Josh Rudolfi of Ankin Law secured a favorable settlement in arbitration for a sterile processing technician who injured her back while moving a full cart of surgical instruments.

1. ILLINOIS WORKERS’ COMPENSATION COMMISSION
DECISION SIGNATURE PAGE
Case Number 19WC009008
Case Name v. Steris Instrument
Management Services, Inc.
Consolidated Cases
Proceeding Type
Decision Type Arbitration Decision
Commission Decision Number
Number of Pages of Decision 15
Decision Issued By , Arbitrator
Petitioner Attorney Joshua Rudolfi
Respondent Attorney
DATE FILED: 3/3/2023
THE INTEREST RATE FOR THE WEEK OF FEBRUARY 28, 2023 4.98%
Signature

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STATE OF ILLINOIS ) Injured Workers’ Benefit Fund
(§4(d))
)SS. Rate Adjustment Fund (§8(g))
COUNTY OF COOK ) Second Injury Fund (§8(e)18)
None of the above
ILLINOIS WORKERS’ COMPENSATION COMMISSION
ARBITRATION DECISION
Case # 19 WC 9008
Employee/Petitioner
v.
Steris Instrument Management Services, Inc.
Employer/Respondent
An Application for Adjustment of Claim was filed in this matter, and a Notice of Hearing was mailed
to each party. The matter was heard by the Honorable , Arbitrator of the Commission,
in the city of Chicago, on April 28, 2022. After reviewing all of the evidence presented, the
Arbitrator hereby makes findings on the disputed issues checked below, and attaches those findings
to this document.
DISPUTED ISSUES
A. Was Respondent operating under and subject to the Illinois Workers' Compensation or
Occupational Diseases Act?
B. Was there an employee-employer relationship?
C. Did an accident occur that arose out of and in the course of Petitioner's employment by
Respondent?
D. What was the date of the accident?
E. Was timely notice of the accident given to Respondent?
F. Is Petitioner's current condition of ill-being causally related to the injury?
G. What were Petitioner's earnings?
H. What was Petitioner's age at the time of the accident?
I. What was Petitioner's marital status at the time of the accident?
J. Were the medical services that were provided to Petitioner reasonable and necessary? Has
Respondent paid all appropriate charges for all reasonable and necessary medical services?

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K. What temporary benefits are in dispute?
TPD Maintenance TTD
L. What is the nature and extent of the injury?
M. Should penalties or fees be imposed upon Respondent?
N. Is Respondent due any credit?
O. Other
ICArbDec 4/22 Web site: www.iwcc.il.gov

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FINDINGS
On 2/27/2019, Respondent was operating under and subject to the provisions of the Act.
On this date, an employee-employer relationship did exist between Petitioner and Respondent.
On this date, Petitioner did sustain an accident that arose out of and in the course of employment.
Timely notice of this accident was given to Respondent.
Petitioner's current condition of ill-being is causally related to the accident.
In the year preceding the injury, Petitioner earned $32,219.20; the average weekly wage was
$619.60.
On the date of accident, Petitioner was 30 years of age, single with 1 dependent child.
Petitioner has received all reasonable and necessary medical services.
Respondent has not paid all appropriate charges for all reasonable and necessary medical services.
Respondent shall be given a credit of $7,022.02 for TTD, $0 for TPD, $0 for maintenance, and $0 for
other benefits, for a total credit of $7,022.02.
Respondent is entitled to a credit of $0 under Section 8(j) of the Act.
ORDER
Respondent shall pay reasonable and necessar medical services of $66,040.00, as provided in §8(a)
of the Act, itemized: $10,245.00 to Rehab, $14,889.00 to Pain Mana ement
S ecialists, $36,197.00 to Pain Associates, and $4,709.00 to
, Ltd., and adjusted in accord with the Medical Fee Schedule provided in §8.2 of the Act.
Respondent shall pay Petitioner temporary total disability benefits of $413.06/week for 22 weeks,
commencing 3/21/2019 through 8/22/2019, as provided in §8(b) of the Act.
Respondent shall be given a credit of $7,022.02 for temporary total disability benefits that have been
paid.
Respondent shall pay Petitioner 37.5 weeks of permanent partial disability benefits, at a rate of
$371.76/week, because Petitioner sustained a 7.5% loss of a person-as-a-whole.
RULES REGARDING APPEALS Unless a party files a Petition for Review within 30 days after receipt
of this decision, and perfects a review in accordance with the Act and Rules, then this decision shall
be entered as the decision of the Commission.
STATEMENT OF INTEREST RATE If the Commission reviews this award, interest at the rate set forth
on the Notice of Decision of Arbitrator shall accrue from the date listed below to the day before the
date of payment; however, if an employee's appeal results in either no change or a decrease in this
award, interest shall not accrue.

