Strong Law - 2024 ITLA Workers' Compensation Seminar.pptx

ITLA WORKERS’
COMPENSATION
SEMINAR 2024
PROVING
CAUSATION
PRESENTED BY
TODD A. STRONG

• “Workers’ compensation laws balance
competing interests: employees give
up their right to sue in civil court and
potentially win large awards in
exchange for more modest but
prompt compensation;”
• “When an injury is sustained at work,
the injury may be compensable
according to the Act.”
• “The Illinois Workers’ Compensation
Commission resolves claims made by
injured workers for injuries arising
out of and in the course of
employment.”
PROVING CAUSATION:
IWCC 2023 ANNUAL
REPORT AND
MISSION DIRECTIVES

Proving Causation:
Illinois Workers’
Compensation
Commission website
description
•About
•Workers’ compensation is a no-fault system of
benefits paid by employers to workers who
experienced work-related injuries or diseases.

Proving
Causation:
Illinois
Workers’
Compensation
Commission
Handbook
Description
Section 1: Overview
4. What injuries and diseases
are covered
under the law?
The Workers’ Compensation Act
provides that accidents that arise
out of and in the course of
employment are eligible to
receive workers’ compensation
benefits. This generally means
that the Act covers injuries that
results in whole or in part from
the employee’s work.
* * *
Section 4: Resolving a Dispute
at the Commission
5. What are the most
commonly disputed issues
in cases filed at the
Commission?
d) Causal connection: the
medical condition was caused or
aggravated by the alleged
accident or exposure.

PROVING CAUSATION:
ILLINOIS WORKERS’
COMPENSATION
COMMISISON
MANDATED WORKPLACE
NOTICES TO EMPLOYEES

Proving Causation:
Illinois Workers’
Compensation
Commission Forms –
Request for Hearing
Alternative language suggestion:
Petitioner claims his or her accidental
injury was a causative factor to his or
her current condition.

Proving
Causation:
Illinois Workers’
Compensation
Commission
Forms – Petition
for Review of
Arbitration
Decision

PROVING CAUSATION:
STATUTORY PERSPECTIVE
Illinois Workers’ Compensation Act
820 ILCS 305 et seq
The number of times variations of “cause” appears in the Illinois Workers’ Compensation Act:
Cause 26
Caused 8
Causes 4
Causing 1
Causally 1
Causation 0
Causative 0

ILLINOIS WORKERS’ COMPENSATION
ACT
820 ILCS 305 et seq.
Section 1(d) (d) To obtain compensation under this Act, an
employee bears the burden of showing, by a
preponderance of the evidence, that he or she
has sustained accidental injuries arising out of
and in the course of the employment.
AMENDED 08/08/2011
Section 2 . . . accidental injuries sustained by himself or any
employee, arising out of and in the course of the
employment according to the provisions of this
Act . . . . The State of Illinois hereby elects to
provide and pay compensation according to the

PROVING CAUSATION:
USE OF THE RULES
GOVERNING
PRACTICE
PERSPECTIVE
*THESE PROVIDE
PROCEDURAL GUIDANCE TO
PROVING CAUSATION BUT NO
SUBSTANTIVE GUIDANCE

PROVING CAUSATION: ADMINISTRATIVE LAW
PERSPECTIVE – ILLINOIS DEPARTMENT OF LABOR
West’s Illinois Administrative Code, Title 56. Labor and Employment
Chapter I. Department of Labor
Subchapter B. Regulation of Working Conditions
Part 350. Health and Safety (Refs & Annos)
Subpart B. Injury/Illness Recordkeeping and Reporting Requirements
56 Ill. Adm. Code 350.270
350.270 Determination of Work-Relatedness
a) Basic Requirement
An injury or illness is work-related if an event or exposure in the work environment either caused or
contributed to the resulting condition or significantly aggravated a pre-existing injury or illness.
Work-relatedness is presumed for injuries and illnesses resulting from events or exposures
Occurring in the work environment, unless an exception in subsection (b)(2) specifically applies.
b) Implementation
1) Work Environment
The work environment is defined as the establishment and other locations where one or more employees
are working or are present as a condition of their employment. The work environment includes not only physical
locations, but also the equipment or materials used by the employee during the course of work.

