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Illinois Appellate Court Fourth District Hands Down Troubling Opinion in Tazewell County v. Illinois Workers’ Compensation Commission
Medical causation is easy to misunderstand and difficult to interpret. Aristotle happened to dig deep into the study of causal connection and concluded that the critical condition needed for proper knowledge of a thing is grasping its cause. In the arena of workers’ compensation, figuring out the cause of an employee’s condition is indeed a critical condition in determining whether the claim is compensable. In a repetitive trauma claim where a preexisting condition is involved, figuring out causation is even more nuanced, and no less important than in a case involving a single, identifiable accident. The Appellate Court’s decision in Tazewell County v. Illinois Workers’ Compensation Commission, 2025 IL App (4th) 230754WC proposes a troubling shortcut to compensability in these cases, at the cost of employers and business across Illinois.
The petitioner in Tazewell alleged that her left shoulder condition was due to the awkward maneuvering and positioning of her left shoulder as a dental hygienist. Petitioner worked full-time as a dental hygienist for 14 years and testified that she felt pain at work when she elevated her arm while performing her job duties. Petitioner’s treating physician concluded that the repetitive job duties were a “contributory cause of pain at her left shoulder.” According to the treating physician, the type of job duties performed by the petitioner “can result in increased pain in patients who have preexisting rotator cuff pathology”. It was undisputed that the petitioner in Tazewell had a preexisting, non-work-related left shoulder condition of left rotator cuff tear, impingement syndrome, and AC joint arthritis.
Respondent’s IME physician concluded that petitioner was experiencing a manifestation of the symptoms of her preexisting condition, but that her left shoulder condition was not aggravated or accelerated by the work duties. One aspect of the IME’s rationale was the very minimal amount of force needed to position a mirror, one of the job duties at issue.
Four courts and five years after the alleged manifestation date, the etiology of petitioner’s condition in Tazewell is still a mystery. And, according to the Appellate Court in Tazewell, we don’t need to dig deep into any answers about the cause of petitioner’s pain. The fact that petitioner felt pain while on the job was enough for the Tazewell County Court to award compensation. The crux of the Appellate Court’s decision was as follows, “We believe that, when a preexisting condition is asymptomatic and then becomes painful as the result of work-related activity, that symptomatic condition is compensable under the Act as an aggravation of the preexisting condition even in the absence of an organic or structural change in the preexisting condition.”
The Dissenting Justice correctly pointed out that the Majority didn’t follow well-established legal principles on repetitive trauma claims, that causation rested on speculation, and the decision was improper. We agree. The Illinois Supreme Court has previously stated that where the employee suffers from a pre-existing condition, recovery will depend on the employee’s ability to show that a work-related accidental injury aggravated or accelerated the pre-existing condition, and that the condition is not the result of the normal degenerative process. In Tazewell, the petitioner never met her burden regarding the same. Sisbro, Inc., 207 Ill. 2d at 204-05.
To add insult to injury (or just pain, perhaps), the Appellate Court denied the employer’s Petition for Re-hearing and Application for Certification on Leave to Appeal to the Supreme Court. According to the Court, the case did not involve a substantial question which warranted consideration by the Supreme Court. Ironically, however, the Appellate Court acknowledged that the case was an issue of first impression and reviewed cases from 15 other states to consider what to do in the instant case.
There is no sugar-coating the fact that the Tazewell Court handed a serious blow to employers. By establishing that pain alone amounts to a compensable claim in repetitive trauma claims involving a preexisting condition, it is hard to imagine that employers will not see a rise in contested claims and legal expenses. It is hard to imagine that employers will not be saddled with trying to present even stronger and more persuasive medical opinions that the Courts may toss aside based on an employee’s subjective reports of pain. The decision also begs the question of what constitutes a preexisting condition in the first place. Does every MRI that shows degeneration amount to a “preexisting condition”?
Best practices for employers include highlighting an employee’s alternative sources of pain, working diligently to obtain pre-existing treatment records, and focusing on initial employee statements to determine whether the employee had pain outside of work.
I believe that the decision in Tazewell caused the pendulum to swing just too far against employers, which reveals its silver lining. I am confident that, due to Tazewell, subsequent Courts will be careful to distinguish each fact-pattern with the recognition of the consequences of failing to rely on medical experts. Employers will become vigilant about assessing credibility at trial, implementing ergonomic training and re-evaluating task assignments. And, as the weight of the pendulum swings back towards the equilibrium position, it will gain speed.