1. 2021 IL App (1st) 201403WC-U
Workers’ Compensation
Commission Division
Order Filed: September 17, 2021
No. 1-20-1403WC
NOTICE: This order was filed under Supreme Court Rule 23 and may not be cited as precedent
by any party except in the limited circumstances allowed under Rule 23(e)(1).
______________________________________________________________________________
IN THE
APPELLATE COURT OF ILLINOIS
FIRST DISTRICT
______________________________________________________________________________
CONIFER CARE CONTINUUM SOLUTIONS, LLC,
Appellant,
v.
THE ILLINOIS WORKERS’ COMPENSATION
COMMISSION et al.,
( , Appellee).
)
)
)
)
)
)
)
)
)
)
)
Appeal from the
Circuit Court of
Cook County
Nos. 2019 L 50523
Honorable
,
Judge, Presiding.
_____________________________________________________________________________
JUSTICE delivered the jud ment of the court.
Presiding Justice and Justices , , and concurred in the
judgment.
ORDER
¶ 1 Held: We affirmed the judgment of the circuit court which confirmed the decision of the
Illinois Workers’ Compensation Commission which found that that the claimant,
, proved that she sustained accidental injuries on July 12, 2016, that
arose out of and in the course of her employment with Conifer Care Continuum
Solutions, LLC. (Conifer) and ordered Conifer to authorize and pay for treatment
recommendations made by the claimant’s physician.
¶ 2 Conifer Care Continuum Solutions, LLC. (Conifer) appeals from the judgment of the

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circuit court which confirmed a decision of the Illinois Workers’ Compensation Commission that:
found 1) that the claimant, , proved by a preponderance of credible evidence tha she
sustained accidental injuries on July 12, 2016, that arose out of and in the course of her
employment with Conifer, and 2) that the claimant’s current condition of Right shoulder ill-being
is causally related to her work injury; and ordered Conifer to authorize and pay for the medical
treatment recommendations of the claimant’s physician. For the reasons which follow, we affirm
the judgment of the circuit court.
¶ 3 The following recitation of the facts relevant to a disposition of this appeal is taken from
the evidence adduced at the arbitration hearing held on November 29, 2017.
¶ 4 Prior to the event giving rise to this action, the claimant suffered an injury to her right
shoulder as the result of a fall in December 2009. The claimant first sought medical treatment for
that injury when she saw Dr. on January 4, 2010. Dr. ordered an MRI of her
right shoulder, which was performed on January 7, 2010. That scan revealed tendinitis of the biceps
tendon. Dr. continued to treat the claimant until November 8, 2010, when she was released
from his care. According to Dr. , the claimant had a normal shoulder exam at the time that
she was released. The claimant testified that, following her release from Dr. ’s care in 2010
until 2016, she had no issues with her right shoulder and sought no medical treatment for the
shoulder.
¶ 5 The claimant testified that, on July 12, 2016, she was employed by Conifer as a third-party
medical billing follow-up representative. When she was on her way to a meeting with her superior,
Lori Fugate, the claimant stopped to use the restroom. The restroom is in an employee-only area
and is only accessible with keycards. The claimant described the restroom as having four stalls.

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According to the claimant, she made use of the third stall, and when she was in a “squatting”
position on the toilet, she reached behind herself to flush the toilet. She stated that, when she
initially pushed the lever, the toilet did not flush, so she pushed harder. It was at this point that she
felt a sharp pain in her right shoulder down to her elbow. Without objection, the claimant
introduced statements from ten of her co-workers attesting to problems with the flushing
mechanism in the third-stall toilet, including requiring greater force to flush the toilet and multiple
attempts to flush. According to the claimant, she was aware of problems with that particular toilet,
but that the third stall was the only available toilet when she entered the restroom on July 12, 2016.
The claimant testified that, after the incident, she went to the meeting with her supervisor,
, and notified her of the accident. It was the claimant’s belief that a report of the accident
was filled out several weeks later by her director, .
¶ 6 Following the incident, the claimant first sought medical treatment for her right shoulder
on July 29, 2016, when she presented to Dr. , complaining of right shoulder pain and
weakness in forward reaching and overhead lifting. Dr. ’s notes of that visit contain a history
of the claimant attempting to flush a toilet at work on July 12, 2016, when she experienced a
ripping sensation in the lateral aspect of her right shoulder. Following his examination of the
claimant’s right shoulder, Dr. noted his suspicion that the claimant sustained a rotator cuff
tear secondary to “*** flushing a malfunctioning toilet with an outstretched posteriorward
reaching arm” and had early symptoms of a frozen shoulder. Dr. administered an injection
into the claimant’s right shoulder, prescribed physical therapy, and ordered an MRI of the
claimant’s right shoulder. The claimant was advised that she could continue working full duty.
¶ 7 An MRI of the claimant’s right shoulder taken on August 3, 2016, revealed distal

