June 2026; New Legislative Changes to IL WC Act Arrive; New Odd Strategy Claimant Attorneys May be Trying to Rein in IME sites and more

Synopsis: Legislative Alert!!!Illinois Lawmakers Fiddle with the IL Workers’ Compensation Act. IL WC Medical Defenses Now More Perilous for Illinois Employers. Thoughts and Research by John P. Campbell and Eugene F. Keefe

The Illinois General Assembly recently passed House Bill 5228, introducing significant changes to the Illinois Workers’ Compensation Act. These revisions will greatly impact how employers, claims professionals, and attorneys on both sides manage and defend claims in this state, as explained below. This will not become law unless and until the Governor signs it—he has 60 days to do so.

Editor’s Comment: Every five or six years we see some tinkering to our IL Workers’ Compensation Statute. While this round of changes are few, perhaps the most significant change this time involves the Section 12 Examination process, often called the independent medical exam (IME).

Please note there may now be three distinctly different IME’s in the IL WC matrix:

• IME’s that deal with reasonableness and necessity of provided or proposed care:

• IME’s that deal with solely with causation;

• IME’s that deal with disability ratings/return to work issues when MMI has been reached.

Under the revised statute, with regard to IME’s that relate, in whole or in part, to reasonableness and necessity of medical care, IL employers and insurance representative are effectively “on the clock”. An IME must be completed and report tendered to Petitioner and/or their representative and the treater within a 90-day timeframe. Of note, statutory language specifically indicates that the report“shall be provided by the medical practitioner to the employee or employee’s representatives and the employee's treating healthcare professionals within 90 days.” This appears to compel the IME physician to tender the report directly to Petitioner. Moreover, the 90-day period begins when the employer receives the medical records from the treating healthcare professional requesting the medical service. As such, Respondents are afforded time to gather the relevant records needed to perfect the exam.

Nevertheless, this new 90-day window creates a time crunch for the employer or claim representative to obtain an IME. Respondents must also carefully track the date medical records were received and be mindful of the need to turn around an IME report in 90 days. Finding board-certified IME physicians who acknowledge and comply with this tight turnaround time may prove an additional challenge. 

It is also worth noting that according to the revised statute addressing Utilization Review, “A report made under Section 12 is not a valid utilization review and shall not be used to determine the appropriateness, medical necessity, reasonableness, or quality of treatment.” This is an important change, as the statute previously outlined an IME under Section 12 as one form of utilization review. That appears to no longer be the case. We also feel this legislative language is confusing for the average claims handler or risk manager. Send a reply if you have questions.

Moreover, as we indicate above, IME physicians must now be board-certified in the same specialty as the treating healthcare professional requesting approval for recommended medical care. If the employer fails to comply with these new rules after receiving medical records from the treating healthcare professional, or blows the 90-day deadline for production of the IME report, there is a rebuttable presumption that the employer shall be responsible for the payment of additional compensation under the Section 16 and 19 penalty provisions under The Act. That said, as you may know penalties and fees are calculated on benefits that aren’t being paid—if you and your company/TPA are up to date on benefits, the Section of the new legislation is nonsensical. However, in cases where a surgery has been performed on a disputed basis, and the charge is outstanding, this 90 day window applies to perfect an IME to maintain denial of the procedure performed. 

Please also note, this 90-day turn-around appears to apply only to an IME that addresses reasonableness and necessity of care (past or proposed care). Therefore, if an IME is ordered at the end of a claim to address, say, return to work function and/or an impairment rating, this 90 day deadline is not applicable pursuant our reading of the plain language of the statute.

The more difficult question is whether an IME challenging causation is beholden to the 90-day reporting deadline. For example, if the IME determines a medical condition is unrelated to the work injury, the treatment may be denied by Respondent in reliance of the IME, but not due to the “reasonableness and necessity” of the proposed procedure. The denial has nothing to do with whether treatment is needed. In such a case, it is unclear whether the new statutory provision would require the same 90 day turn around.

