The permanent and stationary date is a medically determined date when an injured worker’s condition has stabilized and is unlikely to improve. At this time the injured worker can be evaluated for permanent disability from his or her injury.
An injured worker is not entitled to temporary disability benefits after the permanent and stationary date.
The treating physician who determines whether an injured worker is permanent and stationary will write a report called a Permanent and Stationary report and send it to the insurance company.
When the insurance company receives a Permanent and Stationary report it will:
- advise the injured worker that he or she can dispute the treating physician’s findings through the med-legal process
- determine based on work restrictions in the report if permanent work is available for the injured worker with the employer
- begin to pay an estimated amount of permanent disability
- determine the value of future medical care and attempt to settle the claim by way of Stipulated Award or Compromise and Release
If an insurance company believes that a treating physician is excessively treating an injured worker, it may request a med-legal examination. An independent doctor called an Agreed Medical Evaluator (AME) or Qualified Medical Evaluator (QME) will examine the injured worker.
The AME or QME may find the injured worker permanent and stationary and send a Permanent and Stationary report to the insurance company. This will trigger the same actions by the insurance company as if the report was sent in by the treating physician.
In this article, our California personal injury attorneys will explain:
- 1. What is meant by permanent and stationary?
- 2. How does an injured worker become permanent and stationary?
- 3. What does an insurance company do when an injured worker is permanent and stationary?
- 4. Disputing of permanent and stationary status
- 5. What the permanent and stationary date means in a California workers’ compensation case
A disability is considered permanent and stationary when the employee’s condition:
- has stabilized; and
- unlikely to change substantially in the next year with or without medical treatment.”1
Permanent and stationary does not mean the complete end of medical treatment. Even if an injury requires lifetime medical care, there is still a point when further treatment will not improve the injured worker’s condition.2
Example: Derek injures his back at work. Over the next eight months, he receives physical therapy and a series of three epidural injections. Derek’s back condition improves, but he still has some pain.
Derek’s treating doctor believes Derek’s condition will not improve further. The doctor releases Derek from care, meaning Derek will not have continued regular treatment for his back. He will only come back if he has a flare-up.
Treatment for Derek’s’ flare-ups will not change the permanent loss of function from his injury.
Permanent and stationary status in California workers’ compensation is a medical determination. An injured worker can only become permanent and stationary based on a medical report.
The treating doctor will treat the injured worker until he or she believes that further treatment will not be effective. At such a point, the treating doctor will write a report called a Permanent and Stationary Report.3
At the permanent and stationary date, the doctor determines if the injured worker has a physical loss of function and loss of future earning capacity.4
The Permanent and Stationary report must be written within 20 days of the examination date finding that the injured worker’s condition has stabilized.5 The report must contain a discussion on the existence and extent of permanent disability and any need for future medical care.6
Example: Amy is treated for a year and a half for her carpal tunnel injury. She has carpal tunnel releases on both wrists. Her treating doctor decides that her condition has stabilized in his examination on April 12.
On April 20th, the doctor writes a Permanent and Stationary report and sends it to the insurance company.
The report states that Amy’s condition is permanent and stationary as of April 12th. She has an 8% permanent impairment for each wrist and needs future medical care in the form of short courses of physical therapy for flare-ups.
In California workers’ compensation, permanent and stationary is often used interchangeably with stating that an injured worker has reached maximum medical improvement (MMI). MMI is a term taken from the American Medical Association Guides to the Evaluation of Permanent Impairment, Fifth Edition.
The AMA Guides is the medical basis for permanent disability ratings in California workers’ compensation.7 A doctor rates an injured worker’s permanent impairment based on procedures in the AMA Guides.
When an insurance company receives a Permanent and Stationary report, it must take several actions based on the report. Failure to act can lead to penalties against the workers’ comp insurance company.
The insurance company is required to send an injured worker notices of his or her right to dispute the determination of the treating physician.8 The injured worker has a right to a second opinion on his or her level of permanent disability. This is done through the med-legal process.
Example: At Josh’s visit with his treating physician, he is told his condition has stabilized. Several weeks later Josh receives his doctor’s Permanent and Stationary report letter from the insurance company. The letter states that his condition is permanent and stationary based on the treating physician’s report.
Josh also receives a notice that if he disagrees with the findings of the treating physician on the permanent disability, he can request a Qualified Medical Examiner Panel list using the med-legal process. Josh can select one doctor from the list to evaluate his permanent disability.
The injured worker may be given permanent work restrictions by the treating physician. The employer will have to determine if it has permanent work for the injured worker within the restrictions.
The insurance company advises the employer of the work restrictions in the Permanent and Stationary report. The employer must decide if it wants to offer at least twelve months of work to the injured worker, in keeping with his or her work restrictions.9
The permanent work is different than the modified work or light duty an employer can offer an injured worker while he or she is receiving ongoing medical treatment and before the permanent and stationary date.
The modified work / light duty is a temporary job, with the idea that an injured worker’s condition will improve enough to return to his or her regular work.
If there is no permanent work available that suits the injured worker’s work restrictions, he or she may be entitled to a supplemental job displacement voucher. The employer has 60 days after the insurance company receives a report that an injured worker is permanent and stationary to offer work.10
Example: Sara has been treated for fifteen months for a low back injury. She is found permanent and stationary by her treating doctor. She is restricted from repetitive bending and sitting for more than one hour without a break.