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subscapularis tendinopathy, mild posterior supraspinatus bursal surface degeneration/tendinitis, no
retracted rotator cuff tear seen; mild degenerative irregularity anterior-inferior labrum without
labral tear seen; maintained glenohumeral articular surfaces; and mild degeneration osteoarthritis
at the acromioclavicular joint accompanied by a laterally sloping acromion with supraspinatus
abutment.
¶ 8 When the claimant saw Dr. on August 8, 2016, he noted that he had reviewed the
MRI. According to Dr. ’s notes of that visit, he diagnosed the claimant as suffering from
shoulder pain, a traumatic tear of the rotator cuff, and a frozen shoulder. However, when deposed,
Dr. testified that the August 3, 2016 MRI revealed tendinopathy to the insertion of the
tendon with no frank rotator cuff tear. Dr. prescribed pain medication for the claimant and
recommended a course of physical therapy.
¶ 9 On August 10, 2016, the claimant began physical therapy. The therapist’s notes of that visit
states that the location of the claimant’s right shoulder pain was lateral, anterior, and posterior,
which the claimant characterized as constant, dull, throbbing, aching, stabbing, and of moderate
severity, radiating to the elbow. The therapist listed the claimant’s problems as hip pain, lumbar
radiculopathy, low back pain, a frozen shoulder, and a traumatic tear of the rotator cuff. The
claimant continued to undergo physical therapy until the date of the arbitration hearing.
¶ 10 When the claimant next saw Dr. on September 12, 2016, she reported improved
motion but complained of increased pain in her shoulder. Dr. administered an injection to
the claimant’s right shoulder and advised her to continue physical therapy, but he placed no
restrictions on her work duties.
¶ 11 On October 10, 2016, Dr. noted that the claimant’s range of motion continued to

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improve. As of that visit, Dr. found that the claimant’s condition was beginning to plateau.
He recommended that the claimant continue with physical therapy. Dr. placed no
restrictions on the claimant’s work duties.
¶ 12 When the claimant saw Dr. on November 7, 2016, she again reported improved
range of motion. Dr. ’s diagnosis remained unchanged: shoulder pain, traumatic tear of the
rotator cuff, and a frozen shoulder. Dr. testified that he discussed surgical options with the
claimant during that visit, which he suspected would entail a subacromial decompression and
possible rotator cuff repair. The claimant indicated that she wished to proceed with the surgery.
Dr. continued to prescribe pain medication and authorized the claimant to continue full-
duty work.
¶ 13 The claimant saw Dr. on November 15, 2016. Dr. ’s notes of that visit state
that the claimant complained of severe lateral shoulder pain. Dr. administered another
injection to the claimant’s right shoulder and recommended continued physical therapy.
¶ 14 On December 8, 2016, the claimant was examined at Conifer’s request by Dr.
F , an orthopedic surgeon. He testified that the claimant gave a history of having injured
herself at work on July 12, 2016, when she reached behind her back to flush a toilet. During that
visit, an x-ray of the claimant right shoulder was taken which revealed a type I acromion with no
glenohumeral joint space narrowing. Dr. F agreed with the radiologist’s interpretation of
the claimant’s August 3, 2016 MRI as showing: distal subscapularis tendinopathy, mild
supraspinatus bursal surface degeneration/tendinitis, no retracted rotator cuff tear; mild
degenerative irregularity of the anterior-inferior labrum without labral tear seen; maintained
glenohumeral articular surfaces; and mild degeneration osteoarthritis at the AC joint accompanied