Section 2005.30 The Minimum Definition of Pre-existing Illness
or Pre-existing Condition
a) A “pre-existing illness” or “pre-existing condition” as constructed by the definition of sickness and the provisions for Time
Limit on Certain
Defenses in an accident and health insurance policy issued after the effective date of this Part shall mean any disease, illness,
sickness,
Malady or condition which was:
1) diagnosed or treated by a legally qualified physician prior to the effective date of coverage for the insured with consultation,
advice or treatment by a legally qualified physician occurring within 24 months prior to the effective date of coverage for the
insured; or
2) diagnosed or treated by a legally qualified physician prior to the effective date of coverage for the insured, but a legally
qualified physician demonstrates that there is a reasonable medical question that the disease, illness, sickness, malady or
condition involved did continue within 24 months prior to the effective date of coverage for the insured without the necessity
of consultation, advice or treatment by a legally qualified physician; or
3) evident because there was a clear, distinct symptom or symptoms of the disease, illness, sickness, malady or condition
demonstrable prior to the effective date of coverage for the insured with the occurrence of such symptoms being evidence
within 12 months prior to the effective date of coverage for the insured and in which, the opinion of a legally qualified
physician, would;
A) indicate that the diseases, illness, sickness, malady or condition probably began and manifested itself before the effective
date of coverage for the insured, and
Illinois Administrative Code / Title 50: Insurance / Chapter I: Department of Insurance /
Subchapter z: Accident and Health Insurance / Part 2005 Pre-Existing Illness
PROVING CAUSATION: ADMINISTRATIVE LAW
PERSPECTIVE – ILLINOIS DEPARTMENT OF INSURANCE

PROVING
CAUSATION:
COMMON
LAW
PERSPECTIV
E
Public Policy Consideration
Burden of Proof: “A
Causative Factor”
Repetitive Trauma Injuries
Pre-existing Condition
Present
Subsequent Injury

PROVING CAUSATION:
PUBLIC POLICY CONSIDERATION – ILLINOIS WORKERS’
COMPENSATION COMMISSION DUTY
I. BASIC ASPECTS OF THE WORKERS’
COMPENSATION ACT
A. [1.1] Introduction
“An injury arises out of the employment if, at the time of the occurrence, the
employee is performing acts the employee was instructed to perform by the
employer, acts the employee has a common-law pr statutory duty to perform, or
acts the employee
might reasonably be expected to perform incident to assigned duties.”
-Caterpillar Tractor Co. v. Industrial Commission, 129 Ill.2d 52, 541 N.E.2d 665, 133
Ill.Dec. 454 (1989)
“The requirement that the injury occur in the course of employment is
concerned with the time, place, and circumstances of the injury.” Paganelis v.
Industrial Commission
132 Ill.2d 468, 548 N.E.2d 1033, 139 Ill.Dec. 477 (1989)

PROVING CAUSATION:
PUBLIC POLICY CONSIDERATION –
ILLINOIS WORKERS’ COMPENSATION
COMMISSION DUTY
BASIC ASPECTS OF THE WORKERS’ COMPENSATION ACT
B. [1.2] Primary Purposes of the Workers’
Compensation Act
“In Shell Oil Co. v. Industrial Commission, 2 Ill.2d 590,
119 N.E.2d 224, 228 (1954), the Supreme Court stated
that “the burdens of caring for the casualties of
industry should be borne by industry and not by the
individuals whose misfortunes arise out of the
industry, nor by the public”
“In Sharp v. Gallagher, 95 Ill.2d 322, 447 N.E.2d 786, 69
Ill.Dec. 351 (1983) . . . The Compensation Act is the
exclusive remedy against an employer or its insurer
for a work-related injury.” Sharp, supra, 447 N.E.2d at
787.
“In General American Life Insurance Co. v. Industrial
Commission, 97 Ill.2d 359, 454 N.E.2d 643, 648, 73
Ill.Dec. 546 (1983) . . . The Compensation Act replaces
common-law rights and defense; it is liberally
construed but not given a strained construction that
it is not fairly within its provision.”
“The Act provides remedies and protection for employees,
thereby promoting the general welfare of the State. Hence, it
was enacted in furtherance of sound public policy. (Kelsay,
[supra, 384 N.E.2d at 357].) The overriding purpose of the Act is
to protect injured employees and their dependents, by
Providing a prompt, sure remedy for injuries and by insuring
The availability of medical treatment, by shifting the financial
burden of such treatment to the employer. (Hinthorn v. Roland’s
of Bloomington, Inc. (1988), 119 Ill.2d 526, 534, 116 Ill.Dec. 694,
519 N.E.2d 909; McGee v. Ractian Construction
Co. (1992), 231 Ill.App.3d 929, 936, 173 Ill.Dec. 382, 596
N.E.2d 1261).
“. . . Neither an employer nor an insurance company can
interfere
with an employee’s exercise of rights under the Compensation
Act
or discriminate against, threaten to discharge, or refuse to
rehire
An employee because of the exercise of these rights.” 820 ILCS
305/4(h).

