December 2025; Doctor-Shopping Claimant Gets Half a Loaf of Benefits; Masseuse Gets "Rubbed the Wrong Way" by IL WC Decisions and more

Synopsis: Doctor-Shopping IL WC Claimant Gets Half a Loaf of Benefits.

Editor’s comment: My strongest recommendation in handling claims (and Claimants) such as this is to implement and stick to UR or utilization reviewwhen a man or woman is making an IL WC claim and treating and treating and treating some more. UR in the IL WC Act has presumptive value, if the rules setting it up are closely followed. Please note IME’s were used in this claim and did not slow Claimant from seeking a kaleidoscope of worthless and expensive medical care with doctor after doctor after doctor. Guess what, none of the care or tests or scans had any discernible value, other than to run up a gigantic medical payout. If you have questions or concerns about using UR in your IL WC claims, send a reply and we will get you answers.

Consider a Release/Resignation When Possible

From my review of the IWCC website, Claimant had four prior IL WC claims, all against the same employer. He may be a model for one of our clients’ requests thatwe always seek a release/resignation coincident to settling an IL WC claim. We tell our clients, it is our opinion we can’t legally force a resignation but there is no harm in asking. If you have questions or concerns about release/resignations in IL WC claims practice, send a reply and we will get you answers.

Read ‘Em And Weep – More than a Dozen Doctors of All Stripes and Sorts

This claim was just decided before the IL WC Appellate Court. Claimant testified that he worked for his employer as an auto technician for the past 40 years. On November 19, 2020, Claimant was performing a tire rotation. As he changed the last tire, he claims he slipped, fell backwards, hit his head on the ground and the tire fell onto his head. He initially claimed he lost consciousness. Claimant believed he injured his head, right eye, neck, and back. Claimant testified that he never received prior treatment for a concussion but acknowledged receiving an injection for lower back pain a few months prior to the accident.

Claimant testified that he did not have any physical restrictions affecting his ability to work prior to the November 19, 2020 accident. Claimant presented for treatment at the Silver Cross Hospital emergency department the next day on November 20, 2020, complaining of pain in the back right side of his head, nausea, and headache. Claimant did not mention at the ED that he lost consciousness. The physical examination demonstrated no dizziness, altered level of consciousness, tingling, weakness, tenderness, or contusions. Claimant demonstrated full strength and normal range of motion.

A computed tomography (CT) scan of claimant’s brain showed no acute hemorrhage, effects, shifts, or fluid. The results of the November 20, 2020, scans were normal and compared to a September 8, 2019, CT scan conducted after claimant presented to the ED with chest pain, dizziness, and occipital pain with radiating pain to the back of the neck and towards the eyes. ED staff diagnosed claimant with a likely concussion and closed head injury. ED staff also directed him to drink water and take Tylenol and ibuprofen. He was released from work for two days and instructed to follow up with his primary care provider (PCP).

On November 24, 2020, claimant presented to his PCP, a family practitioner, Dr. Michelle Danaher, complaining of headache, dizziness, nausea, and backache. The physical exam was normal. Dr. Danaher assessed claimant as suffering from a concussion without loss of consciousness and neck pain.

Claimant next saw Dr. Georgios Filiadis, who noted claimant’s complaints of blurred vision, dizziness, and right temporal parietal occipital pain that claimant rated 6/10. Claimant also reported losing consciousness during the accident, which Dr. Filiadis noted had not been reported during claimant’s initial visit on November 20, 2020. Scans were normal.

A couple days later on December 4, 2020, claimant presented to Joliet, IL neurologist Dr. Samina Bokhari. Claimant reported an ongoing 10-year history of “visual symptoms” that occurred once every two months wherein he experienced a “visual aura that usually starts on one side of [his] visual field and gradually moves on to the central visual field” followed by blurred vision. Physical exam was otherwise normal. An EEG and MRI were performed and results were generally normal.

Claimant next presented to Dr. Yousuf Sayeed, a pain management doctor. Claimant later presented to physician’s assistant, Ryan Enger, for more pain management. Claimant returned to Dr. Bokhari who felt Claimant might have post-concussion syndrome.

During March 2021, claimant returned to Dr. Bokhari who opined Claimant was outwardly normal.

On March 3, 2021, claimant presented to Dr. Ashraf Hasan, an interventional pain manager. Dr. Hasan treated claimant with various injections. During May 2021, the employer sent claimant to Dr. Jeffrey Kramer for an Independent Medical Evaluation (IME). Dr. Kramer is a professor at Rush. Dr. Kramer opined Claimant needed more care and the prior care was all related.

