One of the most frustrating realities of California workers’ compensation is that the system, which exists to protect injured workers, can be weaponized against them through sloppy medical reporting. A situation we encountered this week is a perfect example of why the initial steps you take after a workplace injury matter enormously.
What Happened: A Benefits Disruption Caused by Contradictory Medical Reporting
We recently received word that one of our clients had her temporary disability benefits unilaterally stopped by the workers’ compensation claims adjuster. The reason? A confusing and contradictory progress report from Concentra and uncompromising adjuster.
Here is what happened. After our client’s accepted workers’ compensation injury, she was initially sent to Concentra, a large occupational medicine clinic commonly used by employers and insurance carriers as a primary treating physician (PTP) at the outset of claims. Concentra gave her an off-work note that included specific work restrictions her employer could not accommodate. Under California workers’ compensation law, when an employer cannot accommodate a physician’s work restrictions, the injured worker is entitled to temporary total disability (TTD) benefits.
So far, so good. But then Concentra submitted a PR-2 progress report to the claims adjuster, and that report contained a critical internal contradiction. In one section of the report, the doctor indicated the applicant could return to work at full duties. In another section of the same report, the physician indicated he was continuing her work restrictions. The two statements are irreconcilable. The Work Activity Status report actually given to our client listed her restrictions.
Rather than seeking clarification from Concentra, or deferring to the off-work note that had been issued directly to the patient, the claims adjuster stopped our client’s TTD benefits without warning.
Why This Matters: The Adjuster’s Obligation and the Problem with Unilateral Benefit Terminations
Under California Labor Code § 4650 and related regulations, an injured worker’s temporary disability benefits cannot simply be terminated without proper basis. When a medical report contains an obvious internal contradiction, and it contradicts her work restriction note. The appropriate response from a claims adjuster is to seek clarification, not to use the ambiguity as an excuse to cut off benefits.
This is the kind of conduct that, if it continues or causes unreasonable delay, can give rise to a claim for penalties under Labor Code § 5814. We are actively working to resolve this situation for our client and expect her benefits to be reinstated.
The Bigger Issue: Why Industrial Clinics Are Often the Wrong Choice for Injured Workers
This situation is not unusual when and industrial clinic like Concentra is the treating physician. Concentra is a national occupational medicine chain, and while it may be adequate for first aid claims, it is frequently ill-suited for injured workers with more complex needs.
If your workers’ compensation claim involves any of the following, we strongly recommend switching your treating physician away from industrial clinic as soon as possible:
- Multiple treatment modalities (physical therapy, imaging, specialist referrals, injections)
- Surgery or a recommendation for surgical evaluation
- Periods of time off work requiring temporary disability benefits
- Disputed injury or a claim where the insurance carrier is likely to contest the extent of your injury
- Multiple body parts or a cumulative trauma claim
In these situations, you are entitled under California law to select a physician from your employer’s Medical Provider Network (MPN), or if your employer does not have a properly noticed MPN, or if you predesignated a personal physician before the date of injury, you may have the right to treat outside the MPN entirely.
How to Switch Your Treating Physician in a California Workers’ Compensation Claim
Switching doctors in a workers’ compensation claim is not always straightforward, but it is a right most injured workers have. The process generally involves:
- Identifying physicians within your employer’s MPN who specialize in your type of injury and have a reputation for providing honest, thorough medical care
- Requesting a change of physician in writing to the claims adjuster
- Getting the transfer authorized and ensuring the doctor’s office schedules the patient
An experienced California workers’ compensation attorney can help you navigate this process and identify physicians who will actually advocate for your recovery, and not just return you to work as quickly as possible to minimize costs for the insurance company.
The Takeaway: Act Early, Choose Your Doctor Wisely
The decisions made in the first weeks of a workers’ compensation claim have consequences that echo throughout the life of the case. The treating physician’s reports form the evidentiary foundation for your entire claim, and they drive your disability rating, your temporary disability payments, your treatment authorizations, and ultimately your settlement value.
If you were sent to Concentra following a workplace injury and your claim involves anything more than a simple first aid issue, it is worth speaking with a workers’ compensation attorney before your medical treatment becomes entrenched with a clinic that is not working in your interest.
If you are dealing with a benefits disruption, a contradictory medical report, or any difficulty with your current treating physician, contact our office for a free consultation. We help injured workers throughout Southern California navigate exactly these situations.