 “With respect to factual matters, it is within the province of the Commission to judge the credibility of the
witness, resolve conflicts in the evidence, assign the weight to be accorded the evidence, and draw reasonable
inferences therefrom.” Hosteny v. Illinois Workes’ Compensation Comm’n., 397 Ill.App.3d 665, 675 (2009).
 “The Industrial Commission is the ultimate decisionmaker in workers’ compensation cases * * *.” Durand v.
Industrial Comm’n, 224 Ill.2d 53, 63, 308 Ill.Dec. 715, 862 N.E.2d 918 (2006).
 “The Commission’s factual findings are against the manifest weight of the evidence only when an opposite
conclusion is clearly apparent – that is, when no rational trier of fact could have agreed with the agency.”
Beelman Trucking v. Illinois Workers’ Compensation Comm’n, 233 Ill.2d 364, 370, 330 Ill.Dec. 796, 909 N.E.2d 818 (2009).
 “As respondent observes, employers take their employees as they find them.” Baggett v. Industrial Comm’n, 201
Ill.2d 187, 199, 266 Ill.Dec. 836, 775 N.E.2d 908 (2002).
 “In resolving factual matters, it is the function of the Commission to access the credibility of the witnesses, resolve
conflicts in the evidence, assign weight to be accorded the evidence, and draw reasonable inferences therefrom.”
Hosteny v. Illinois Workers’ Compensation Comm’n, 397 Ill.App.3d 665, 674, 340 Ill.Dec. 475, 928 N.E.2d 474 (2009).
 “This is especially true with respect to medical issues, where we owe heightened deference to the Commission due
to the expertise it has long been recognized to possess in the medical arena.” Long v. Industrial Comm’n, 76 Ill.2d
561, 566, 31 Ill.Dec. 815, 394 N.E.2d 1192 (1979).
PROVING CAUSATION:
ILLINOIS WORKERS’ COMPENSATION COMMISSION DUTY

“When a primary injury is
shown to have arisen out
of and in the course of
employment, as required
for a claimant to be
entitled to workers’
compensation for the
injury, every natural
consequence that flows
from the injury likewise
arises out of the
employment.” Compass
Group
“It is the
Commission’s duty to
resolve conflicts in
the evidence,
particularly medical
opinion evidence.”
Navistar, 331
Ill.App.3d at 415, 264
Ill.Dec. 631, 771 N.E.2d
36.
PROVING CAUSATION:
ILLINOIS WORKERS’ COMPENSATION COMMISSION DUTY

PROVING CAUSATION: BURDEN OF PROOF – “A CAUSATIVE FACTOR”
 “The employee bears the burden of proving by a preponderance of the evidence that his or her injury arose out of
and occurred in the course of the employment.” Baldwin v. Illinois Workers’ Compensation Comm’n, 409 Ill.App.3d
472, 477 (2011).
 “An injury is said to “arise out of” one’s employment if its origin is in some risk connected with or incidental to the
employment so that there is a causal connection between the employment and the accidental injury.” McAllister,
2020 IL 124848; Caterpillar Tractor Co. v. Industrial Comm’n, 129 Ill.2d 52, 58 (1989).
 “To determine whether a claimant’s injury arose out of his or her employment, we must first categorize the risk to
which the employee was exposed.” McAllister, 2020 IL 124848; First Cash Financial Services, 367 Ill.App.3d at 105.
 “Illinois courts recognize three categories of risks: (1) risks distinctly associated with the employment; (2) risks
personal to the employee; and (3) neutral risks. McAllister, 2020 IL 124848; Baldwin, 409 Ill.App.3d at 478; First Cash
Financial Services, 367 Ill.App.3d at 105.
 “A risk is associated with one’s employment if, at the time of the occurrence, the employee was performing (1) acts
that he or she was instructed to perform by the employer, (2) acts that he or she had a common-law or statutory
duty to perform, or (3) acts that the employee might reasonably bee expected to perform incident to his or her
assigned duties. McAllister, 2020 IL 124848; Caterpillar Tractor Co., 129 Ill.2d at 58.
 “A risk is incidental to the employment when it belongs to or is connected with what the employee has to do in
fulfilling his or her job duties. McAllister, 2020 IL 124848.

 “Personal risks include nonoccupational diseases, personal defects or weakness, and confrontations with personal
enemies.” Illinois Consolidated Telephone Co., 314 Ill.App.3d at 352; Illinois Institute of Technology Research Institute, 314
Ill.App.3d at 162.
 “Although generally noncompensable, personal risks may be compensable where conditions of the employment
increase the risk of injury. Illinois Institute of Technology Research Institute, 314 Ill.App.3d at 163.
 To satisfy the “arising out of” requirement, it must be shown that the injury has its origin in some risk connected with,
or incidental to the employment so as to create a causal connection between the employment and the accidental
injury. There are three categories of risk for an employee: 1) risks distinctly associated with the employment – these
are obvious kinds of injuries such as tripping, slipping, at a construction site, lifting heavy material, etc. These types of
injures are compensable; 2) Risks personal to the employee – these are risks that include personal infirmities or illness
and are generally not compensable. An exception to this rue exists when the work place conditions significantly
contribute to the injury or expose the employee to added or increased risk of injury; 3) Neutral risks – which have no
particular employment or personal characteristics. McAllister.
 The court held that common bodily movements and everyday activities are compensable and employment related if
the common bodily movement resulting in an injury had its original in some risks connected with, or incident to,
employment so as to create a causal connection between the employment and the accidental injury. McCallister.
 According to the Act, in order for a claimant to be entitled to workers’ compensation benefits, the injury must “aris[e]
out of” and occur “in the course of” the claimant’s employment. 820 ILCS 305/1(d).