The insurance company will ask Sara’s employer if it has permanent work for Sara based on the work restrictions. If the employer does not, Sara will be provided with a $6,000 supplemental job displacement voucher. She can use this for training for a new job.
An injured worker’s loss of ability from an injury is an irreversible condition.11 The only way to compensate the injured worker for the loss is through a cash payment of permanent disability benefits.
The insurance company takes the disability found in the Permanent and Stationary report and uses the California Permanent Disability Rating Schedule (PDRS) to come up with a permanent disability percentage.
The permanent disability percentage is converted into a dollar value.12 The greater the disability, the greater the dollar value.
The insurance company advises the injured worker of the permanent disability value and the payments it will make to the injured worker.
Example: The insurance company receives a Permanent and Stationary report from Mike’s treating doctor. The report states that Mike has a 15% impairment to his low back.
Using the PDRS, the insurance company calculates Mike’s permanent disability at 21%. It sends a letter to Mike saying that based on the Permanent and Stationary report of his doctor, he has 21% permanent disability. It will pay him $23,345 at $290 a week paid every two weeks.
Mike will receive checks biweekly of $580 until the total reaches $23,345.
Future medical care is an important consideration as it is part of the calculation for a Compromise and Release settlement. In a Compromise and Release the injured worker is taking the cash value of his or her future medical care over the medical care itself.
If the injured worker would like to keep his or her ability to receive future medical care or the insurance company is unwilling to buy it out, the parties can agree on a Stipulated Award.
A Stipulated Award is an agreement between the insurance company and the injured worker on the parts of body the worker injured and the amount of permanent disability, but it leaves the option for future medical care.
Example: Sam has permanent disability of 17% for his knee injury. The Permanent and Stationary report states he may require future knee surgery.
Since there is a permanent disability value and future medical finding, the total dollar value of Sam’s case can be estimated.
Sam and the insurance company negotiate a settlement of his claim for $30,000. The insurance company calculated the permanent disability value at $17,545, and Sam and the insurance company agreed that the value of the future knee surgery is approximately $13,000.
If Sam wants to keep the future medical care, he can settle his workers compensation claim with a Stipulated Award at 17% for his knee and be paid $17,545.
It will not always be the treating physician that first finds an injured worker permanent and stationary.
In the med-legal process, either the insurance company or the injured worker can object to any finding of the treating physician and request that an independent doctor evaluates an injured worker’s condition.
Often, the insurance company will believe the injured worker’s condition is permanent and stationary, while the treating physician wants to continue treatment. In that case, the insurance company will object to the treating doctor’s reporting and request a med-legal evaluation.
At the med-legal evaluation, the evaluating doctor, called an Agreed Medical Evaluator (AME) or Qualified Medical Evaluator (QME), will find the injured worker permanent and stationary and provide a permanent disability rating.
This report and rating will very likely bring the case to a conclusion by way of a Stipulated Award or Compromise and Release.
Example: Kayla has been treating with her doctor for over two years for a shoulder and neck injury. Her treating doctor continues to request and provide treatment.
Kayla’s condition does not appear to be improving. In the insurance company’s opinion, Kayla’s condition should be considered permanent and stationary, but her doctor has not given an opinion on this.
The insurance company objects to the treating doctor’s reporting, and Kayla is sent to a QME. The QME finds that Kayla’s condition has stabilized, and she is permanent and stationary. The QME gives Kayla a percentage rating for the disability of her shoulder and neck and lists future medical care.
The insurance company can now try to settle Kayla’s case. The QME report gives the insurance company the information to estimate the case value.
The permanent and stationary date is an important milestone in the workers’ compensation case.
An insurance company will likely want to settle an injured worker’s claim as soon as it receives a Permanent and Stationary report.
However, an injured worker should not rush into a settlement as soon as there is a permanent and stationary finding. He or she has a right to a second opinion through the med-legal process.
There are also times when an insurance company will disagree with the findings in the permanent and stationary report of the treating doctor and will want to try to reduce it through a second opinion med-legal report.
In all of these situations, the value of an injured worker’s case becomes the main issue of negotiation after the permanent and stationary date.
Call us for help…
For help with filing a workers compensation claim in California, completing workers comp forms or appealing a denial of benefits, contact us. Our firm helps police officers, firefighters and other workers to get compensation for their job-related injuries in California.
- Cal. Code Regs., tit. 8 § 10152.
- Bstandig v. Workers’ Comp. Appeals Bd. (1977) 68 Cal. App. 3d 988, 996.
- Cal. Code Regs., tit. 8 § 9785.3.
- Brodie v. Workers’ Comp. Appeals Bd. (2007) 40 Cal. 4th 1313, 1320.
- Cal. Code Regs., tit. 8 § 9785, subd. (h).
- Cal. Lab. Code § 4660.
- Cal. Lab. Code § 4061.
- Cal. Lab. Code § 4658.7(b)(1)(B)(2)
- Cal Lab. Code § 4658.7(b)(1).
- Brodie, at p. 1320.
- Cal. Lab. Code § 4658.