During July 2021, Claimant presented to Dr. Mohammed Khan at the Silver Cross Neuroscience Institute complaining of right-sided neck pain, vertigo, blurry vision, and occipital headaches. Claimant denied losing consciousness at the time of the accident. Dr. Khan reviewed claimant’s diagnostic studies, examined claimant, and noted that claimant’s brain showed no structural damage, his cervical spine showed no disc herniations, his gait was stable, and his upper extremity lacked radiculopathy. Dr. Khan diagnosed cervical strain and recommended physical therapy.

On July 20, 2021, claimant presented to Dr. Kenneth Moore at the University of Illinois. Dr. Moore noted that he had not encountered a patient with the same grouping of symptoms and called it a “very UNUSUAL case.” On a follow-up visit, Dr. Moore diagnosed claimant with traumatic brain injury without loss of consciousness. Claimant reported hearing music when the furnace blower turns on. Sensory and neural testing was normal. Dr. Moore concluded Claimant did not have any anatomic symptoms and did not meet the criteria for any recognized primary headache disorder. On August 15, 2021, Dr. Moore diagnosed claimant with monocular vision loss, noting that Claimant’s asserted blindness symptoms were unlikely related to his work injury and usually a stroke warning.

On September 1, 2021, claimant returned to Dr. Bokhari complaining of headaches and dizziness. Various tests were negative. Dr. Bokhari suggested a referral for psychiatric services if the auditoryhallucinations persisted, but claimant did not pursue the services.

On September 13, 2021, claimant presented to Dr. Thomas Deutsch at Rush Medical Ophthalmology Associates complaining of blurred vision with episodes occurring throughout the day, a couple days a week. Dr. Deutsch diagnosed claimant with vitreous detachment in the right eye with no indication of stroke, and post-concussion syndrome.

On September 29, 2021, employer sent claimant to Dr. Kern Singh for another IME. Claimant complained of pain that therapy and injections failed to relieve. Dr. Singh reviewed Dr. Kramer’s May 27, 2021, IME report, Dr. Moore’s notes, and the February 18, 2021, MRI. Dr. Singh diagnosed soft tissue muscle strain of the cervical and lumbar spine which had resolved. He opined that claimant reached MMI and could return to work.

On October 5, 2021, Dr. Kramer conducted a follow-up IME. Dr. Kramer diagnosed claimant with occipital neuralgia on the right, temporary aggravation of underlying degradation of the cervical region, and associated scalp tenderness. Dr. Kramer noted that “[claimant’s] current pain complaints are markedly out of proportion to any objective findings.”

Claimant’s workers’ compensation benefits ended October 25, 2021. He continued treatment through group health insurance. He may be on Medicare now.

On November 1, 2021, claimant presented to Dr. Dore Robinson complaining of neck pain traveling down to his left leg, and pain along the left side of his low back. Dr. Robinson diagnosed claimant with cervical and lumbar radiculopathy and recommended physical therapy and pain management.

On November 23, 2021, claimant saw Dr. Joel See for interventional pain management.

On December 9, 2021, claimant presented to Dr. Molly O’Shaughnessey. Dr. O’Shaughnessy’s neuro exam noted that claimant denied headaches.

On December 20, 2021, claimant returned to Dr. Robinson complaining of more pain. Chiro treatment was recommended and discarded by Claimant.

On March 20, 2022, claimant presented to Dr. Rani Chovatiya, Dr. Ankit Bhatia, and Dr. Dang for pain management for headaches. Claimant’s physical exam was normal.

At a November 21, 2022, arbitration hearing, Claimant testified he was awarded Social Security Disability Benefits and had not been released to work.

The arbitrator awarded reasonable and necessary medical expenses of $18,869.30. The Arbitrator awarded temporary total disability benefits of $968.04/week for 47 5/7 weeks, commencing November 20, 2020, through October 19, 2021. Prospective medical care was denied.

On June 14, 2024, the Commission, with one Commissioner dissenting, affirmed and adopted the arbitrator’s decision.

On January 15, 2025, the Circuit Court of Cook County confirmed the Commission’s decision.

On appeal to the IL WC Appellate Court, Claimant argued the Arbitrator and Commission’s decisions were against the manifest weight of the evidence because claimant was in good health prior to the accident, treating physicians never released claimant to work, and the Arbitrator and Commission relied on Dr. Singh and Dr. Kramer’s opinions despite conflicting medical opinions.

The Appellate Court, WC Division confirmed they review the Commission’s factual determinations under the manifest-weight-of-the[1]evidence standard. In resolving factual matters, the Appellate Court confirmed it is within the province of the Commission to assess the credibility of the witnesses, resolve conflicts in the evidence, assign weight to be accorded the evidence, and draw reasonable inferences from the evidence.