 “The ‘arising out of’ component is primarily concerned with causal connection. To satisfy this requirement it must
be shown that the injury had its origin in some risk connected with, or incidental to, the employment so as to
create a causal connection between the employment and the accidental injury.” Sisbro, 207 Ill.2d at 203, 797
N.E.2d 665; Caterpillar v. Ind. Comm’n, 129 Ill.2d 5, 440 N.E.2d 861.
 “An injury ‘arises out of’ one’s employment if it originates from a risk connected with, or incident to, the
employment involving a causal connection between the employment and the accidental injury. A risk is incidental
to the employment when it belongs to or is connected with what the employee has to do in fulfilling his or her job
duties.” Orsini, 117 Ill.2d at 45, 509 N.E.2d 1005.
 “Every natural consequence that flows from an injury that arose out of and in the course of one’s employment is
compensable under the Act absent the occurrence of an independent intervening accident that breaks the chain
of causation between the work-related injury and an ensuing disability or injury.” Dunteman v. Illinois Workers’
Compensation Comm’n, 2016 IL App (4th
) 150543WC.
 “To obtain compensation under the Act, an employee must establish by a preponderance of the evidence a causal
connection between a work-related injury and the employee’s condition of ill-being.” Vogel, 354 Ill.App.3d at 786,
821 N.E.2d 807.
 “Every natural consequence that flows from a work-related injury is compensable under the Act unless the chain
of causation is broken by an independent intervening accident.” National Freight Industries, 2013 IL App (5th
)
120043WC, 993 N.E.2d 473.
 “Under an independent intervening cause analysis, compensability for an ultimate injury or disability is based upon
a finding that the employee’s condition was caused by an event that would not have occurred “but for” the original
injury.” International Harvester Co., 46 Ill.2d at 245, 263 N.E.2d 49.

• “Whether a causal connection exists between an employee’s condition of ill-being and a particular work-related
accident presents a question of fact.” Vogel, 354 Ill.App.3d at 786, 821 N.E.2d 807.
• “A reviewing court may not substitute its judgment for that of the Commission on factual matters merely
because other inferences from the evidence may be reasonably drawn.” Berry v. Industrial Comm’n, 99 Ill.2d
401, 407, 459 N.E.2d 963 (1984).
• “We review the Commission’s factual determinations under the manifest-weight-of-the-evidence standard.” Orsini
v. Industrial Comm’n, 117 Ill.2d 38, 44, 509 N.E.2d 1006 (1987).
• “To obtain compensation under the Workers’ Compensation Act (820 ILCS 305/2), a claimant must show by a
preponderance of the evidence that he or she has suffered a disabling injury arising out of and in the course of
his or her employment.” Sisbro, Inc. v. Industrial Comm’n, 207 Ill.2d 193, 203, 797 N.E.2d 665 (2003).
• “The ‘arising out of’ component addresses the causal connection between a work-related injury and the claimant’s
condition of ill-being.” Sisbro, 207 Ill.2d at 203, 797 N.E.2d 665.
• “A claimant need prove only that some act or phase of his or her employment was a causative factor in the
ensuing injury.” Twice Over Clean, Inc. v. Industrial Comm’n, 348 Ill.App.3d 638, 643, 809 N.E.2d 778 (2004).

 “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, 797 N.E.2d 665.
 “A claimant is entitled to receipt of workers’ compensation benefits once a sufficient causal connection between the
injury and the employment has been established, irrespective of whether his condition of ill-being could have been
caused by normal daily activities; whether any normal daily activity is an overexertion or whether the activity
engaged in presented risks no greater than those to which the general public is exposed are matters to be
considered when deciding whether a sufficient causal connection between the injury and the employment has
been established in the first instance.” Sisbro v. Industrial Comm’n, 207 Ill.2d 193, 797 N.E.2d 665 (2003).
 “That is to say, for an injury to be compensable, it generally must occur within the time and space boundaries of
the employment.” 1 A. Larson, Workers’ Compensation Law, Sec. 12.01 (2002)

 “An injury occurs ‘in the course’ of employment when it occurs during employment at a place where the employee
may reasonably perform employment, at a place where the employee may reasonably perform employment
duties, and while a worker fulfills those duties or engages in some incidental employment duties.” Baggett v.
Industrial Comm’n, 201 Ill.2d 187, 194, 775 N.E.2d 908 (2002).
 “The Supreme Court restated its long-standing position in holding: For an injury to have arisen out of the
employment, the risk of injury must be a risk peculiar to the work or a risk to which the employee is exposed to
a greater degree than the general public by reason of his employment. . . . A risk is incidental to the employment
when it belongs to or is connected with what the employee has to do in fulfilling his duties. . . .” Orsini v.
Industrial Comm’n, 117 Ill.2d 38, 409 N.E.2d 1005 (1987).
 “To obtain benefits under the Act, a claimant must establish by a preponderance of the evidence that he sustained
an accidental injury ‘arising out of’ and ‘in the course of’ the claimant’s employment.” 820 ILCS 305/1(d); McAllister v.
Illinois Workers’ Compensation Comm’n, 2020 IL 124848, 181 N.E.3d 656; Sisbro, Inc. v. Industrial Comm’n, 207 Ill.2d 193,
203, 797 N.E.2d 665 (2003).

