The protections of the Illinois Workers’ Compensation Act are not limited to those injured workers who sustain acute traumatic injuries.  The Act also provides compensation to employees if the performance of that person’s job over the course of an extended period results in a gradual onset of problems.  These are referred to as repetitive trauma accidental injuries.

The main difficulty with these repetitive trauma claims is determining the date of the accident.  Long ago, the Supreme Court of Illinois established that the relevant date is the date on which the injury “manifests itself,” which is the date on which both the fact of the injury and the causal relationship of the injury to the claimant’s employment would have become plainly apparent to a reasonable person.  There are long-standing guiding principles regarding what is to be considered when evaluating when the work-injury relationship would have become plainly apparent, including the tenet that the date on which the employee first notices a problem is not necessarily the manifestation date; rather, because repetitive trauma injuries are progressive, the employee’s medical treatment, as well as the severity of the injury and particularly how it affects the employee’s job performance, are relevant in determining objectively when a reasonable person would have plainly recognized the injury and its relation to work.  Resolution of this issue has proven to be fairly complicated in many cases.

For example, in Sheils v. Illinois Workers’ Compensation Commission, 2015 IL (1st) 132843WC-U, the employee had spent 40 years working as a graphic designer.  Each workday, she spent eight hours on the computer doing keyboarding and using the mouse; her work was dependent on continuous hand movements, requiring utilization of the fine motor skills, with prolonged grasping and precise manipulation of the mouse, as well as constant keyboard strokes.  In 2001, she began to notice intermittent pain and numbness in both hands; her symptoms were mild, however, and did not interfere with her ability to work.  In the fall of 2008, she was evaluated by a rheumatologist after an adverse reaction to an antibiotic; during a January, 2009 follow up appointment, she advised the doctor that for the past few months, she’d had finger tingling, as well as change in color in the fingertips with exposure to cold.  The doctor diagnosed possible carpal tunnel syndrome and prescribed wrist splints to be worn at night.  When the employee’s symptoms failed to improve by April, the doctor referred her to a neurologist, whom she saw on May 28, 2009.  The neurologist documented a history of tingling in her hands for a little over a year; she had been wearing carpal tunnel splints for five months, but experienced no significant improvement.  After a discussion of the worker’s contributory activities, the neurologist conducted a nerve study; on June 10, 2009, the doctor phoned the employee and told her that she was suffering from bilateral carpal tunnel syndrome and, based on their prior discussion of her job and its concomitant repetitive hand activities, her symptoms were related to her work demands.  The injured worker thereafter filed a claim for workers’ compensation benefits alleging a repetitive trauma injury manifesting on June 10, 2009.

The matter was brought to trial, and the Commission denied the employee’s claim.  The Commission emphasized that the injured worker had been wearing night splints since 2001 and had been keyboarding, using a mouse, and writing at work since 1992, and found that the medical records did not “corroborate repetitive trauma that would have manifested itself to a reasonable person for the first time on June 10, 2009.”

On appeal, the argument was made that although the worker had been experiencing intermittent difficulties for some time, the record was wholly devoid of any discussion of a relationship between her work activities and her hand complaints until June 10, 2009.  The injured worker’s attorneys highlighted that prior to that date, her symptoms were aggravated by changes in temperature and most prevalent at night; moreover, none of her treating physicians had given any indication that her problems were caused by her work activities.  It was not until May 25, 2009, after a thorough history and discussion of her regular job activities, that the neurologist had first broached the idea that her condition might be work-related.  This connection was not confirmed until June 10, 2009, when the doctor reviewed the diagnostic test and phoned the employee to advise her she had work-related carpal tunnel syndrome.  As such, the argument was made to the appellate court that it was not until June 10, 2009 that the causal relationship between the employee’s work activities and her repetitive trauma injury became “plainly apparent.”  In a unanimous order, the First District Appellate Court accepted that argument:

The claimant admitted experiencing intermittent difficulties with her hands and wrists as early as 2001. However, she was able to continue performing her job without significant medical complications, lost working time, or the need to be reassigned to different work. She testified that it was not until June 2009 that her symptoms became so bad that she ‘couldn’t stand it anymore,’ and she had to seek medical treatment. Prior to this time, the claimant experienced symptoms, but she was able to perform her job duties and did not know whether her condition would degenerate to a point where it would impact her ability to do her job. The claimant continued to work until the breakdown of her physical structure. The Act was intended to compensate workers who have been injured as a result of their employment, and to deny an employee benefits for a work-related injury that is not the result of a sudden mishap or completely disabling penalizes the employee who faithfully performs her job duties despite bodily discomfort and damage…

The record is devoid of any discussion of a relationship between the claimant’s work activities and her complaints until June 2009. The claimant testified that she discussed her job duties with Dr. DiSanto. She stated that on June 10, 2009, Dr. DiSanto told her that she had carpal tunnel syndrome and that it was work related. The claimant’s symptoms did not affect her job performance until June 2009, and it was not until June 10, 2009, that she was diagnosed with carpal tunnel syndrome and her diagnosis was linked to her work duties. It was not until that date that the causal relationship between the claimant’s symptoms and her work duties became plainly apparent to her. We will not penalize the claimant for working diligently through her pain until it affected her ability to perform her job and required medical treatment. The Commission’s determination that the claimant failed to prove a manifestation date of June 10, 2009, is contrary to the manifest weight of the evidence. Sheils, ¶50-51.

Carpal Tunnel Syndrome (CTS), Illinois Workers’ Compensation Act, Illinois Workers’ Compensation Commission, Repetitive Trauma, Supreme Court of Illinois

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