Who is going to pay for this new legislative requirement?

As the IME report in a “reasonableness and necessity” opinion is going out from the IME doc in four different directions—do all four parties split the cost? We are certain this is a new issue that isn’t addressed at all in the new proposed law.

We are confident the rebuttal to shared IME cost(s) from the Claimant bar will simply assert that the party who ordered the exam must pay for the exam/report and copying/transmission/FedEx, just as before this new law. On the other side of that argument is the fact the employer/insurance carrier/TPA ordered the IME document, owned it and only had to disclose in limited circumstances.

Traditionally, the IME doctor has a reasonable and healthy fee for the exam and report combined. It has traditionally been one fee. The doctor may not turn it over to any party before he or she is paid, but we feel the secret parties-that-be-who run the IWCC feel Petitioner is not going to pay anything for the IME report, just as before. I believe they feel doctors will copy and send four reports and only charge Respondent for the newly required handling/copying/mailing.

As John Campbell reads the statute, it is simply adding a deadline to complete the IME process and tender four reports—three of which will be sent for “free.” If Respondent fails to pay for the IME, John is sure the doctor will not turn it over, even if the 90 days expires.

There is no penalty to the doctor, but Respondent may bear the ramifications if the doctor fee is not paid and a report is not tendered. Therefore, I think our more sound advice is for the Respondents to be sure the IME fee is paid timely so the report is not delayed.

UR Re-Done in IL WC

In addition, there are similar changes to Section 8.7 of the Act regarding utilization review. Just as required by an IME physician, a utilization review medical provider must have a current certification by a recognized American specialty board in the area appropriate to the subject of review. Further, any certification or non-certification shall be valid for 3 months after the date which the employee and healthcare provider receives certification.

Section 8.7 now specifically excludes a Section 12 IME exams as a form of Utilization Review and further asserts that “Any other denial or refusal of the necessity of medical services except by utilization review constitutes unreasonable and frivolous delay” This language appears contradictory to the provision in Section 12, where IME’s are often employed to specifically address the reasonableness and necessity of medical services. 

We do feel UR providers will quickly catch up to these new challenges.

Summary

Absent an effective date, we should assume these changes will be in effect upon signature by the Governor. We further expect these changes will apply to both pending and future claims where an IME has not yet been perfected. Therefore, our best advice is to implement a new protocol for IME’s ASAP to meet this 90 day requirement.  Any current claim where an IME is being contemplated, Respondents should presume the 90-day clock has begun to run on the need to produce an IME report, once you have all relevant treatment records necessary for the exam.

Finally, for our readers in the trenches of day-to-day claim handling, it is important to also note the new bill increases the burial expense on death claims from $8,000 to $10,000.

We appreciate your thoughts and comments, please post them on our award-winning blog.

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Synopsis: New and Irritating IME trend that may be coming to an IL WC claim you are managing.

Editor’s comment: We have recently seen notes from a treating doctor that summarily finds a Claimant cannot travel 

• Short distances or

• Any distance

Due to injury. It appears clear this physician is probably being coached to write this note. In using this path, the treating doctor is blocking access to doctors/surgeons and specialists outside of the immediate area where Claimant resides.

We are letting the IL WC defense industry know this laughable idea is probably coming at you soon. Our suggestion is to make clear there is no part of the IL WC Act or Rules that provides a “limit” on how far an injured claimant has to travel for medical care or an IME.

Two other thoughts in response:

• Have the IME doctor go to Claimant’s home (we said it was a thought!!) or

• Do a remote IME in the appropriate case with Arbitrator approval. 

We appreciate your thoughts and comments, please post them on our award-winning blog.

April 2026; Disputed Work-Related Death of "Traveler" Reviewed; AI and Workers Comp and more

Synopsis: Illinois WC Appellate Solid Ruling on Disputed Work-Related Death of “Traveler” Leaves Us Guessing… Subway v. IL WC Commission. 