CONCLUSION
Illinois Supreme Court, over the course of 60 years of decisions, uses language “a causative factor” in determining
work-relatedness, causal connection, and the language of Section 1(d) and 2 of IWCA. The language begins:
“To come within the statute the employee must prove that some act or phase of the employment was a causative
factor in the ensuing injury. He need not prove it was the sole causative factor nor even that it was the principal
causative factor, but only that it was a causative factor in the resulting injury. In the absence of such proof, the
injury is not compensable.”
 Republic Steel Corp. v. Ind. Comm’n, 26 Ill.2d 32 (1962) – Heart Attack
 Wirth v. Ind. Comm’n, 57 Ill.2d 475 (1974) – Heart Attack
 Sisbro, Inc. v. Ind. Comm’n, 207 Ill.2d 193 (2003) – Charcot Diabetic Foot
 McCallister v. IL Workers’ Compensation Comm’n, 2020 IL 124848 – Knee in Cooler
 Twice Over Clean v. Ind. Comm’n, 214 Ill.2d 403 (2005) – Heart Attack
 County of Cook v. Ind. Comm’n, 69 Ill.2d 10 (1977) – Heart Attack

PROVING CAUSATION: REPETITIVE TRAUMA INJURIES
• “The injury manifests itself on the date when both the injury and its causal relationship to the claimant’s
employment become readily apparent to a reasonable person.” Peoria County Belwood Nursing Home v.
Industrial Comm’n
• “Employee was diagnosed with carpal tunnel syndrome as a result of repeated trauma to her wrist in her
operation of two large washing machines in the laundry room of a nursing home. Injury occurred over time and
was found to be work-related and not the result of normal degenerative aging process.” Peoria County Belwood
Nursing Home v. Industrial Comm’n, 115 Ill.2d 524, 505 N.E.2d 1026 (1987).
• In the Illinois Supreme Court case Durand v. Industrial Comm’n, the court noted that a worker’s compensation
claim was timely filed. The court held that a reasonable person would not have known of the injury and its
connection to ability to work. The court’s decision highlights the difficulty in analyzing repetitive or cumulative
trauma injuries. The Court noted that Illinois courts have reserved flexibility in determining when a repetitive
trauma accident has occurred. The statute of limitations for filing a workers’ compensation claim in Illinois is
three years from the date of the injury or two years from the date of the last payment of benefits, which is
later. Durand v. Industrial Comm’n, 224 Ill. 2d 53.

PROVING CAUSATION: WHEN PREEXISTING CONDITION IS PRESENT
 An aggravation of a preexisting condition can be a compensable claim within the meaning of the Illinois Workers’
Compensation Act.
 “A preexisting condition does not preclude a finding of compensability. The aggravation of a preexisting condition
is compensable under the workers’ Compensation Act. Although a preexisting condition does not preclude a
workers’ compensation award if the condition is aggravated or accelerated by the employment, the condition must,
in fact, be aggravated by the employment, and the aggravation must be attributable to a specific time, place, and
cause rather than to the effects of prolonged stress on the body.” Lawless v. Industrial Comm’n, 96 Ill.2d 260, 449
N.E.2d 850 (1983).
 “Even though a workers’ compensation claimant has a preexisting condition which may make them more
vulnerable to injury, recovery for an accidental injury will not be denied as long as it can be shown that the
employment was also a causative factor. Sisbro, Inc. v. Industrial Comm’n, 207 Ill.2d 193, 797 N.E.2d 665 (2003); Par
Electric v. Illinois Workers’ Compensation Comm’n, 2018 IL App (3d) 170656WC, 118 N.E.3d 681 (App. Ct. 3d Dist. 2018).
 “Employers take their employees as they find them.” Schroeder v. Illinois Workers’ Compensation Comm’n, 79 N.E.2d
833 (App. Ct. 4th
Dist. 2017); Sisbro Inc. v. Industrial Comm’n, 207 Ill.2d 193, 797 N.E.2d 665 (2003); Par Electric v. Illinois
Workers’ Compensation Comm’n, 2018 IL App (3d) 170656WC, 118 N.E.3d 681 (App. Ct. 3d Dist 2018); Global Products v.
Workers’ Compensation Comm’n, 392 Ill.App.3d 408, 911 N.E.2d 1042 (1st
Dist. 2009).