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by a laterally sloping acromion with supraspinatus abutment. Dr. F opined that the
claimant’s MRI scan revealed “no traumatic lesions or pathology whatsoever.” On examination,
he found no scapular winging or dyskinesis with range of motion. He believed, however, that,
during his examination of the claimant, she demonstrated inconsistent range of motion indicative
of mild symptom magnification. He testified that the claimant was not credible with localizing
symptoms. He stated that the claimant’s symptom magnification is consistent with his overall
theory, or hypothesis; namely, “that she is symptom magnifying and actually doesn’t have
anything wrong with her shoulder.” According to Dr. F , the claimant’s subjective
complaints were not supported by the objective findings. He stated that her MRI failed to
demonstrate any structural pathology and opined that the mechanism of injury she described was
not of sufficient magnitude to cause any structural pathology. Dr. F found that “[t]here is
no disability associated with the 07/12/2016 work injury.” He reported that, on examination, he
found no clinical evidence that the claimant had a frozen shoulder. Dr. F noted that “[t]here
are no clear preexisting conditions of the claimant’s right shoulder related to the 07/12/2016
injury.” Dr. F was of the opinion that the claimant’s treatment to date was reasonable and
necessary. However, he testified that, in his opinion, the claimant had a resolved right shoulder
strain, that she had reached maximum medical improvement for her right shoulder, that there is no
surgical indication, and that the claimant could continue working without restrictions.
¶ 15 When the claimant was seen by a physician’s assistant at Dr. ’s office on December
9, 2016, she continued to complain of lateral shoulder pain and weakness. She was still working
full duty.
¶ 16 At the time of her January 20, 2017, appointment with Dr. , the claimant again

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complained of lateral shoulder pain and weakness. Dr. noted that the claimant was
significantly symptomatic with lateral shoulder pain and weakness with forward reaching. Dr.
continued to recommend surgery.
¶ 17 When deposed, Dr. testified that he compared the claimant’s August 3, 2016 MRI
with the one taken of her right shoulder on January 6, 2010. He stated that both scans demonstrated
an intact rotator cuff. According to Dr. , the 2010 MRI was essentially normal with the
exception of bicipital tendinitis, but there is an interval change relative to the tendinopathy present
in the 2016 scan. He admitted, however, that it was possible that the changes were due to normal
degenerative process. Dr. was asked his opinion as to the cause of the claimant’s right
shoulder condition and he testified as follows:
“Albeit an uncommon mechanism, what was described to me by the patient was that she
was essentially reaching behind her in an awkward position pushing down on the lever of
– of a malfunctioning toilet. You know, so there’s a tremendous amount of lever force that
the patient was generating specifically because of the posterior reach and the – and the
length of the lever arm, so to speak. And then at that time, she experienced sudden onset
lateral shoulder pain, which would be consistent to pathology to the rotator cuff. Based on
that – and also upon the fact that I had previously seen and treated the patient for a right
shoulder issue that previously resolved, it’s my opinion that the right shoulder pathology
is causally connected to that event.”
Dr. testified that he continued to recommend surgery.
¶ 18 The claimant testified that she is still able to work and had not missed work as the result of
her injury. She stated that she wished to have the recommended surgery, but she had not yet

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received approval from the workers’ compensation carrier. According to the claimant, her medical
bills had been paid “up to a certain point” but some had not been paid.
¶ 19 Following an arbitration hearing held on November 29, 2017, the arbitrator issued a written
decision on February 25, 2018, finding that the claimant failed to prove that she sustained an
accidental injury that arose out of her employment on July 12, 2016, and denied her benefits under
the Workers’ Compensation Act (Act) (820 ILCS 305/1 et seq. (West 2014)). Specifically, the
arbitrator found that the claimant was not credible and found the opinions of Conifer’s expert
witness, Dr. F , to be more persuasive than the opinions of Dr. , the claimant’s treating
physician.
¶ 20 The claimant filed a petition for review of the arbitrator’s decision before the Commission.
On August 8, 2019, the Commission, with one commissioner dissenting, issued a written decision
reversing the decision of the arbitrator. The Commission’s majority found that the claimant proved
by a preponderance of the credible evidence that she sustained accidental injuries on July 12, 2016,
which arose out of and in the course of her employment with Conifer and that her current condition
of right shoulder ill-being is causally related to her work accident. In so finding, the Commission’s
majority found the opinions of Dr. , the claimant’s treating physician, to be more persuasive
than the opinions of Dr. F , Conifer’s expert witness. The Commission’s majority ordered
Conifer to authorize and pay for the current treatment recommendations of Dr. , including
diagnostic arthroscopic surgery. The mater was remanded to the arbitrator for further proceedings.
The dissenting commissioner found both that the claimant’s accident did not arise out of her
employment and that she failed to prove a causal connection between her condition of right
shoulder ill-being and her accident of July 12, 2016.