Editor’s comment: First, the term “traveling employee” isn’t defined anywhere in the IL WC Act or Rules. The IWCC and courts can interpret it, as they feel it best. Typically, the lack of statutory direction means we are going to see unexpected outcomes related to indefinable “travelers” when such cases reach our usually liberal IL WC reviewing court. Welcome to the People’s Republic of Illinois, as my old friend would say. This ruling is less than liberal and is crystal clear to your editor.

Does the Traveling Employee Concept bring global coverage of anything an Illinois Worker does outside the “office?”

Please note lots and lots of workers no longer work full-time in an office—there are now “remote” workers and “hybrid” workers, whatever that means. As I have advised everyone in the IL WC matrix who will listen, if you provide “global coverage” of any event to make it covered under WC, you no longer need lawyers, whether they be hearing officers or attorneys on both sides. Work comp becomes more like group health and short-term disability—fill out the form and you get the coverage offered. Yes, I agree IL WC without any defenses is going to be pricy.

The concept of “traveling employee” in most States of the United States relates to “duh” employees who are injured while on a “trip.” On the other side of that coin--if a claimant is an office worker and goes to a local pharmacy to buy a pack of gum, in my view, they aren’t a “traveler,” as they are doing normal life activities and need to be careful. The higher protections that I feel should be afforded to “traveling employees” means the person is in a foreign country or distant place that might have unexpected risks, language, police and dangers. There is nothing unexpected about going to buy gum at a local store—you don’t need to add the “traveling employee” concept to confuse everyone. If you ask me, stick to traditional work relation analysis.

In this ruling, Claimant is the heir of a decedent. She is seeking benefits for Decedent’s fatal “one-car” automobile accident while the Decedent was employed by respondent Subway, her employer. She was traveling from one small-town IL location to another, moving supplies. Nothing exciting about that trip.

Benefits were awarded and the employer appealed to the IL WC Appellate court. The Appellate Court, WC Division reversed the judgment of the circuit court and set aside the Commission’s decision and remanded this matter to the IWCC panel for findings on “reasonable and foreseeable.” As a veteran defense attorney, I am perplexed. Keep reading, please.

At the Arbitration hearing, evidence presented was

(1) A death certificate,

(2) Decedent’s medical and funeral bills,

(3) An expert opinion report from Dr. Ronald Henson,

(4) a certified Illinois State Police investigation report, and

(5) a certified coroner’s report.

As I indicated above, the hearing evidence also included a stipulation Decedent was driving from a Subway store in Gillespie, Illinois, to another Subway store in Litchfield, Illinois, to deliver restaurant supplies. That is about a ten-mile trip on wide-open IL state roads and would be expected to take about 10 mins.

For reasons I don’t understand and completely disagree with, the record reflects the arbitrator and counsel for the employer agreed decedent was to be considered a “traveling employee” for purposes of determining this claim for benefits under the IL WC Act. From my perspective as a critic of IL WC law, there isn’t anything unusual or dangerous to drive that far on the roads that were used. I strongly criticize the decision to stipulate to “traveling employee.”

The evidence presented showed that during the trip, the decedent was involved in a severe “one-car” collision, in which her vehicle slammed into the rear of a stopped truck and trailer, causing her passing. The term “one-car” collision is a technical term used to cover the fact only one vehicle was moving.

With respect to the deceased and family, Decedent didn’t survive the impact. From my reading of the Appellate Court ruling, there were no skid marks and no evasive maneuvers demonstrated by braking marks. While we should feel remorse for the loss of this worker to her friends and family, the event as described could have readily killed the truck driver and, if Decedent was driving by a schoolyard or church, this one-vehicle event could have been calamitous.

Emergency room records contain a nurse’s note that “no attempt to stop was made” and a notation of “distraction injury.” A certified Illinois State Police investigative report stated that a firefighter at the scene collected a cell phone from the decedent’s vehicle and told the investigating officer it was playing a video when he picked it up.

The accident report noted cell phone use, no use of a safety belt, speeding, and failure to reduce speed to avoid a crash. A toxicology analysis in the Montgomery County coroner’s report showed cardiac blood testing was positive for lots of different types/levels of marijuana.