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________________________________________ MARCH 3, 2023
Signature of Arbitrator

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v. Steris Instrument Management Services
19
INTRODUCTION
This matter proceeded to hearing before Arbitrator . The disputed
issues were: C: Did an accident occur that arose out of and in the course of Petitioner’s
employment by Respondent?; F: Is Petitioner’s current condition of ill-being causally
related to the accident?; J: Were the medical services that were provided to Petitioner
reasonable and necessary? Has Respondent paid all appropriate charges for all
reasonable and necessary medical services?; K: What temporary benefits are in dispute?
TTD; L: What is the nature and extent of the injury?
The Arbitrator redacted identifying information that was included in certain
exhibits in violation of Illinois Supreme Court Rule 138.
STATEMENT OF FACTS
Petitioner has worked for Respondent Steris Instrument
Management Services at the in sterile processing for 6
years. Petitioner’s job duties required her to wash and sterilize surgical instruments and
assemble the surgical trays. Her job required her to lift trays and perform other lifting.
Petitioner was working for Respondent on February 27, 2019 when she injured her
lower back. Petitioner testified that she was working in “decontamination”, which is
where instruments are cleaned, when she was pulling a heavy cart on wheels out of an
elevator in order to clean instruments. The cart weighed over 30 pounds. Petitioner
testified that she notified her manager, , and finished her shift that day. On cross-
examination she acknowledged that she worked her regularly scheduled shifts through
March 20, 2019.
Petitioner testified that she was sent for medical care at “ ” (Occupational
Health Centers of Illinois) on March 4, 2019 (PX #1). She complained of 8/10 back pain
and stiffness that had started “last Wednesday” while pushing and pulling carts at work.
Petitioner had a history of a thoracic injury 2 years before with a normal MRI and which
resolved with physical therapy. There was no lower extremity numbness or tingling or
weakness. She denied radiating pain. On examination Petitioner had tenderness over the
lumbar spine. Lumbar range of motion was diminished. Muscle strength was normal,

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and sensation was intact. Straight-leg raise was normal on both the right and the left.
There was a positive Waddell sign.
Dr. S diagnosed back strain and prescribed Metaxalone, Naproxen,
Muscle Rub. He also prescribed physical therapy 3 times a week for 2 weeks. Petitioner
was placed on light duty restrictions of no lifting greater than 20 pounds but may
push/pull up to 40 pounds. Respondent accommodated those restrictions.
Petitioner had physical therapy at from March 5 through March 18,
2019. Petitioner followed up at on March 11, 2019 with the same complaints
and recommendations as before. Petitioner again followed up at on March 18,
2019. She reported 7.5/10 back pain with no improvement. Physical therapy was
discontinued, medications continued, and Petitioner was referred to a physiatrist.
Petitioner was still working light duty.
On March 21, 2019 Petitioner testified she sought a second opinion with
chiropractor Dr. at Rehab (PX #2). Dr. noted
Petitioner’s complaints left and right lumbar pain, left and right sacroiliac pain, and left
and right pelvis hip pain. The doctor also noted pain radiating down the back of the right
thigh. Subjective pain was noted at 10/10. On the Patient Information form Petitioner
marked body silhouettes indicating pain in the mid and lower back, as well as head pain.
She did not mark indicating pain in the hips or legs. She noted her back pain was 10. In
a self-reporting symptoms form Petitioner indicated she had upper back pain radiating
into both shoulders. She also noted right-sided lower back pain radiating into the thigh.
On examination Dr. noted painful lumbar range of motion. Various
testing was positive on both the left and the right: Kemps, straight-leg raise, Soto Hall,
Patrick Fabere, Yeoman’s, and Milligrams, left greater than right. Trendelenburg and
Ely’s were positive on the left only. Hibbs was positive on the right only. Valsalva,
Bechterew’s, and Nachals were negative bilaterally. Doctor also noted PSOAS
muscle weakness on both the left and the right. Quad and hamstring muscles were weak
on the left only.
Dr. diagnosed low back pain and lumbar radiculopathy, which was related
to the reported work accident on February 27, 2019. The doctor ordered a lumbar MRI
and chiropractic therapy. The doctor also issued work restrictions of no repetitive
bending and no standing or sitting in excess of 2 hours. Lifting was limited to 20 pounds.