“Recovery is permitted for subsequent work-related injuries if these later injuries would not have occurred but for the initial
Work-related injuries.” Lagerstorm v. Dupre, 185 Ill.App.3d 1020, 542 N.E.2d 73 (1st
Dist. 1989).
“The relevant inquiry in preexisting-condition cases is whether the employee’s condition is attributable solely to a
degenerative process of the preexisting condition or to the aggravation or acceleration of the preexisting condition
resulting from a work-related accident.” Sisbro , Inc., 207 Ill.2d at 204-05, 797 N.E.2d 665.
“This court has recognized repeatedly that, when the claimant’s condition is weakened by a work-related accident, a
subsequent accident that aggravates the condition does not break the causal chain.” Lee v. Industrial Comm’n, 167
Ill.2d 77,
87, 656 N.E.2d 1084 (1995).
“Whether a claimant’s disability is attributable solely to a degenerative process of the preexisting condition or to an aggravation
or acceleration of a preexisting condition because of an accident is a factual determination to be decided by the Industrial
Commission.” Roberts v. Industrial Comm’n, 93 Ill.2d 532, 538, 445 N.E.2d 316 (1983).
“An employee’s recovery depends on the employee’s ability to show that a work-related accidental injury aggravated or accelerat
the preexisting disease such that the employee’s current condition of ill-being can be said to have been causally connected to th
work-related injury and not simply the result of a normal degenerative process of the preexisting condition.” Sisbro, Inc.,
207 Ill.2d at 204-05, 797 N.E.2d 665.
PROVING CAUSATION: WHEN PREEXISTING CONDITION IS PRESENT

PROVING CAUSATION: DESPITE PRESENCE OF SUBSEQUENT INJURY
• “Under an independent intervening cause analysis, compensability for an ultimate injury or disability is based
upon a finding that the employee’s condition was caused by an event that would not have occurred ‘but for’ the
original injury.” International Harvester Co. v. Industrial Comm’n, 46 Ill.2d 238, 245, 263 N.E.2d 49 (1970).
• “That the other event, whether work-related or not, may have aggravated the employee’s condition is
irrelevant.” Vogel, 354 Ill.App.3d at 786, 821 N.E.2d 807.
• “An employer is relieved of liability only if the intervening cause completely breaks the causal chain between
the original work-related injury and the ensuring condition of ill-being.” Global Products v. Illinois Workers’
Compensation Comm’n, 392 Ill.App.3d 408, 411, 911 N.E.2d 1042 (2009).
• “Every natural consequence that flows from an injury that arose out of and in the course of the claimant’s
employment is compensable unless caused by an independent intervening accident that breaks the chain of
causation between a work-related injury and an ensuing disability or injury.” Teska v. Industrial Comm’n, 266
Ill.App.3d 740, 742, 640 N.E.2d1 (1994).
• “Where the work injury itself causes a subsequent injury, the chain of causation is not broken.”
• “Generally, every natural consequence that flows from the injury which arose out of and in the course of the
claimant’s employment is compensable under the Workers’ Compensation Act, unless such injury is caused by
an independent intervening act.” Dunteman v. Illinois Workers’ Compensation Comm’n, 52 N.E.3d 718 (App. Ct. 4th
Dist. 2016); Par Electric v. Illinois Workers’ Compensation Comm’n, 2018 IL App (3d) 170656WC.

 “An ‘independent intervening cause’, in the context of a workers’ compensation case, is one that breaks the chain
of causation between a work-related injury and the ensuring disability or injury.” Dunteman v. Illinois Workers’
Compensation Comm’n, 52 N.E.3d 718 (App. Ct. 4th
Dist. 2016).
 “In the workers’ compensation context, for an employer to be relieved of liability by virtue of an intervening
cause, the intervening cause must completely break the causal chain between the original work-related injury
and the ensuing condition.” Par Electric v. Illinois Workers’ Compensation Comm’n, 2018 IL App (3d) 170656WC, 118
N.E.3d 681 (App. Ct. 3d Dist 2018).
 “In the workers’ compensation context, so long as a “but-for” relationship exists between the original event and
the subsequent Condition, the employer remains liable. Par Electric v. Illinois Workers’ Compensation Comm’n, 2018
IL App (3d) 70656WC, 118 N.E.3d 681 (App. Ct. 3d Dist 2018).
PROVING CAUSATION: DESPITE PRESENCE OF SUBSEQUENT INJURY

PROVING CAUSATION: MEDICAL PERSPECTIVE
 “Medical testimony is not necessarily required to either establish or disprove causation and disability in a
workers’ compensation hearing.” Heston v. Industrial Comm’n, 164 Ill. App. 3d 178, 517 N.E.2d 632 (5th
Dist.,
1987).
 “Where medical knowledge of an ailment is limited, medical testimony as to causation cannot and need not
be unqualified and unequivocal.” United States Steel Corp. v. Industrial Comm’n, 32 Ill.2d 68, 203 N.E.2d 569
(1964).
 “To the extent that the medical testimony might be construed as conflicting, it is well established that
resolution of such conflicts falls within the province of the Commission, and its findings will not be reversed
unless contrary to the manifest weight of the evidence.” Caterpillar Tractor Co., v. Industrial Comm’n, 92 Ill. 2d
30, 37, 440 N.E.2d 861(1982).
 “Decisions concerning conflicting medical testimonies are given deference so long as they are not against
the manifest
weight of the evidence.” Caterpillar Tractor Co., 92 Ill. 2d at 37, 440 N.E.2d 861.