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¶ 21 Conifer sought a judicial review of the Commission’s decision in the circuit court of Cook
County. On December 9, 2020, the circuit court confirmed the Commission’s decision, and this
appeal followed.
¶ 22 For its first argument in support of reversal, Conifer states in its brief that “The Circuit
Court’s confirmation of the IWCC’s [Illinois Workers’ Compensation Commission’s] decision
regarding accident is against the manifest weight of the evidence and should be reversed.”
However, on appeal from a judgment of the circuit court either affirming or reversing a decision
of the Commission, although our judgment is addressed to the order of the circuit court, it is the
decision of the Commission which we review, not the circuit court. Travelers Insurance v.
Precision Cabinets, Inc., 2012 IL App (2d) 110258WC, ¶ 33. The issue is not, as Conifer states,
whether the judgment of the circuit court is against the manifest weight of the evidence; rather, the
issue is whether the Commission’s decision is against the manifest weight of the evidence. We
will, therefore, address the issue of whether the Commission’s findings as to accident are against
the manifest weight of the evidence.
¶ 23 Conifer argues that the claimant’s testimony that she suffered an injury on July 12, 2016,
“is simply not credible.” According to Conifer, “her history of the alleged injury is implausible.”
In support of the argument Conifer notes that there were no witnesses to the accident, and the
claimant waited 2 1/2 weeks before seeking medical treatment. It also relies upon the opinions of
Dr. F that the claimant is not credible.
¶ 24 To obtain compensation under the Act, the claimant must establish by a preponderance of
the evidence that she suffered a disabling injury that arose out of and in the course of her
employment. Land & Lakes Co. v. Industrial Comm’n, 359 Ill. App. 3d 582, 591-92 (2005).

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However, before there can be consideration of whether an accidental injury arose out of
employment, the claimant must prove that she suffered an accidental injury. Elliott v. Industrial
Comm’n, 303 Ill. App. 3d 185, 188 (1999). The issue is one of fact to be resolved by the
Commission. Id. at 189.
¶ 25 In this case, the claimant testified that she was injured when she attempted to flush the
toilet she was using in the employee restroom on Conifer’s premises. It is the function of the
Commission to assess the credibility of the witnesses and assign weight to their testimony. ABBF
Freight System v. Illinois Workers’ Compensation Commission, 2015 IL App (1st) 141306WC, ¶
19. By awarding the claimant benefits under the Act, the Commission implicitly found her
testimony that she sustained an accidental injury on July 12, 2016, to be credible.
¶ 26 The Commission’s determination on a question of fact will not be disturbed on review
unless it is against the manifest weight of the evidence. Orsini v. Industrial Comm’n, 117 Ill. 2d
38, 44 (1987). For a finding of fact to be contrary to the manifest weight of the evidence, an
opposite conclusion must be clearly apparent. Caterpillar, Inc. v. Industrial Comm’n, 228 Ill. App.
3d 288, 291 (1992). Put another way, the Commission’s determination on a question of fact is
against the manifest weight of the evidence when no rational trier of fact could have agreed. Dolce
v. Industrial Comm’n, 286 Ill. App. 3d 117, 120 (1996). A claimant’s testimony standing alone
may be sufficient to support an award of benefits under the Act where all of the facts and
circumstances do not preponderate in favor of the opposite conclusion. Seiber v. Industrial
Comm’n, 82 Ill. 2d 87, 97 (1980).
¶ 27 As stated earlier, the Commission implicitly found the claimant’s testimony that she
suffered an injury on July 12, 2016, to be credible. Although the arbitrator concluded that her