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Dr. began therapy on March 21, which continued through July 23, 2019.
The lumbar MRI was performed on April 1, 2019 at Medical Imaging. The
radiologist, M , MD, noted shallow broad-based disc displacement at L4-5 and
L5-S1, with effacement on the thecal sac. There was disc material extending 0.3 cm
posteriorly into the intervertebral disc space at L5-S1 and abutment on the right and left
S1 nerve roots.
Dr. ’s notes document Petitioner’s improvement with the doctor’s therapy.
On April 29 it was noted that Petitioner had pain radiating into the right buttock rather
than the right thigh and that her pain was now 4/10. On June 10 it was noted the
Petitioner no longer had radiating pain and that her overall pain was 3/10. By July 23,
2019 Petitioner’s pain was at 2/10 with no radiating pain. However, on May 2, 2029 Dr.
referred Petitioner to Dr. J for a pain management consultation.
Petitioner consulted Dr. J of Pain Management Specialists
(“ ”), on referral from Dr. on April 4, 2019, when she was seen by PA-C
M (PX #3). PA-C M noted that Petitioner was injured at work on
February 27, 2019 while pushing/pulling trays with medical instruments. Petitioner
complained of mid back and low back pain which radiated into her right leg. PA-C M
noted a prior back injury from two years prior but was asymptomatic when this injury
occurred.
On exam PA-C M noted diminished and painful range of motion. There was
hypertonicity over the thoracic spine. Muscle strength and sensation were normal.
Straight-leg was normal, but Kemp’s was positive. There were negative Waddells. PA-C
Memon noted the lumbar MRI demonstrated broad-based disc displacement at L4-5 and
L5-S1.
PA-C M assessed Petitioner’s condition as lumbar facet syndrome, lumbar
discogenic pain, a lumbosacral radiculopathy. Bilateral medial branch blocks at L3, L4,
and L5 along with continued physical therapy were recommended. It was noted that
Petitioner’s lumbar condition to be directly related to the injury in question, that
Petitioner’s medical care to date had been reasonable and necessary, and that Petitioner
aggravated a silent and asymptomatic, rendering it symptomatic and in need of treatment
by accelerating the condition. Petitioner was continued off work.
Dr. J performed bilateral medical branch blocks at L3, L4, and L5 on April 17,
2019 and April 24, 2019. Petitioner testified that these injections helped her.

