Medical Evidence of Chest Pain, Shortness of Breath Defeats Reports of Back Injury at Work

Springfield, IL (WorkersCompensation.com) -- It's not uncommon for workers' compensation cases to involve multiple sources of medical evidence that span a period of months or years.

But as Harrah's Illinois Corporation v. Illinois Workers' Compensation Commission, No. 21-MR-1897 (Ill. App. Ct. 10/31/23) showed, sometimes the best bet is to stick with what was reported to doctors and medical staff in the immediate aftermath of an alleged workplace accident.

A casino buffet server, whose duties included cleaning tables, filling water cups, carrying heavy plates and bus tubs, and lifting five-gallon ice buckets overhead, bent over to put plates down when she felt pain across her chest and back. The server left work and received transportation to the emergency room. She returned to work about a week later but was terminated the following week after engaging in a "physical altercation with a coworker at work."

From the server's ER visit and subsequent hospital admission, medical notes indicated:

+ Chest pain with shortness of breath.
+ Complaints of pain in the mid-sternal area.
+ Pain that varied from between 2 and 8 on a scale of 1-10.
+ Sharp chest pain.

Several months after her hospital stay, the server visited her primary care physician, who opined that the workplace injury caused the server's symptoms of severe low back pain with radiation to both legs.

Roughly four months after the server's visit with her PCP, she underwent an independent medical evaluation, which concluded that the majority of her symptoms were preexisting and degenerative in nature due to her significant obesity.

More than a year following the injury, the server underwent a functional capacity evaluation. The therapist who performed the FCE opined that the server could return to work as a waitress with lifting and carrying restrictions. The therapist also restricted the server from walking more than a half mile continuously, engaging in balancing activities that required crouching and walking, and stooping.

Nearly two years after the injury, the server visited a pain management specialist, who opined that she suffered a work injury and also stated that "all the treatments and procedures" that she underwent after the injury were "medically necessary and reasonable."

An arbitrator found that the server failed to prove that she sustained an accident that arose out of and in the course of her employment and denied benefits. The arbitrator concluded that the server's complaints of back pain predated the alleged accident date.

The commission affirmed the arbitrator's decision, prompting the server to seek judicial review in court. The court set aside and reversed the commission's decision. The commission then found that the server was totally disabled from pursuing any meaningful work.

Back in court, the casino sought to have the commission's new decision set aside, but the court rejected that move, prompting the casino to appeal to the next level in court.

In Illinois, an employee's injury is compensable only if it arises out of and in the course of the claimant's employment. For an injury to arise out of the employment, its origin must be in some risk connected with or incidental to the employment so as to create a causal connection between the employment and the accidental injury.

Workers' Comp 101: In Illinois, an injury arises out of one’s employment if, at the time of the occurrence, the employee was performing acts she was instructed to perform by her employer, acts which she had a common law or statutory duty to perform, or acts which the employee might reasonably be expected to perform incident to her assigned duties. Caterpillar Tractor Co. v. Industrial Comm'n, 129 Ill. 2d 52 (Ill. 1989).

"In the course of the employment" refers to the time, place, and circumstances under which the claimant is injured. A compensable injury occurs in the course of employment when it is sustained while a claimant is at work or while she performs reasonable activities in conjunction with her employment.

According to the appeals court, the medical evidence did not back up the server's testimony that she injured her low back when she bent down while carrying heavy plates.

The court cited medical evidence showing shortness of breath and chest pain, not back pain, following the alleged accident.

"There was no mention of any complaints to claimant's lower back or a history of bending and carrying plates that caused a work-related, low back injury" on the date in question.

The court pointed out that additional notes from the server's treatment at the hospital and in the immediate aftermath of the alleged accident reported that the server presented with chest pain that occurred while she was "sitting at work."

Based on this evidence, the court reinstated the commission's initial decision ruling in the casino's favor.

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