Is pain alone sufficient to prove an aggravation of a pre-existing condition? The Appellate Court seems to think so…. So, what does this mean for Employers?

The Appellate Court issued a decision in Tazewell County v. The Illinois Workers’ Compensation Commission, 2025 IL App (4th) 230754WC, that could have serious implications on the compensability of pre-existing conditions.

In Dora Potts v. Tazewell County Health Department, 2022 Ill. Wrk. Comp. LEXIS 434, 22 IWCC 0422, Petitioner began working for Respondent as a registered dental hygienist on December 1, 2005. Petitioner reported her job duties involved repetitive pushing, pulling, reaching, and holding tools. Petitioner alleged that the repetitive nature of her job duties caused cumulative trauma leading to a rotator cuff tear, impingement syndrome and acromioclavicular (AC) joint arthritis. She underwent a left arthroscopy with subacromial decompression, distal clavicle excision of the left shoulder and arthroscopic rotator cuff repair on August 6, 2019. On April 1, 2020, she was released back to work without restrictions.  

At the Arbitration level, Petitioner was found not to have sustained an accident arising out of and in the course of her employment with Respondent. The Arbitrator found that there was no evidence in the treating medical records to support Petitioner’s claims. The Arbitrator reasoned that Petitioner made no reference to a work-related condition in her medical records until April 20, 2020 when she filed her Application for Adjustment of Claim with her attorney and approximately three weeks after reaching maximum medical improvement for the left shoulder.  

The Commission reversed the decision at the Arbitration level, finding that Petitioner sustained a compensable injury. The Commission found that while Petitioner had a pre-existing and unrelated rotator cuff tear, the evidence established that her work duties aggravated her condition to the point that she needed surgery. In tandem with the foregoing conclusion, the Commission reasoned that Petitioner denied any preexisting left shoulder issues, and there were no medical records establishing that Petitioner underwent treatment for the left shoulder prior to April 2019.

Perhaps one of the most notable aspects of the Commission’s decision were the findings of Petitioner’s treating doctor, Dr. Michael Merkley of Midwest Orthopaedic Center, and the Section 12 examiner, Dr. Lawrence Li of Orthopedic and Shoulder Center. Both Dr. Merkley and Dr. Li agreed that Petitioner’s job duties did not cause her rotator cuff tear. However, Dr. Merkley opined that Petitioner’s job duties caused left shoulder pain. Whereas Dr. Li opined that her job duties caused a very temporary aggravation of her left shoulder pain symptoms.

On judicial review, the circuit court of Tazewell County confirmed the decision of the Commission. In affirming the judgement of the circuit court, the Appellate Court found that Petitioner’s repetitive trauma and resulting shoulder pain arose out of and in the course of her employment with Respondent. The primary issue addressed by the Appellate Court was, “Whether repetitive work activity that results solely in pain from a preexisting non-work-related condition is compensable under the Act in the absence of a concomitant worsening of the underlying non-work-related condition.” This issue was of first impression, with the Court noting that other jurisdictions were split on this issue. In its reasoning, the Court stated that, “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.  When a preexisting asymptomatic condition becomes painful for reasons other than an organic or structural change or natural progression, it follows that the preexisting condition was aggravated by something.  If the aggravation is work-related, such as repetitive trauma, and solely causes pain, we hold that the pain suffered is, in and of itself, a compensable aggravation (page 15).”

How does the decision of the Appellate Court effect Employers?

The Appellate Court’s decision will have an impact on our analysis on compensability of pain complaints moving forward. If pain alone is sufficient to prove an aggravation of a pre-existing condition, will Courts rely more on subjective complaints than objective findings? Is pain compensable only when the symptom aggravation is determined to be permanent? Is there a threshold for temporary aggravations of symptoms that lead to pain? How does this impact values for partial permanent disability? Most importantly, how do we challenge this moving forward? Certainly, we must be mindful of this decision and evaluate the potential impact of pain complaints, even when there is a preexisting condition throughout the litigation process.

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How do we defend these types of claims after the Appellate Court’s decision?

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First, we perform a thorough investigation into the potential of any prior treatment for the underlying condition.  If evidence is found of prior pain complaints, then a subjective complaint associated with work activities alone would likely not suffice to prove an aggravation.  Consideration for a medical canvass, subpoenas for pre-accident medical records, and a Section 12 examination should be given in these cases.

Second, we investigate the employee’s credibility since it is particularly important when the evidence is based solely on their complaints.  Statements from co-workers or supervisors could be helpful.  Investigation into activities and hobbies outside of work could also prove fruitful.  Social media checks and/or surveillance should be considered under the right circumstances.

Conclusion

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In summary, the Appellate Court’s decision has demonstrated that pain alone may be sufficient to prove that a work-related accidental injury aggravated or accelerated a preexisting condition such that the employee’s current condition of ill-being can be said to have been casually related to the work event. It appears that even where there is no objective medical evidence to support a causal connection, subjective complaints alone can render a claim compensable. Therefore, we must closely examine the credibility of the claimants in such cases and continue to refine our investigation and defense strategies.

Please look for further discussion and analysis of this case in ASA’s newsletter. In the meantime, please reach out to sahmed@asalawgroup.net or any one of the ASA’s attorneys with any questions or concerns about this case and its effect on your current claims.

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