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Petitioner followed up with PA-C M on May 2, 2019. Petitioner reported
relief from the injections. She presented with 4/10 pain without radicular symptoms.
Due to the positive response from the medical branch blocks bilateral radiofrequency
ablations at L3, L4, and L5 were recommended. Petitioner was continued off work.
Dr. J performed left L3, L4 and L5 radiofrequency ablations on May 8, 2019
and right L3, L4, and L5 radiofrequency ablations on May 15, 2019. Petitioner testified
that these procedures helped her pain.
Petitioner followed up with PA-C M May 23, 2019. She reported significant
improvement following the procedures, with only intermittent left sided “electric shocks”.
Petitioner was continued on medication, physical therapy, and off work.
Orthopedic surgeon Dr. M conducted a §12 IME of Petitioner on July
11, 2019 at Respondent’s request (RX #5). In addition to a clinical examination, Dr.
M reviewed Petitioner’s medical records, including records relating to Petitioner’s
prior work injury in 2016, , physical therapy, Dr. J for medial branch block
injections and ablations, and radiology imaging. Dr. M noted a history consistent
with Petitioner’s medical records and her trial testimony.
On examination Petitioner complained of lower back pain at 30° of lumbar
extension. Dr. M noted that she appeared “quite comfortable.” Petitioner reported
tightness at 80° of lumbar flexion. Lateral bending range was normal but painful. Motor
strength and sensation were normal. Seated straight-leg raise was negative. When lying
on the exam table Petitioner complained of 5/10 low back pain but reported 4/10 pain at
80° of straight-leg raise. The doctor repeated this because of the inconsistency.
Dr. M diagnosed lumbar strain, which he noted was mild, and psychogenic
pain/function overlay and symptom magnification. The doctor noted that Petitioner
denied any prior Workers’ Compensation claims, which was not true. She had had
chiropractic treatment without objective findings, an MRI, and a consultation with Dr.
S in 2016. The doctor also noted positive Waddell testing, a negative straight-
leg, and lack of focal findings during therapy after the accident in 2019. Dr. M
opined that Petitioner’s April 1, 2019 lumbar MRI was 100% normal. He disagreed with
Dr. M ’s reading of broad-based disc protrusions at L4-5 and L5-S1 effacing the thecal
sac and abutting nerve roots without herniation. He took note of Dr. J ’s interventions
with medial branch block injections and medial branch ablations.

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Dr. M reviewed Petitioner’s job description, which he noted did not require
“real heavy lifting” or manual labor. He opined that Petitioner’s lumbar strain should
have resolved within 2 to 4 weeks, with or without treatment, but those 5 to 6 physical
therapy treatments, at most, would have been reasonable. He further opined that Dr.
J ’s interventions were not necessary for failure to meet the generally accepted 2009
criteria of the American Pain Society. Dr. M found Petitioner was at MMI and could
return to unrestricted work as a sterile processing technician. He offered no opinion of
whether Petitioner should or should not have been taken off work for any period of time.
Petitioner also followed up with PA-C M on July 11, 2019. Petitioner still had
painful lumbar motion. Straight-leg raise produced low back pain. Kemp’s test was
positive bilaterally. Physical therapy was continued along with remaining off work.
Petitioner again followed up with PA-C M on August 8, 2019. She denied any
numbness or tingling and rated her pain a 4/10. Continued physical therapy and an FCE
were recommended. Petitioner was off work (PX #3).
On August 22, 2019 Petitioner saw PA-C M for her final appointment.
Petitioner reported significantly decreased pain, 2/10, and no radicular symptoms.
Petitioner was advised to continue with home exercises, to return to work without
restrictions. She was noted at MMI.
Petitioner testified that she had injured her back in 2016 and was released in
November 2016. She denied any back issues between November 2016 and February 27,
2019. She testified that she had no problems performing her full duty job during her 6
years working for Respondent. tenure leading up to the accident. Petitioner testified that
she still works for Respondent, but in a position doing less lifting, making the same wage
as before. Petitioner testified that her medical bills have not been paid. Petitioner
testified that she feels pain in her lower back “every now and then” but takes Tylenol for
that pain.
On cross-examination Petitioner testified that she met with her manager, Mr.
G on March 22, 2019 and reported her accident. He completed an incident
report, Respondent’s Exhibit #1. Petitioner testified that she presented her manager with
a work status slip on March 25, 2019 and was sent home. Petitioner testified that she
likely received an increase in pay since her accident but would have to check her pay stubs.
The last time Petitioner missed any work due to this injury was on August 22, 2019.
Petitioner testified that she has continued working full-time in that capacity since being