This isn’t in the Appellate Court’s ruling but please also note from Secretary of State Alexi Giannoulis website: Distracted Driving Rules in Illinois--Illinois law prohibits the use of electronic communication devices to write, send, or read text messages, emails, or other electronic communications while driving. In 2024, legislation went into effect that also made it illegal to use teleconferencing apps, watch videos, or access social media sites while driving. Hands-free devices or Bluetooth technology is allowed for persons aged 19 and older. But even using hands-free technology is considered a distraction while driving and can be dangerous. If you must make a phone call, even with hands-free technology, it is recommended that you pull off to the side of the road before making the call. The only time Illinois drivers can use a cellphone that is not hands-free is:

• To report an emergency situation.

• While parked on the shoulder of a roadway.

• While stopped due to normal traffic being obstructed and the vehicle is in neutral or park.

• Drivers who are in a crash resulting from distracted driving may face criminal penalties and incarceration.

Dr. Ronald Henson, a consultant with Beran Consulting, Lab Works, and Media Services Inc., and an expert in drug and alcohol toxicology, physiology, and pharmacology, reviewed the police accident report, the County coroner’s preliminary death report, and the toxicology report. His report noted his concerns about the science, measurements and use of marijuana by decedent. He did not opine THC, the active drug in marijuana wasn’t present in Decedent.

Please note in Illinois WC, Section 11 covers the situation of a worker using marijuana prior to injury. The use of marijuana in the workplace is governed by the Cannabis Regulation and Tax Act, which allows employers to enforce drug-free workplace policies and conduct drug tests. The IL WC Act uses a "good faith belief" standard for impairment, meaning employers can treat an employee as impaired if they display specific symptoms that reduce job performance. In short, when a worker tests positive for cannabis after a workplace accident, it creates a rebuttable presumption that their intoxication caused the accident, making it the burden of proof for the employee to show that their cannabis use did not cause the injury.

On this evidence, the arbitrator found that the decedent’s death occurred due to an accident that occurred during the course of her employment and awarded the claimant a weekly death benefit as well as medical and funeral expense benefits. There is no question the value of the death benefit could exceed $1,000,000. In the analysis, the arbitrator did not specifically discuss decedent’s status as a “traveling employee,” rather the decision concluded that claimant’s entitlement to benefits depended more generally on the question of whether the decedent removed herself from the protections of the Act by committing any actions “intentionally, with knowledge that they were likely to result in serious injury, or with a wanton disregard of the probable consequences.”

The arbitrator specifically concluded that the evidence of decedent’s possible “speeding, distraction by use of a cell phone while driving and/or being under the influence of marijuana” did not support denial. I am mildly surprised to report the Arbitrator doesn’t appear to mention the rebuttable presumption that intoxication caused the accident.

The employer appealed the arbitrator’s decision to the Commission, contending in part that the arbitrator applied the incorrect legal test for traveling employees under the Act. The Commission affirmed and adopted the arbitrator’s decision in its entirety. It doesn’t appear they considered or ruled on the rebuttable presumption either. The employer then appealed the Commission’s decision.  The circuit court confirmed the Commission’s decision, and this appeal followed.

On appeal, the employer contended the Commission erred by adopting the arbitrator’s decision, which did not utilize the law applicable to traveling employees. The Appellate Court, WC Division found the Commission’s decision was erroneous in what I consider an unusual fashion.

The reviewing court properly ruled an employee’s injury is typically compensable under the Act only if it “aris[es] out of” and “in the course of” her employment. They found the employee bears the burden of proving each of these elements by a preponderance of the evidence. An injury occurs in the course of the employment when it is sustained while a claimant is at work or while she performs reasonable activities in conjunction with her employment. An injury arises out of one’s employment if it originates from a risk connected with, or incidental to, the employment, so as to create a causal connection between the employment and the accidental injury. The question whether a claimant’s injury arose out of her employment is typically a question of fact to be resolved by the Commission, whose finding will not be disturbed by the reviewing courts unless it is against the manifest weight of the evidence.