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testimony was not credible, it is the Commission that exercises original jurisdiction, and it is not
bound by the arbitrator’s findings. Panganelis v. Industrial Comm’n, 132 Ill. 2d 468, 483 (1989).
Although the claimant delayed seeking medical treatment for 2 1/2 weeks and Dr. ’s notes
state that the claimant reported having experienced a ripping sensation in her right shoulder when
she attempted to flush the toilet, the claimant provided consistent histories as to the mechanics of
her injury to both Dr. and Dr F and 10 of her coworkers gave statements attesting
to the defective nature of the subject toilet’s flushing mechanism. We cannot say that the
Commission’s credibility determination or its factual finding that an accident occurred were
against the manifest weight of the evidence. See Shafer v. Illinois Workers’ Compensation
Comm’n, 2011 IL App (4th) 100505WC, ¶¶ 35-36.
¶ 28 Conifer argues, in the alternative, that the claimant failed to prove that her injuries arose
out of her employment. According to Conifer, the act of flushing a toilet is a normal daily life
activity and, as such, a neutral non-compensable risk. We disagree.
¶ 29 To obtain compensation under the Act, the claimant must establish by a preponderance of
the evidence that she suffered a disabling injury that arose out of and in the course of her
employment. 820 ILCS 305/1(d) (West 2014); McAllister v. Illinois Workers’ Compensation
Comm’n, 2020 IL 124848, ¶ 32; Land & Lakes Co. v. Industrial Comm’n, 359 Ill. App. 3d 582,
591-92 (2005). Both elements must be present at the time of the claimant’s injury in order to justify
compensation. McAllister, 2020 IL 124848, ¶ 32; Illinois Bell Telephone Co. v. Industrial Comm’n,
131 Ill. 2d 478, 483 (1989).
¶ 30 In the course of the employment refers to the time, place, and circumstances under which
the claimant is injured. Scheffler Greenhouses, Inc. v. Industrial Comm’n, 66 Ill. 2d 361, 366

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(1977). Injuries sustained on an employer’s premises and while a claimant is at work are generally
deemed to have been received in the course of the employment. Caterpillar Tractor Co. v.
Industrial Comm’n, 129 Ill. 2d 52, 57 (1989); Wise v. Industrial Comm’n, 54 Ill. 2d 138, 142
(1973). The personal comfort doctrine provides that an employee who, within the time and space
limits of her employment, engages in acts that minister to her personal comfort does not leave the
course of the employment unless the method chosen is so unsound or unreasonable that the conduct
cannot be considered incident to her employment. Circuit City Stores, Inc. v. Illinois Workers’
Compensation Comm’n, 391 Ill. App. 3d 913, 920-21 (2009).
¶ 31 In this case, there is no question that, at the time of her accident on July 12, 2016, the
claimant was in the course of her employment. She was both on Conifer’s premises and working,
and the act of going to the restroom while working is a personal comfort that did not remove the
claimant from the course of her employment. However, even in cases where the personal comfort
doctrine applies, the claimant still has the burden of establishing that her injury arose out of the
employment. Id.
¶ 32 “Arising out of the employment” refers to the origin or cause of the claimant’s injury. For
an injury to arise out of the employment, its origin must be in some risk connected with, or
incidental to, the employment so as to create a causal connection between the employment and the
accidental injury. Typically, an injury arises out of one’s employment if, at the time of the
occurrence, the employee was performing acts she was instructed to perform by her employer, acts
which she had a common law or statutory duty to perform, or acts which the employee might
reasonably be expected to perform incident to her assigned duties. McAllister, 2020 IL 124848, ¶
36; Caterpillar, 129 Ill. 2d at 58.