The Court stated this is especially true with respect to medical issues, to which they owe the IL WC Commission heightened deference because of the expertise it possesses in the medical arena

They indicated they will affirm the Commission’s decision if there is any basis in the record to do so, regardless of whether the Commission’s reasoning is sound or correct. As a long-time veteran IL WC Attorney, I struggle to read our Appellate Court, WC Division saying they will affirm a decision even if the Commission below is incorrect—I don’t believe they do that but I am not sure what to make of this aspect of the opinion.

I cannot find any PPD was awarded in the report on the IL WC website. Again, that is difficult to believe, one has to believe some PPD was awarded, probably as “body as a whole” that is now being awarded by all our IL WC Arbitrators, regardless of the statutory language that clearly blocks some PPD awards from being BAW. If you want more on that concept, send a reply.

Either way, I started this article to tell you to use UR on all claims involving unnecessary care and tooooo many doctors. I appreciate your thoughts and comments. Please post them on our award-winning blog.

Synopsis: Massage Therapist Gets “Rubbed the Wrong Way” by IWCC and Appellate Decisions.

Editor’s Comment: Claimant was employed by respondent, Terminal Getaway Spa, as a massage therapist. He filed a claim for workers’ compensation benefits in which he alleged that his work for Respondent had caused him to develop bilateral carpal tunnel syndrome and bilateral index, middle, and ring trigger fingers.

The Illinois Workers’ Compensation Commission found the alleged manifestation date of those conditions was unproven. Also, the Commission found that work-related causation was unproven. Those two facts led to the claim being denied and the denial affirmed in the reviewing courts.

The Appellate Court, WC Division held that, by finding that causation was unproven, the Commission did not make a finding that was against the manifest weight of the evidence. Given the lack of a proven causal relationship between claimant’s work for respondent and his condition of bilateral carpal tunnel syndrome and bilateral index, middle, and ring trigger fingers, any error the Commission made regarding the manifestation date would be harmless.

On June 22, 2022, at the arbitration hearing, the evidence relevant to the claim of work-related carpal tunnel syndrome and trigger fingers was essentially as follows.

• Claimant was employed by respondent as a massage therapist from January 2014 to September 2015.

• His hours varied, depending on how many customers came in, but typically, he worked seven hours a day, five days a week.

• He gave 8 to 20 massages a day.

• The duration of a massage ranged from 10 minutes to 90 minutes.

• The massages were either a deep tissue massage, a Swedish massage, or a sports massage.

Claimant testified about six months after he started working for Respondent, his hands and wrists began hurting.

He testified it was not until after August 30, 2015, when his manager accidentally shut a closet door on his left hand (an accident that occasioned another workers’ compensation claim), claimant decided to seek treatment for his bilateral hands and wrists. Claimant received separate treatment for the “door closing” claim.

Claimant saw Dr. Richard Kiang of Spine MD Limited for general hand issues. According to Dr. Kiang’s note for that date, claimant’s “Chief Complaint” was “left first through third finger paresthesia with a pain score of six to 10 out of 10”—in short, “[left] hand and finger pain.” Dr. Kiang did not note any complaint of bilateral hand or wrist pain. He administered an EMG to “Rule out sympathetic dystrophy to the L[eft] 2nd and 3rd fingers.” After the EMG, he diagnosed “SEVERE R[IGHT] CARPAL TUNNEL SYNDROME AFFECTING ONLY THE MOTOR ASPECT OF THE NERVE AND MILD L[EFT] CARPAL TUNNEL SYNDROME AFFECTING ONLY THE MOTOR ASPECT OF THE NERVE not likely due to his work injury with contributory L[eft] 2nd and 3rd finger pain.”

On November 25, 2015, five days after Dr. Fink surgically removed a soft-tissue mass from the proximal interphalangeal joint of claimant’s left index finger, claimant attended a follow-up appointment with him. Judging by Dr. Fink’s note for that date, Claimant did not complain to him, at that time, of pain in both hands and wrists. When examining claimant on February 17, 2016, Dr. Fink found that the left index finger had become more mobile. On cross-examination in his evidence deposition, Dr. Fink admitted that, in that visit, claimant did not complain to him of symptoms in both hands and wrists and that, consequently, Dr. Fink did not examine both hands and wrists at that time.

On February 18, 2016, at Respondent’s request, Claimant underwent an independent medical examination by Dr. John J. Fernandez. Claimant complained to Dr. Fernandez of bilateral hand and wrist symptoms.