However, they found a “traveling employee” is one whose work required her to travel away from her employer’s office. The determination whether an injury to a traveling employee arises out of and in the course of her employment is governed by different rules than the rules applicable to other employees. A traveling employee is deemed to be in the course of her employment from the time that she leaves home until she returns. An injury sustained by a traveling employee arises out of her employment if she was injured while engaging in conduct that was reasonable and foreseeable, i.e., conduct that “might normally be anticipated or foreseen by the employer.” Whether an employee was injured while engaging in conduct that was reasonable and foreseeable to the employer is a question of fact to be resolved by the Commission. The reviewing court will typically confirm the Commission’s determination on this question unless it is against the manifest weight of the evidence. However, “[w]hether a claimant must prove certain elements to establish a compensable claim is purely a question of law and it is therefore reviewed de novo.” And, to determine whether an incorrect legal standard was applied requires a reviewing court to first determine the correct legal standard, which is also a question of law that our reviewing court would review de novo.

The unanimous ruling by the IL WC Appellate Court found evidence included a stipulation decedent was driving from one Subway store to another Subway store to deliver restaurant supplies at the time of the incident. As such, the arbitrator and counsel for the employer agreed that the decedent was to be considered a “traveling employee” for purposes of determining this claim for benefits under the IL WC Act. And the arbitrator and the Commission were obligated to analyze the claim for benefits in this matter under the applicable “reasonable and foreseeable” legal test outlined above, a request that was specifically made by Subway in the statement of exceptions to the arbitrator’s decision it filed with the Commission below.

The record was clear that here the Commission “affirmed and adopted” the decision of the arbitrator in full and without further analysis. As noted by the Appellate Court, the arbitrator’s decision itself made no reference to nor any attempt to apply the “reasonable and foreseeable” test applicable to traveling employees. Rather, the arbitrator’s decision, adopted by the Commission, analyzed the issue by considering whether decedent committed actions “intentionally, with knowledge that they were likely to result in serious injury, or with a wanton disregard of the probable consequences.”

As I outline above, Decedent was almost certainly breaking several laws. She was stoned from marijuana use, speeding and subject to criminal penalties for watching her cell phone while driving. I again point out and do so sadly, she was a potentially lethal danger to everyone around her.

In summary, the IL Appellate Court, WC Division found the matter must be remanded to the Commission for a proper analysis under the correct “reasonable and foreseeable” legal test for traveling employees. I feel the Commission has to openly consider the facts above.

We appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: Is workers’ comp ready for AI in the workplace? What are we going to do with all these humans???

Editor’s comment: AI feels like a tsunami to me. It is going to keep coming at us whether we like it or don’t. Hybrid workplaces are blurring responsibility across employers and tech providers.

My law partner confirmed we have the ability to put a stack of medical records into a scanner and AI will review, digest and summarize the stack in minutes/seconds!!

As labor shortages and skills gaps increase across industries, businesses are increasingly turning to artificial intelligence not just to boost productivity, but to fill workforce gaps. What began as a tool for efficiency is quickly becoming a structural solution to hiring constraints, and risk and claims specialists warn the shift is already reshaping workplace risk in ways that could significantly alter the future of workers’ compensation.

As of early 2026, roughly half of US employees now use AI in some capacity at work, with 28% using it at least weekly and 13% using it daily, according to Gallup research. While you would think it would have the opposite effect, among US firms deploying AI, 38% report increasing headcount compared to 23% reducing it.

In sectors such as manufacturing, logistics, and construction, automation and AI-enabled systems are stepping in to manage repetitive, physically demanding, or high-risk tasks. In office environments, generative AI tools are augmenting administrative, customer service, and analytical functions, reducing reliance on scarce talent and allowing existing employees to focus on higher-value work.