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promoted to Sterile Processing Technician II. She testified she has not sought any
medical care for her lower back since August 2019.
On re-direct examination Petitioner testified that she did not seek medical care on
the day she was injured because when she called “work comp” they told her to ice and take
ibuprofen. It was not until two days after that a nurse called Petitioner back and
instructed her to seek care at .
Respondent introduced job descriptions for Petitioner’s position that indicated
Petitioner was required to lift or move up to 50 lbs. frequently, and push/pull up to 300
lbs. (RX #3 & RX #4).
Respondent made an offer of proof of testimony of G . It was offered
that Mr. G was Petitioner’s manager on February 27, 2019 and that Petitioner did
not report her claimed injury on February 27, 2019. It was offered that Mr. G
would testify that Petitioner reported her claimed injury on March 22, 2019. It was
further offered that Mr. G would identify and authenticate Respondent’s Exhibits
#3 and #4 as correct and accurate copies of the job description of a Sterile Processing
Technician I and II, respectively, for Respondent.
CONCLUSIONS OF LAW
C: Did an accident occur that arose out of and in the course of Petitioner’s employment
by Respondent?
The Arbitrator finds that Petitioner proved that she was injured in an accident that
arose out of and in the course of her employment by Respondent.
An injury is sustained in the course of employment when it occurs during
employment, at a place where the worker may reasonably perform employment duties or
engage in some incidental to their employment duties. An injury arises out of one’s
employment if it originates from a risk connected with or incidental to their employment
duties so as to create a causal connection between the employment and the accidental
injury.
Petitioner testified credibly that she was engaged in her normal work duties,
pulling a cart loaded with dirty medical equipment, when she developed low back pain.
She continued to work the day of her accident, February 27, 2019. She was put on light
duty March 4, 2019 by Dr. S at through March 21, 2019 and then taken
off work by Dr. . Petitioner testified credibly that she had an immediate onset of

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low back pain but tried to work until she was sent for medical care at on March
4, 2019. She gave a history of onset of symptoms that coincided with her testimony
Respondent presented no persuasive rebuttal of this issue.
F: Is Petitioner’s current condition of ill-being causally related to the accident?
The Arbitrator finds that Petitioner proved that her condition of ill-being is
causally related to her work accident on February 27, 2019.
The evidence clearly showed there was consensus among Petitioner’s healthcare
providers and Respondent’s retained IME expert, Dr. M , that Petitioner sustained
an injury to her low back that was causally related to her work accident. The dispute
seems to be the nature and extent of that injury, which will be discussed below.
Dr. S of diagnosed back strain on March 4, 2019. The temporal
relation to the work accident creates a reasonable inference of causal connection. Dr.
diagnosed low back pain and lumbar radiculopathy which he found to be causally
connected. PA-C M , under the auspices of Dr. J , assessed Petitioner’s injuries as
lumbar facet syndrome, lumbar discogenic pain, and lumbar radiculopathy, which he
found to be causally connected. Dr. M diagnosed a mild lumbar strain which he also
found was causally connected.
J: Were the medical services that were provided to Petitioner reasonable and
necessary? Has Respondent paid all appropriate charges for all reasonable and
necessary medical services?
The Arbitrator finds that Petitioner proved that the medical services provided and
the charges for those services were reasonable and necessary to cure or relieve the effects
of her injuries. This follows the finding that Petitioner proved causation.
Petitioner was first seen for her injuries at on March 4, 2019. She was
diagnosed with back stain. She received physical therapy and medication for her
symptoms and, also, work restrictions. Although she was not released by Dr. S ,
Petitioner sought care with Dr. . Dr. ’s course of care did not provide the
desired relief, so Petitioner was referred to Dr. J for pain management. Dr. J
administered medial branch block injections and then radiofrequency ablations in
Petitioner’s lumbar spine. Dr. J ’s interventions were successful in relieving
Petitioner’s complaints to the point that she could return to full duty work.