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¶ 33 No citation is necessary to support our conclusion that the act of using the toilet in an
employee restroom on the employer’s premises is neither an act which the employee is instructed
to perform by her employer nor an act which she had a common law or statutory duty to perform.
The issue is whether the claimant’s use of the defective toilet in Conifer’s employee restroom was
an act which she could reasonably have been expected to perform incident to her employment.
¶ 34 In determining whether a claimant’s injury arose out of her employment, the risk to which
she was exposed must first be categorized. McAllister, 2020 IL 124848, ¶ 36; First Financial
Services v. Industrial Comm’n, 367 Ill. App. 3d 102, 105 (2006). Risks fall into three categories;
namely, (1) risks distinctly associated with the employment, (2) risks personal to the employee,
and (3) neutral risks. McAllister, 2020 IL 124848, ¶ 38.
¶ 35 Employment risks are those that are inherent in one’s employment. They include obvious
industrial conditions that result in injuries or occupational diseases. McAllister, 2020 IL 124848,
¶ 40. They also include injury causing defects on an employer’s premises. Id.; First Financial
Services, 367 Ill. App. 3d at 106. Injuries resulting from employment risks are deemed to arise out
of one’s employment and are compensable under the Act. McAllister, 2020 IL 124848, ¶ 40.
¶ 36 Personal risks include nonoccupational diseases, personal defects or weakness, and
confrontations with personal enemies. Illinois Consolidated Telephone Co. v. Industrial Comm’n,
314 Ill. App. 3d 347, 352 (2000) (Rakowski, J., specially concurring); Illinois Institute of
Technology Research Institute v. Industrial Comm’n, 314 Ill. App. 3d 149, 162-63 (2000).
Included in this category would be injuries sustained by falling due to a bad knee or an episode of
dizziness. Illinois Institute of Technology Research Institute, 314 Ill. App. 3d at162-63. Although
injuries sustained by reason of a personal risk are generally not compensable under the Act, they

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may be compensable in circumstances where conditions of the employment increase the risk of
harm. Illinois Institute of Technology Research Institute, 314 Ill. App. 3d at163, n.1.
¶ 37 Neutral risks have no particular employment or personal characteristics. Illinois
Consolidated Telephone Co., 314 Ill. App. 3d at 353 (Rakowski, J., specially concurring). Injuries
from a neutral risk generally do not arise out of one’s employment and are only compensable under
the Act in circumstances where the employment exposes one to an increased risk of harm.
Metropolitan Water Reclamation District of Greater Chicago v. Illinois Workers’ Compensation
Comm’n, 407 Ill. App. 3d 1010, 1014 (2011). The increased risk of harm may be qualitative, such
as some aspect of the employment that contributes to the risk, or quantitative, as in cases where an
employee is exposed to the common risk more frequently than the members of the general public.
McAllister, 2020 IL 124848, ¶ 44; Metropolitan Water Reclamation District of Greater Chicago,
407 Ill. App. 3d at 1014.
¶ 38 In this case, the Commission found that the claimant’s injuries arose out of her the
employment with Conifer. Conifer asserts that “[t]he act of flushing a toilet is a normal daily life
activity and, therefore, a neutral risk.” We agree. We do not agree, however, that the act of flushing
a malfunctioning toilet is a normal daily activity. Although the Commission employed a neutral
risk analysis in concluding that the claimant’s injuries arose out of her employment with Conifer,
finding that she was exposed to the risk of injury from the malfunctioning toilet to a greater degree
than members of the general public, it also found that, “to a certain extent, the malfunctioning
toilet represented an employment risk.”
¶ 39 We will affirm a decision of the Commission if there is any basis in the record to do so,
regardless of whether the Commission’s reasoning is correct or sound. Freeman United Coal Co.

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v. Industrial Comm’n, 283 Ill. App. 3d 785, 793 (1996). In this case, we find the Commission’s
neutral risk analysis rather dubious, but we find more than sufficient support in the record for its
conclusion that the malfunctioning toilet to which the claimant was exposed represented an
employment risk.
¶ 40 The claimant testified that, when she pushed hard on the toilet’s leaver after it initially
failed to flush, she felt a sharp pain in her right shoulder, running down to her elbow. The claimant
introduced statements from 10 of her co-employees attesting to the defective nature of the flushing
mechanism of the subject toilet, including requiring greater force to flush the toilet. The claimant
testified that she was aware of the toilet’s defective flushing mechanism prior to the event giving
rise to the instant claim. Further, it is undisputed that the subject toilet was located in an employee
restroom on Conifer’s premises. If, as the evidence supports, the subject toilet had a
malfunctioning flushing mechanism and the toilet was located in an employee restroom on
Conifer’s premises, then the risk of injury presented by the malfunctioning toilet was an
employment risk. As noted earlier, injuries suffered as the result of a defect on the employer’s
premises are classified as employment risks, and injuries resulting from employment risks are
deemed to arise out of the employment.
¶ 41 Whether an employee’s injuries arose out of and in the course of her employment is a
question of fact to be determined by the Commission. Brais v. Illinois Workers’ Compensation
Comm’n, 2014 IL App (3rd) 120820, ¶ 19. In resolving questions of fact, it is the function of the
Commission to judge the credibility of witnesses and resolve conflicting evidence. O’Dette v.
Industrial Comm’n, 79 Ill. 2d 249, 253 (1980). The Commission’s resolution of a question of fact
will not be disturbed on review unless it is against the manifest weight of the evidence. Orsini, 117