On March 21, 2016, when Dr. Fink examined claimant again, he diagnosed a “stitch abscess” on the left index finger. At that time, he did not note any complaints of pain in both hands and wrists. On March 30, 2016, after reading Dr. Fernandez’s report of his independent medical examination of claimant, Dr. Fink wrote a narrative report disagreeing with Dr. Fernandez’s finding of a lack of work-related causation. Dr. Fink reiterated the opinion he had given previously, namely, that the closet door accident had caused claimant to develop (1) a soft[1]tissue mass on a joint of his left index finger and (2) after surgical removal of the mass, a “residual abscess” and “subsequent scar tissue” on that finger joint.

In addition, on March 30, 2016—apparently for the first time in his records—Dr. Fink noted a complaint by claimant of carpal tunnel syndrome in his right hand and a milder case of carpal tunnel syndrome in his left hand. According to Dr. Fink, there was “a definite causal relationship between [claimant’s] work as a massage therapist and symptomatology.” Dr. Fink recommended surgical removal of the stitch abscess (which eventually went away on its own, without surgery). Also, to prevent further atrophy and a worsening of complex regional pain syndrome, he recommended carpal tunnel releases in both hands.

On May 25, 2016, claimant complained to Dr. Fink of decreased sensation in both hands—greater in the left hand than in the right. Dr. Fink continued to recommend carpal tunnel releases.

In his evidence deposition, Dr. Fernandez agreed, on the basis of EMG findings and his own physical examination of claimant, that claimant had carpal tunnel syndrome and trigger digit. For two reasons, however, Dr. Fernandez disagreed that claimant’s work for respondent had caused the carpal tunnel syndrome. First, even if Dr. Fernandez agreed that working as a massage therapist could cause or aggravate carpal tunnel syndrome (he did not so agree, but assuming he did agree), “temporality,” or “the onset of symptoms,” was lacking in this case. One would expect the massage therapist to “develop symptoms with those activities,” but claimant’s history was different.

After the closet door injury to his left hand, he stopped working, and he remained off work for two months before an EMG was performed. It was not until March 2016 that he was “really given a true diagnosis of carpal tunnel by Dr. Fink”—when claimant had been off work for seven months. Dr. Fernandez would have expected that if the carpal tunnel syndrome were “work-related due to repetitive exposure frequency,” being off work would have caused the symptoms to improve rather than worsen over the “last four years” that claimant had now been off work.

The Appellate Court, WC Division ruled “Setting th[e] so-called manifestation date is a fact determination for the Commission” and the Court would defer to that fact determination unless it is against the manifest weight of the evidence

To be against the manifest weight of the evidence, the fact determination must be one with which “no rational trier of fact” could agree. Claimant argues that, by setting the manifestation date in June 2014, six months after the start of his employment with respondent, the Commission made a decision that was against the manifest weight of the evidence, for in June 2014, claimant merely began noticing symptoms in his hands and wrists and it is clear, from case law, that “the date on which the employee notices a repetitive-trauma injury is not necessarily the manifestation date”

Although claimant testified that, six months after he began his employment with respondent, that is, in June 2014, his hands and wrists began bothering him, he points out, on appeal, that he “was last seen by Dr. Gerber on October 28, 2015 who recommended an [EMG] test, which showed evidence of [claimant’s] carpal tunnel syndrome. On March 30, 2016, Dr. Fink authored a Narrative Report where he explicitly noted that [claimant] had ‘complaints of severe carpal tunnel syndrome on the right and mild on the left so there is definite causal relationship between his work as a massage therapist and symptomatology.’ ” Thus, claimant concludes, “this Court can reasonably infer that [claimant] first learned that his carpal tunnel syndrome was related to his work activities as a massage therapist between October 28, 2015 and March 30, 2016.”

Claimant makes a valid point here about the manifestation date. The trouble is, he appears to overlook the Commission’s alternative reason for denying workers’ compensation benefits for the bilateral carpal tunnel syndrome and trigger fingers: claimant’s failure to prove work-related causation. The Commission wrote: “Dr. Fernandez testified that he did not believe [Claimant’s] bilateral carpal tunnel syndrome was related to his activities as a massage therapist because of the (1) temporality of [Claimant’s] onset of symptoms and (2) the type of force [Claimant’s] job duties required.

There must be a showing that the injury is work related and not the result of a normal degenerative aging process.” By leaving the issue unaddressed, the Court found Claimant effectively conceded that he failed to make the required showing of work-related causation with respect to his bilateral carpal tunnel syndrome and trigger fingers.

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