 “Where, without the fault of the employee, the original compensable injury is aggravated by the negligence of a physician, the
aggravation is not a new injury but is connected with, and becomes a part of, the original injury, and the employer is liable for
the aggravation of injuries due to malpractice.” Caterpillar Tractor Co. v. Industrial Comm’n, 92 Ill. 2d 30, 440 N.E.2d 861 (1982).
 “Medical evidence, however, is not essential to support a finding that a causal relationship exists between an employee’s work
duties and his or her condition of ill-being.” International Harvester v. Industrial Comm’n, 93 Ill. 2d 59, 63 (1982).
 “A chain of events which demonstrates a previous condition of good health, an accident, and a subsequent injury resulting in
disability may be sufficient circumstantial evidence to prove a causal nexus between the accident and the employer’s injury.”
International Harvester v. Industrial Comm’n, 93 Ill. 2d at 63-64.
 “Moreover, an occupational accident need not be the sole or principal causative factor in the resulting condition of ill-being, as
long as it was a causative factor.” Sisbro, Inc., 207 Ill. 2d at 205.
 “Hence, an employee need prove only that some act or phase of his or her employment was a causative factor in the resulting
injury.” Land & Lakes Co. v. Industrial Comm’n, 359 Ill.App.3d 582, 592 (2005).
 “It is the function of the Commission to decide questions of fact, judge the credibility of witnesses and resolve conflicts in the
events.” Hosteny, 397 Ill.App.3d at 674. “This is especially true with respect to medical issues, to which we owe the Commission
heightened deference because of the expertise it possesses in the medical arena.” Long v. Industrial Comm’n, 76 Ill. 2d 561, 566
(1979).

PROVING
CAUSATION
FROM A MEDICAL
STANDPOINT
Methodology,
Techniques and
Criteria

PROVING
CAUSATIO
N: MEDICAL
PERSPECTIVE
BRADFORD-HILL CRITERIA

NATIONAL INSTITUTE FOR
OCCUPATIONAL SAFETY AND HEALTH
(NIOSH) CRITERIA
PROVING CAUSATION:
MEDICAL PERSPECTIVE

AMA
CAUSATION
TERMS
Aggravation: A permanent worsening of a prior, or underlying, condition by an event or exposure.
Exacerbation: A temporary worsening of a prior, or underlying, condition by an event or exposure that will, or has, returned to
baseline.
Acceleration : The hastening of the appearance or symptoms of an underlying disease process by an event or exposure.
Precipitat ion: The "lighting up" (that is, an increase in symptoms) of a latent, or asymptomatic, disease process by an event or exposure.
Recurrence : Signs or symptoms of a prior illness or injury appearing without a provocative event.

When asked to give opinions on causal connection opinions every day in my practice following the initial assessment of an injured
worker what do I look for?
1. Gathering a detailed history of the injury mechanism is crucial. I ask questions about what happened, who witnessed the event, and
what the injured worker believes caused the event. I often request the injured worker to provide a detailed written description.
2. Cases where I see the injured worker within 24-48 hours after the injury are more credible compared to evaluating an injured
worker several days later, especially when there is no timely reporting of the work accident, e.g. initial emergency room records,
prompt care records.
3. Consistency of the medical records of both mechanism of injury and reporting of subjective complaints, over time regarding the
reported incident is a critical factor in forming my opinions on causation.
4. I am often asked to review a video of an alleged work accident to provide a basis for my opinion on causation.
5. I review incident reports and workplace accident investigations to form opinions on causation.
6. In cases where an injured worker tests positive for drugs and/or alcohol, my examination of the injured worker is critical for
presumptive rebuttal. An examination showing physical signs of impairment along with positive drug tests provides a critical basis
for intoxication.
7. Non-musculoskeletal cases such as cardiac, skin, respiratory, and environmental exposure are more challenging regarding
causation opinions. Each of these situations requires more detailed analysis of the workplace using the principles of epidemiology
regarding people, place, and time factors involved in the case.
8. In toxic exposures, the frequency, intensity, and duration of the exposure are key factors in determining causation.
9. In alleged cumulative trauma disorder cases, obtaining a detailed job description is essential. I have a standard format that I use
and will often request a video and/or actual ergonomic evaluation of the job by myself or someone else. Job descriptions from
employer and separately from employee are important to consider.
10. An important factor in cumulative trauma disorder cases is improvement away from the ergonomic stressors if I place an injured
worker on restricted duty. Dose exposure or duration of exposure s well as intensity of exposure.
11. Similarly, if there are multiple workers reporting similar complaints while doing the same or similar job, those population clusters
support a causation opinion.
12. I use the NIOSH (National Institute for Occupational Safety and Health) criteria for establishing the work-relatedness of carpal
Dr. David Fletcher
Board Certified - Occupational Medicine