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Ill. 2d at 44. The foregoing analysis leads us to conclude that the Commission’s finding that the
claimant’s injuries arose out of and in the course of her employment is not against the manifest
weight of the evidence, as an opposite conclusion is not clearly apparent.
¶ 42 Next, Conifer argues, “[a]ssuming arguendo” that the claimant proved that she sustained a
compensable work accident, “she failed to prove causation between her condition of ill-being, if
any, and the incident in question.” Conifer appears to support the argument with the opinions of
Dr. F that the claimant was engaged in symptom magnification and that there is nothing
wrong with her shoulder. The flaw in the argument is Conifer’s failure to recognize that the
Commission found the opinions of Dr. , the claimant’s treating physician, to be more
persuasive than the opinions of Dr. F .
¶ 43 Contrary to Dr. F ’s causation opinions, Dr. testified that the claimant’s
condition of right shoulder ill-being is causally connection to her work accident when she reached
behind herself in an awkward position and pushed down on the lever of a malfunctioning toilet. In
deciding the factual issue of causation, it was the function of the Commission to judge the
credibility of witnesses and resolve conflicting medical evidence. O’Dette v. Industrial Comm’n,
79 Ill. 2d 249, 253 (1980). The Commission found Dr. ’s causation opinion to be more
persuasive than Dr. F ’s contrary opinion, and we are unable to find that its determination
in that regard is against the manifest weight of the evidence. Whether this court might have reached
the same conclusion is not the test of whether the Commission’s determination is supported by the
manifest weight of the evidence. Rather, the appropriate test is whether there is sufficient evidence
in the record to support the Commission’s determination. Benson v. Industrial Comm’n, 91 Ill. 2d
445, 450 (1982). In this case, we believe that there is.

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¶ 44 As a final issue, Conifer argues “[a]lternatively, if this Court finds the opinions of the [sic.]
Dr. ’s more credible than those of Dr. F , *** [the claimant’s] condition was pre-
existing and degenerative in nature and could have been aggravated by any daily life activity.”
According to Conifer, “using a restroom is a normal daily activity and if an act as simple as this
resulted in a shoulder injury, the injured worker failed to prove causation.” We find no merit in
the argument.
¶ 45 First, this is not simply a case of using a restroom. This case involves an injury that was
sustained while attempting to flush a defective toilet. Second, whether a claimant’s disability is
attributable solely to a degenerative process of a preexisting condition is a factual question to be
resolved by the Commission. Sisbro v. Industrial Comm’n, 207 Ill. 2d 193, 205-06 (2003).
Although the claimant sustained a right shoulder injury in 2009, she testified that she had no
problems with the shoulder from the time of her release from care in November 2010 until her
work-related accident on July 12, 2016. According to Dr. , the claimant had a normal
shoulder exam when he released her from care in November 2010. He also testified that he
compared the claimant’s August 3, 2016 MRI with the one taken of her right shoulder on January
6, 2010, and although both scans demonstrated an intact rotator cuff, the 2010 MRI was essentially
normal with the exception of bicipital tendinitis; whereas, the 2016 scan shows an interval change
relative to the tendinopathy present. Dr. admitted that it was possible that the changes were
due to normal degenerative process but nevertheless opined that the claimant’s condition of right
shoulder ill-being is causally related to her work accident.
¶ 46 A work-related injury need not be the sole or principal causative factor, as long as it was a
causative factor in the resulting condition of ill-being. Sisbro, 207 Ill. 2d at 205. In this case, Dr.

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opined that it was, and we are unable to find that an opposite conclusion is clearly apparent.
¶ 47 For the reasons stated, we affirm the judgment of the circuit court that confirmed the
Commission’s decision.
¶ 48 Affirmed.