In California workers' compensation cases, one of the most confusing situations for injured workers and employers alike occurs when an employee has been declared "permanent and stationary" (P&S) but later experiences changes in their condition or work restrictions. This blog post explores the critical question: Can temporary disability benefits resume after a P&S determination?
The General Rule: P&S Status Ends Temporary Disability
When an Agreed Medical Evaluator (AME) or Qualified Medical Evaluator (QME) determines that an injured worker has reached P&S status, this typically marks the end of temporary disability benefits. According to [LC § 4650(b)]( https://app.sullivanoncomp.com/external_resources?type=LAB&number=4650 ), once an employee's condition becomes permanent and stationary, the employer generally stops temporary disability payments and begins permanent disability payments instead.
California Code of Regulations defines "permanent and stationary status" as the point when an employee "has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment."
The Exception : When Conditions Deteriorate
Despite the general rule, California workers' compensation law recognizes that medical conditions can change. If an employee's condition deteriorates after being declared P&S, they may be entitled to a new period of temporary disability benefits. But what exactly constitutes "deterioration" in this context?
What Qualifies as "Condition Deterioration"
For a condition to be considered deteriorated after a P&S determination, there must be:
1. **Actual Medical Change**: A genuine worsening of the medical condition, not merely a different doctor's opinion about the same condition.
2. **Demonstrable Evidence**: Medical evidence documenting the change, such as new objective findings, increased symptoms, or additional limitations.
3. **Causal Connection**: The deterioration must be related to the original industrial injury.
Real-World Examples of Deterioration
Courts have recognized various situations that constitute deterioration after a P&S determination:
- Increased Symptoms with Objective Findings: In County of San Bernardino v. WCAB (Ramirez ), an applicant's testimony about worsening back pain that limited lifting, sitting, stooping, and bending, combined with a doctor's report showing increased pain and additional work restrictions, constituted substantial evidence of deterioration.
- New Objective Findings: In Chabot-Las Positas Community College v. WCAB (Sultan) , new findings including positive straight-leg raising, muscle weakness, diminished sensation, and calf atrophy were considered evidence of deterioration.
- Need for Surgery: When a condition worsens to the point that surgery becomes necessary, this can constitute deterioration, as seen in *Draper v. WCAB*.
- Functional Limitations: In Detjen v. WCAB , new and further disability was established by a medical report indicating the applicant "could no longer function adequately in the labor market."
What Does NOT Qualify as Deterioration
Not all changes after a P&S determination warrant new temporary disability benefits:
- Same Condition, Different Opinion: A doctor's report that simply re-evaluates the applicant's condition without noting new facts or changes does not prove deterioration.
- Minor Treatment Changes Without Condition Change: In Mathis v. WCAB , "a change in the prescription for a back support, without a change in physical findings, was not a new and further disability."
- Pre-existing Symptoms Without Worsening: Conditions that existed at the time of the P&S determination but were not included in the original award, without evidence of worsening, do not constitute deterioration.
The Practical Scenario: New Work Restrictions After P&S
Let's consider a common scenario: An AME or QME determines a worker is P&S, but a subsequent work status report from another physician indicates modified duties are needed. Is the worker entitled to temporary disability benefits if the employer cannot accommodate these restrictions?
The answer depends on whether the new work restrictions reflect:
1. A genuine deterioration in the worker's condition (which may entitle them to TD benefits), or
2. Simply a different medical opinion about the same condition (which typically would not warrant new TD benefits)
Burden of Proof and Medical Evidence
The determination of whether an injured worker is entitled to a new period of temporary disability after being declared P&S is a question of fact that must be supported by substantial medical evidence. A mere change in a doctor's opinion without evidence of actual deterioration is generally insufficient.
Key Takeaways for Injured Workers and Employers
For injured workers:
- If your condition worsens after a P&S determination, seek medical care and documentation of the changes
- Ensure your physician clearly documents any new symptoms, objective findings, or functional limitations
- Understand that a different doctor's opinion about the same condition may not be enough to restart TD benefits
For employers and claims administrators:
- When faced with a request for TD benefits after a P&S determination, carefully review the medical evidence
- Look for documentation of actual deterioration, not just different opinions about the same condition
- Consider whether the new work restrictions can be accommodated before denying benefits
Conclusion
While a P&S determination generally ends temporary disability benefits, California workers' compensation law recognizes that medical conditions can change. When there is substantial medical evidence of deterioration in an injured worker's condition, and the employer cannot accommodate resulting work restrictions, temporary disability benefits may resume.
Each case must be evaluated on its specific facts and medical evidence. Understanding the distinction between genuine deterioration and merely different medical opinions about the same condition is crucial for both injured workers seeking benefits and employers managing claims.
Disclaimer: This blog post is for informational purposes only and does not constitute legal advice. Workers' compensation laws and regulations are complex and subject to change. Consult with a qualified attorney for advice specific to your situation.