AI risks in the workplace

At the same time, so-called “physical AI”, including autonomous systems, robotics, and smart machinery, are performing more and more tasks. This evolution is shifting workplace exposure away from traditional human-driven incidents toward risks tied to system failures, software errors, and machine downtime.

AI-powered systems can also reduce accidents. Computer vision tools and predictive analytics are already being deployed to identify hazards before incidents occur, enabling earlier intervention and improving overall workplace safety.

We appreciate your thoughts and comments. Please post them on our award-winning blog.

March 2026; Happy St. Patrick's Day to All; Some IL WC Claims Are Now Being Treated as Common Law or even Criminal Law Claims; Tim O'Gorman on a Interesting Fall-Down Claim and more

Synopsis: Shocking IL WC Claims Where Our IL Courts Don’t Treat Them as WC Claims!!

Editor’s Comment: As we reported last October 2025, in Rivas V. Benny’s Prime Chophouse LLC, Claimant was at work, ate food from his employer and sadly passed away at work. Turns out he was very allergic to sea food. You may note his widow probably didn’t get a dime in IL WC death benefits because to accept such benefits would change the course of the litigation that almost certainly was driven by the widow’s counsel into the common law courts.

Please also note Decedent passed in 2010. While the widow may now get some recovery, assuming she is still alive and with us, it is hard for me to imagine she was better served to go into the snail-like common law courts.

I cautioned we have to remember this claim may be appealed to and accepted for appeal by the IL Supreme Court. Their ruling may again greatly change this outcome. But for now, it is an Appellate ruling of note.

Please note if they had proceeded to seek WC death benefits, the IL WC death claim would have been paying her regular WC checks for the last fifteen+ years plus additional increases from the IL WC Rate Adjustment Fund.

In 2012 the widow Rivas filed a common law negligence lawsuit, alleging the restaurant was “aware” of her husband’s shellfish allergy—whatever that might mean. I find it impossible to believe restaurant management was aware of the acute and deadly nature of the seafood allergy and encouraged Claimant to play “Russian Roulette” with its free grub. The widow also claimed the employer somehow “failed” to inform Decedent the meal contained shellfish.

The point I am trying to make for my readers is simple—if it was competently presented at a WC hearing, there is no way in my mind, none, that our liberal IL WC Commission could not have found this claim and her recovery to be from the workers’ comp system.

If, instead of suffering a fatal exposure, Decedent had broken a leg or popped a disc in his spine, in my view, he would have a 99% chance of IL WC recovery. He was at work. He was probably wearing clothes and equipment from his work. He was given food from his employer’s oven. He was eating in the company of co-workers only. Who in their right mind would think the event was non-work-related in this liberal State?

In short, I believe this was a WC claim that was turned into a common law claim to seek millions of dollars. After more than a decade and a half of litigating, you tell me, is the widow better or worse?

Shocking Second Death Claim – Are Incompetent Village Workers Going to Face Criminal Charges?? If Not, Why Not?

An Illinois appellate court revived a wrongful death lawsuit filed by the estate of a municipal water worker who drowned after being sent alone into an underground vault, ruling the claims are not barred by workers compensation exclusivity.

In Heiden v. Village of Westmont, the Illinois Appellate Court for the Third District reversed a lower court’s dismissal of the case and remanded it for further proceedings.

The case stems from the February 2023 death of Matthew Heiden, a 20-year-old employee of the Village of Westmont’s water department. According to the complaint, the village sent Mr. Heiden alone into a permit-required confined space to repair a leaking valve without required safety precautions or protective equipment. While Mr. Heiden was in the underground vault, a valve dislodged, trapping his arm as the vault filled with water. Emergency responders eventually freed him, but he was pronounced dead at a hospital.

From those facts, there is no question this is an IL WC Death claim. The maximum IL WC Death benefit would pay the widow around $100k per year with annual increases from the IL WC Rate Adjustment Fund. She would get over $2.5M.

