should seek a second opinion consultation from a prospective treating physician.
A trustworthy physician also aggressively rejects dubious IME analysis—like “it’s pre-existing”, “age-related”, or “wasn’t symptomatically lit up or aggravated.” Because, despite the fact that there were no symptoms or limitations present before the industrial injury or occupational disease, there certainly are now. Your physician knows the vocational rehabilitation rules and will fight for your ability to get retrained if an occupational injury or illness prevents you from returning to your job of injury. They should advise you to seek legal counsel if there are any frictions whatsoever involved in your L&I claim.
Your medical provider should not be afraid of the involvement of counsel, but rather, they should work hand-in-glove with your medical provider to ensure that you are getting all of the benefits to which you are entitled under the law. In short, your medical provider should be a willing advocate for their patient’s best interests, or they should otherwise not act as an attending provider in workers’ compensation matters.
Are There Any Risks to Leaving a Concentra Provider?
Yes. You need to select your medical provider carefully and according to the specific needs of your industrial injury or occupational disease. For example, a chiropractor should not be the attending physician in a lung disease case because chiropractic training is not directed at pulmonary conditions.
Similarly, an Occupational Disease physician (whether or not at Concentra) with no apparent care or diagnostic skills beyond what can be determined through “objective” medical evidence should not be the attending physician in a pain syndrome, concussion, or other complex cases where the medical diagnosis isn’t discrete and obvious. A medical provider who practices medicine in an inflexible and constrained fashion within a corporate structure that falsely indoctrinates their employees (or fails to train them sufficiently to the contrary) that “objective” evidence is a legal requirement in all workers’ compensation cases and at all phases in the process should not remain your attending physician.
In fact, if you leave such a provider, regardless of whether they practice in a facility with a reputation for marketing to employers, the Claims Manager at the Department of Labor & Industries may develop an impression that you are “doctor shopping” and then look skeptically on your position when conflicts arise in your claim.
Free Case Review with an L&I Attorney in Washington
In conclusion, stay away from Concentra or other corporate providers that actively market their services to employers. If it makes sense under the particular circumstances of your case, of course. You may also benefit from a free consultation with an experienced L&I attorney to help you navigate your L&I claim. Call Washington Law Center today to get started.
ABOUT THE AUTHOR:
Spencer Parr is a litigation and trial attorney at Washington Law Center focused primarily in the areas of Labor & Industries claims and injury pension benefits. Before co-founding Washington Law Center, Spencer served in the U.S. Army. He has litigated major issues in the law, represented clients from coast to coast, and dedicated his professional life to assisting the injured and disabled. Click here to learn more about Spencer. View More Labor & Industries and Work Injury Resources.