MEDICAL ARTICLES ON
PROVING CAUSATION (articles included
in packet)
“Determining Work-Relatedness of Acute Shoulder Trauma”
“Occupational Risk Factors for Carpal Tunnel Syndrome”
“Cubital Tunnel Syndrome Occurrence in Workers: A Review”
“Occupational Risk Factors for Shoulder Tendon Disorders 2015 Update”
Dr. Blair Rhode

DISPROVING CAUSATION: DEFENSE TACTICS
“In cases involving multiple workplace accidents and, therefore, multiple potential causes for a claimant’s ill-being,
Court have made clear that (e)very natural consequence that flows from an injury that arose out of and in the course
Of one’s employment is compensable . . . absent the occurrence of an independent intervening accident that breaks
The chain of causation between the work-related injury and ensuing disability of injury.” National Freight v. Illinois
Workers’ Compensation Comm’n, 993 N.E.2d 473 (5th
Dist. 2013) (citing Vogel v. Industrial Comm’n, 354 Ill.App.3d
780, 786, 821 N.E.2d 807 (2005).
• Causal connection can be severed
• To be relieved of liability, intervening cause must break causal connection
• If subsequent accident does not result in new findings or aggravation, causal
connection is unaffected
• If new medical finding, seek expert opinion on causal connection
• Use investigative tools to determine new medical findings

AGGRAVATION OF PRE-EXISTING CONDITION
Pre-existing conditions will not prevent recovery under WC Act if condition was aggravated or
accelerated
by claimant’s employment. Caterpillar Tractor Co. v. Industrial Comm’n, 92 Ill. 2d30, 440 N.E.2d 861
(1982)
• Claimant had preexisting non-work related rheumatoid arthritis, and injured his back while
moving a casting
• Court determined that the work-related low back pain was a contributing factor to his
subsequent disability
• Compensation was awarded
• Claimant’s injury need not be the sole factor that aggravates a preexisting condition, so long
as it is a factor that contributes to the disability
Johns-Mansville Products Corp. v. Industrial Comm’n, 78 Ill. 2d 171, 177, 399 N.E.2d 606 (1979) denies
recovery where the employee’s health has so deteriorated that any normal daily activity is an
overexertion or where the activity engages in presented risks no greater than those to which the
general public is exposed.

DISPROVING CAUSATION:
DEFENSE TACTICS
EFFECTS OF PRIOR ACCIDENTS
-Prior accidents and injuries can have
significant impact on new injury claims -Use your investigative tools
•-Obtain ISO Claim Search Summary
•-Subpoena prior carriers
•-Subpoena group insurance records
•-Subpoena medical records and diagnostic films
•-Use IWCC electronic records
•-Analyze prior medical findings
•-Use Circuit Court electronic records
•-Analyze prior medical findings
•-Determine whether finding is a result of new
accident or product of prior accident
-Obtain expert physician’s opinion on
causal connection
-Provide your expert with all medical
records and films

DISPROVING CAUSATION:
DEFENSE TACTICS
• EFFECT OF SUBSEQUENT ACCIDENTS
•-What if Petitioner’s actions preclude his recovery?
• -Section 19(d) of the WC Act states:
•(d) If any employee shall persist in insanitary or injurious practices which tend to either imperil or retard his
recovery or shall refuse to submit to such medical, surgical, or hospital treatment as is reasonably essential to
promote his recovery, the Commission may, in its discretion, reduce or suspend the compensation of any such
injured employee. However, when an employer and employee so agree in writing, the foregoing provision shall
not be construed to authorize the reduction of suspicion of compensation of an employee who is relying in
good faith, in treatment by prayer or spiritual means alone, in accordance with the tenets and practice of a
recognized church or religious denomination, buy a duly accredited practitioner thereof

CASE LAW
“This court has consistently held that where the injury results from a personal risk, as opposed to a risk inherent in
the
claimant’s work or workplace, such injuries are not compensable.” Orsini, 509 N.E.2d at 1008-1009
National Freight v. Illinois Workers’ Compensation Comm’n, 993 N.E.2d 473 (5th
District 2013)
 -Petitioner injured his back on 11/6/06 while pulling boxes off of a truck while in employ of Fischer
Lumber
 -Back surgery was schedule for 12/5/08
 -Petitioner injured on 12/4/08 in motor vehicle accident while in employ of National Freight
 -Second accident resulted in new & more extensive injuries than those of 11/6/06 accident
 -Court held that second accident broke causal connection between claimant’s condition of ill-being
& initial accident
 -Court cited to changes in symptoms, pathology, type of surgery required, and ability to work
 -Petitioner would be entitled to seek permanency award from first employer once he reached MMI

Strong Law - 2024 ITLA Workers' Compensation Seminar.pptx

More Related Content

Similar to Strong Law - 2024 ITLA Workers' Compensation Seminar.pptx

Recently uploaded

Strong Law - 2024 ITLA Workers' Compensation Seminar.pptx