An investigation by the Illinois Department of Labor identified multiple safety failures, including the absence of a confined-space entry permit, lack of training and personal protective equipment, failure to de-energize the water main and the absence of a retrieval system such as a harness and line. The worker’s estate sued the village and others, alleging the municipality intentionally violated safety rules and knowingly sent the worker into a dangerous confined space.

A Du Page County circuit court dismissed the claims against the village, ruling they were barred by the exclusivity provisions of the Illinois Workers’ Compensation Act.

The IL Appellate Court disagreed, finding the estate plausibly alleged intentional conduct sufficient to invoke an exception to workers compensation exclusivity, which generally bars civil suits against employers for workplace injuries.

Please note the logical conclusion of what the IL Appellate Court ruled is the presence of intentional conduct leading to the passing of this unfortunate soul. When the Courts find intentional conduct led to the death of someone, that means someone should be on the hook for murder, right?

In summary, it is difficult to watch from the sidelines and try to figure out where our Illinois courts and the forces of ITLA will go.

We appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: KCB&A Gets A Great New LegalScore Performance Rating from Gallagher Bassett.

Editor’s comment: We salute the Gallagher Bassett Organization and look forward to bringing great service and advice to them and all our amazing defense clients.

If you are seeking great defense counsel, email jcampbell@keefe-law.com or sbiery@keefe-law.com.

Synopsis: So, is Everything that Happens at Work a Compensable Claim in Illinois Now?... NOT AT ALL!! Research and drafting by Timothy O’Gorman, J.D.

Editor’s comment: While the trend for expanding compensability in Illinois WC is troubling, there are still viable defenses to some incidents and injuries at the workplace.

In Juarez v. IWCC, a Petitioner who suffered an unexplained syncopal (or fainting) episode due to diabetes was denied benefits for injuries caused by a fall.

Petitioner was a machine operator who fell while working and suffered injuries to her head and ribs. Petitioner testified she suffered from diabetes and took medications to control her condition. Petitioner testified on the date of accident, she was working on a platform and was required to move from one side of the platform to the other repeatedly.

Petitioner asserted on the day of the accident, she slipped and fell on the platform. She did not ascribe a cause to the slip/fall.

Paramedics were called and believed Petitioner was suffering from diabetic symptoms and administered blood sugar controlling medications. Petitioner was taken to the emergency room where she explained she had not taken her medication that day, had not eaten breakfast and instead drank a sugary drink.  

Petitioner’s primary care physician testified that in the days preceding the accident, Petitioner’s metabolic testing demonstrated uncontrolled blood sugar levels and that subsequent to the accident, Petitioner told her PCP she lost consciousness after hitting her head.

Petitioner also treated with three different orthopedic physicians whom she told she slipped and fell at work. Petitioner also testified during trial she slipped and fell while working. She never outlined any “cause” of the slip/fall.

We have to consider--Is an idiopathic fall subject to McCallister analysis which requires some aspect of employment to have contributed to the alleged injury? The IL WC Appellate Court affirmed denial and specifically stated that when the cause of a fall (or any injury) is due solely to a cause related to Petitioner’s actions, behaviors or other health issues and there is no factor of their employment that caused their injury, the McCallister standard is not met and therefore, not compensable.

Establishing the idiopathic nature of a fall is difficult and is often a question of fact for the IL Commission. Defining the injury in this case as “idiopathic” is misleading. More accurately stated, Respondents in such cases have the burden to identify a cause of an injury separate from and unrelated to employment tasks being performed at the time of injury. In this case, Petitioner’s diabetic condition caused her injury and Respondent was able to point to that specific condition as the cause of her injury.

Additionally, there may be exceptions to this rule in “traveling employee” cases or cases where a claimant’s underlying health condition may have been made worse by employment conditions. Understanding the full context of not only a Petitioner’s pre-existing health conditions but also how they may have been affected by working conditions can help prepare defenses and predict outcomes.

As I indicate above, this article was researched and drafted by Timothy O’Gorman, J.D. You can relay questions, concerns and Green Beer to Tim at togorman@keefe-law.com--kidding about the Green Beer reference!!!