An injured worker must show that his or her current condition of ill-being is causally connected to a work-related accident or occupational disease exposure to be eligible for Illinois workers’ compensation benefits.
Causation is a frequently disputed issue in workers’ compensation claims, especially where the injured worker has a pre-existing condition or the injury is the result of repetitive or cumulative trauma. Insurance companies may deny these cases without even hiring an independent medical examiner. If a claim has been denied on the basis of causation, injured workers should consider consulting with an experience attorney.
Current Condition of Ill-Being Causally Connected to Accident or Occupational Exposure
“To prevail on a claim for benefits under the [Workers’ Compensation] Act, the employee must establish, among other things, that his or her current condition of ill-being is causally connected to a work-related injury.” Elgin Board of Education School District U-46 v. Illinois Workers’ Compensation Commission, 409 Ill. App. 3d 943 (2011) Google Scholar | Illinois Courts PDF.
“To recover compensation under the [Occupational Diseases] Act, a claimant must prove both that he or she suffers from an occupational disease and that a causal connection exists between the disease and his or her employment.” Bernardoni v. Industrial Commission, 362 Ill. App. 3d 582 (2005) Google Scholar | Illinois Courts.
The question is: how connected must the condition be with the work-related injury or occupational disease exposure?
The Causation Standard
In answering this question, the Illinois Supreme Court has been very clear:
Accidental injury need not be the sole causative factor, nor even the primary causative factor, as long as it was a causative factor in the resulting condition of ill-being.
Sisbro, Inc. v. Industrial Commission, 207 Ill. 2d 193 (2003) (emphasis on the “a” added) Google Scholar | Illinois Courts. See also Vogel v. Industrial Commission, 354 Ill. App. 3d 780 (2005) (“A claimant need prove only that some act or phase of his or her employment was a causative factor in the ensuing injury.”) Google Scholar | Illinois Courts.
The Illinois causation standard is considered too liberal by many employers and insurers, who for years have been attempting to legislate a “primary factor,” “major contributing cause,” or “more than 50% responsible” standard.
Pre-Existing Conditions – Aggravation or Acceleration
In cases of pre-existing conditions, injured workers are eligible for benefits if they can show that their accidents or occupational exposures aggravated or accelerated the pre-existing condition:
It has long been recognized that, in preexisting condition cases, recovery will depend on the employee’s ability to show that a work-related accidental injury aggravated or accelerated the preexisting disease such that the employee’s current condition of ill-being can be said to have been causally-connected to the work-related injury and not simply the result of a normal degenerative process of the preexisting condition.
The claimant in Sisbro, who had adult onset diabetes, twisted his ankle at work and experienced pain and swelling. About two weeks later, after the swelling had subsided, he visited his podiatrist for regularly scheduled preventative foot care in relation to his diabetes. He told his doctor about the accident and was advised to notify his doctor if his condition changed. Another two weeks later, the swelling resumed and the claimant was diagnosed with “acute onset of diabetic Charcot osteoarthropathy.”
At the arbitration hearing, the claimant’s podiatrist testified that Charcot involves “the destruction of the bone and tissue of the joint caused by an underlying neurological involvement, often related to diabetes.” He testified that some type of trauma, sometimes even minor trauma, initiates the onset of Charcot. He opined that, while the claimant had underlying diabetic neuropathy, the claimant’s accident triggered the acute onset of the Charcot.
Disputing the claim, the employer’s expert testified that the Charcot in the claimant’s ankle was a long-standing degenerative condition, which developed slowly over time as a result of the diabetes, related neuropathy, and “microtraumas” to the feet from everyday living. The Illinois Workers’ Compensation Commission found in favor of the claimant and the case was appealed all the way to the Illinois Supreme Court.
The Illinois Supreme Court began its analysis by reiterating the relevant legal standards:
It is axiomatic that employers take their employees as they find them. When workers’ physical structures, diseased or not, give way under the stress of their usual tasks, the law views it as an accident arising out of and in the course of employment. Thus, even though an employee has a preexisting condition which may make him 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.
It is a well-settled rule that where an employee, in the performance of his duties and as a result thereof, is suddenly disabled, an accidental injury is sustained even though the result would not have obtained had the employee been in normal health. Accidental injury need not be the sole causative factor, nor even the primary causative factor, as long as it was a causative factor in the resulting condition of ill-being.
The courts are very deferential to the Commission when reviewing its decisions:
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. Further, a reviewing court must not disregard or reject permissible inferences drawn by the Commission merely because other inferences might be drawn, nor should a court substitute its judgment for that of the Commission unless the Commission’s findings are against the manifest weight of the evidence.
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.
In this case, the Illinois Supreme Court found that there was sufficient evidence in support of the Commission’s decision that the claimant’s work accident of twisting his ankle accelerated or aggravated his pre-existing condition. The Commission’s finding was not against the manifest weight of the evidence.
Repetitive or Cumulative Trauma
Similar to pre-existing conditions, in the case of repetitive or cumulative trauma, an injured worker is eligible for benefits if they can show that the “injury is work related and not the result of a normal degenerative aging process.” Peoria County Belwood Nursing Home v. Industrial Commission, 115 Ill. 2d 524 (1987) Google Scholar.
Independent Intervening Causes
On the opposite side of the pre-existing condition defense, employers and insurance companies sometimes argue that an event after a work-accident has “broken the causal chain” such that they should no longer be liable for the claimant’s condition of ill-being. This is called an independent intervening cause.
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.
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.
For example, in Dunteman v. Illinois Workers’ Compensation Commission, 2016 IL App (4th) 150543WC Illinois Courts PDF, the claimant suffered a serious infection after lancing a work-related blister himself. The Illinois Appellate Court rejected the employer’s argument that the self-lancing was an independent intervening cause because the claimant would not have suffered the infection “but-for” the existence of the work-related blister.
Chain of Events Theory
While a strong medical opinion from the injured worker’s treating physician or independent expert is always helpful in cases of disputed causation, it is not always necessary.
The Illinois Supreme Court has explained:
This court has held that medical evidence is not an essential ingredient to support the conclusion of the Industrial Commission that an industrial accident caused the disability. 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 employee’s injury.
International Harvester v. Industrial Commission, 93 Ill. 2d 59 (1982) Google Scholar.
Corn Belt Energy Corp. v. Illinois Workers’ Compensation Commission, 2016 IL App (3d) 150311WC (the claimant’s “chain of events” theory was sufficient to prove causation despite the fact that his accident was not witnessed and he had a pre-existing condition) Google Scholar | Illinois Courts PDF.
Sisbro, Inc. v. Industrial Commission, 207 Ill. 2d 193 (2003) (“We have never found a causal connection to exist between work and injury and then, in a further analytical step, denied recovery based on a ‘normal daily activity exception’ or a ‘greater risk exception.'”) Google Scholar | Illinois Courts.
Land and Lakes Company v. Industrial Commission, 359 Ill. App. 3d 582 (2005) (“Proof of prior good health and change immediately following and continuing after an injury may establish that an impaired condition was due to the injury.”) Google Scholar.
Pulliam Masonry v. Industrial Commission, 77 Ill. 2d 469 (1979) (“It is not necessary to establish a causal connection by medical testimony.”) Google Scholar.