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However, Dr. M disputed the necessity of any medical care beyond 5 to 6
physical therapy sessions. Dr. M opined that Petitioner should have recovered from
the mild lumbar strain he diagnosed even without treatment within 2 to 4 weeks. He
found the April 1, 2019 lumbar MRI to be “100% normal.” Dr. M further opined that
Dr. J ’s interventions were unnecessary in that they did not comport with the 2009
criteria of the American Pain Society. Dr. M also noted positive Waddell testing.
The doctor did diagnose a mild lumbar strain but also diagnosed psychogenic
pain/function overlay and symptom magnification.
The Arbitrator did not find Dr. M ’s opinions persuasive. He strongly
disagreed with Dr. Me s interpretations of the April 1, 2019 lumbar MRI. Dr.
Me made specific findings as noted above which Dr. M read as “100% normal.”
The Arbitrator assumes Dr. Me is board-certified radiologist and notes Dr. M is
a board-certified orthopedic surgeon. The Arbitrator defers to the physician whose sole
specialty is interpreting radiologic imaging.
Dr. M also relied on a positive Waddell finding. Dr. M did not document
his own finding of a positive Waddell sign. The only note regarding a positive Waddell
sign was in the initial clinical note, which was nonspecific. Dr. M did not
note the negative Waddells documented by PA-C M at . His failure to find
a positive Waddell himself and disregarding the negatives at further detracts
from the persuasiveness of his opinions.
Dr. M opined that Dr. J ’s administering of medial branch block injections
and radiofrequency ablations did not comport with the 2009 Guidelines of the American
Pain Society. Dr. M did not cite the particular guideline he relied on or include the
relevant guideline in his report. Dr. M did not cite or rely on relevant guidelines,
criteria, or protocols of professional medical specialties devoted to pain management:
American Board of Anesthesiology, American Board of Pain Medicine, or American Board
of Physical Medicine and Rehabilitation. The Arbitrator finds that Dr. M ’s reliance
on the unstated guidelines of the American Pain Society does not support his opinion.
In that same vein, the Arbitrator does not find Dr. M ’s opinion regarding Dr.
J ’s interventions persuasive for the fact that those interventions worked. Petitioner’s
clinical presentation improved as a result of the injections and ablations. Her pain and
limitations resolved to the point of MMI and a return to full duty work.
Therefore, the Arbitrator awards the following unpaid medical charges: $10,245.00 to
Fitness Rehab, $14,889.00 to Pain Management Specialists, $36,197.00 to
Interventional Pain Associates, and $4,709.00 to Anesthesia, Ltd., to
be adjusted in accord with the Medical Fee Schedule as provided in §8.2 of the Act.

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K: What temporary benefits are in dispute? TTD
The Arbitrator finds that Petitioner is entitled to TTD benefits from March 21, 2019
through August 22, 2019, a period of 22 weeks payable at a rate of $413.06 per week.
Petitioner was taken off work by Dr. on March 21, 2019. Petitioner continued in
an off-work status ordered by Dr. J through her release on August 22, 2019 to return
to full duty work.
The Arbitrator therefore awards TTD for this 22-week period, less Respondent’s
stipulated credit of $7,022.02 representing TTD benefits paid prior to trial.
L: What is the nature and extent of the injury?
The Arbitrator evaluated Petitioner’s Permanent Partial Disability in accord with
§8.1b of the Act:
i) No AMA Impairment Rating was admitted in evidence. The Arbitrator
cannot give any weight to this factor.
ii) Petitioner was employed as a Sterile Processing Technician I at the time of the
accident. She was able to return to full duty work and was promoted to Sterile
Processing Technician II after her return. The Arbitrator gives great weight to this
factor because of evidence of diminished disability.
iii) Petitioner was 30 years old at the time of her accident. She had a statistical life
expectancy of approximately 55 years. Due to petitioner’s full recovery, the
Arbitrator gives little weight to this factor.
iv) There was no evidence that Petitioner’s earnings capacity was adversely affected
by her injuries. She returned to full duty work and later earned a promotion. The
Arbitrator gives great weight to this factor because of evidence of diminished
disability.
v) Petitioner had abnormal lumbar MRI findings along with lower back pain and right-
sided radiculopathy. She received conservative care which did not relieve her
symptoms. She then received a course of medial branch block injections and
radiofrequency ablations in her lumbar spine, which relieved her symptoms. The
Arbitrator gives great weight to this factor.
Based on all the evidence and above 5 factors, the Arbitrator finds that Petitioner sustained
a permanent partial disability to the extent of 7.5% loss to the person-as-a-whole, 37.5 weeks of
benefits, pursuant to §8(d)(2) of the Act.

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___________________ _________________
, Arbitrator Date