State News : Illinois

by: Kisa P. Sthankiya

By: Jigar S. Desai

In a February 26, 2026, opinion, the Illinois Appellate Court, Fifth District, Workers’ Compensation Commission Division, addressed a question of first impression under the Workers’ Compensation Act (Compensation Act), 820 ILCS 305/1, et seq.: whether a claimant who sustains a single injury to one body part may receive concurrent awards under both the scheduled loss provisions of §8(e) and the person-as-a-whole provisions of §8(d)(2). Azcon Metals v. Illinois Workers' Compensation Commission, 2026 IL App (5th) 250301WC. The court held that a claimant must elect one remedy or the other for the same injury, and that an employer who made a voluntary payment under §8(e) is entitled to a credit against a subsequent award under §8(d)(2).

The court affirmed the Commission’s award of permanent partial disability benefits under §8(d)(2) but reversed the Commission’s denial of credit to the employer for benefits previously paid under §8(e).

The decision provides important guidance on the interplay between §§8(e) and 8(d)(2), the election-of-remedies doctrine in workers’ compensation, and the credit principles that apply when employers make prompt voluntary payments under the Compensation Act.

Factual Background

Tom Snyder sustained an injury to his right foot and leg while working for Azcon Metals on March 19, 2020. His right foot was crushed between two rail cars. Snyder initially underwent surgery that resulted in the amputation of four toes on his right foot. However, the following day, he underwent a second surgery that resulted in the amputation of his right leg at the mid-tibia, below the knee.

Following the surgeries, Snyder was fitted for a transtibial prosthetic and participated in physical therapy, work hardening, and a functional capacity evaluation. The evaluation indicated that he could perform work at the heavy physical demand level but had decreased tolerance for prolonged standing and walking on uneven surfaces. Snyder participated in vocational rehabilitation and expressed his intent to pursue employment in heating, ventilation, and air conditioning or in the construction industry, acknowledging that those fields may require traversing uneven ground but believing he could manage the slower pace of such work.

Following the work injury, the employer promptly paid Snyder $97,010.30 in permanent partial disability benefits for the scheduled loss of his right foot pursuant to §8(e)(11) of the Compensation Act. The payment was made in two installments: $60,716.19 on April 20, 2020, and $36,294.11 on April 28, 2022, calculated at 167 weeks using a stipulated minimum statutory amputation rate of $580.90.

Procedural History

On April 17, 2020, Snyder filed an application for adjustment of claim. The matter proceeded to an arbitration hearing on January 27, 2023. At the outset of the hearing, the parties stipulated that the employer had paid, and was entitled to credit for, $17,438.31 in temporary total disability benefits and $42,822.94 in maintenance benefits. The parties further stipulated that the employer had paid $97,010.30 in permanent partial disability benefits for the scheduled loss of Snyder’s right foot under §8(e)(11), but they disagreed as to whether the employer was entitled to a credit for that payment against any additional permanent partial disability award.

Snyder waived his right to a wage differential award under §8(d)(1). The arbitrator awarded all requested medical expenses and, after considering the factors set forth in §8.1b(b)(v) of the Compensation Act, found that Snyder sustained permanent partial disability to the extent of 65 percent loss of use of the person as a whole under §8(d)(2). The arbitrator denied the employer’s request for a credit for the §8(e)(11) payment against the §8(d)(2) award.

On review, the Commission unanimously reduced the §8(d)(2) award from 65 percent to 45 percent loss of use of the person as a whole, finding that Snyder was young and remained capable of physically demanding work. The Commission, however, agreed with the arbitrator that the employer was not entitled to a credit. The Commission characterized the credit issue as one of first impression, concluded that §8(d)(2) did not permit an offset for previously paid amputation benefits, and noted that the employer had paid benefits under the incorrect section — §8(e)(11) (loss of foot, 167 weeks) rather than §8(e)(12) (amputation below the knee, compensated as loss of a leg at 215 weeks).

The circuit court affirmed the Commission’s decision in its entirety. The employer appealed to the appellate court.

The Appellate Court’s Analysis

Framing the Issue

As a threshold matter, the appellate court corrected the framing of the employer’s first argument on appeal. The employer had argued that the Commission erred by awarding benefits under both §§8(e) and 8(d)(2). The court clarified that the Commission did not “award” benefits under §8(e); rather, the employer had made a voluntary payment under that section prior to arbitration. The Commission only awarded benefits under §8(d)(2) and separately considered whether the employer was entitled to a credit. Accordingly, the court reframed the central issue as whether the Commission erred by denying the employer a credit for its voluntary §8(e) payment against the §8(d)(2) award.

Standard of Review

The court noted that while the Commission’s determination of whether an employer is entitled to a credit is ordinarily reviewed for abuse of discretion, the Commission in this case interpreted statutory provisions and concluded that §8(d)(2) did not permit an offset. Because the dispute involved statutory interpretation, the court applied de novo review.

Election of Remedies: Section 8(e) Versus Section 8(d)(2) for a Single Injury

The core of the court’s analysis addressed the interplay between §§8(e) and 8(d)(2). The court acknowledged the tension between the two provisions. Section 8(e) provides that a claimant who receives a scheduled loss “shall not receive any compensation under any other provisions of this Act.” 820 ILCS 305/8(e). Section 8(d)(2), on the other hand, states that compensation awarded under that subsection “shall not take into consideration injuries covered under paragraphs (c) and (e)” and that such compensation “shall not affect the employee’s right to compensation payable under paragraphs (b), (c) and (e) . . . for the disabilities therein covered.” 820 ILCS 305/8(d)(2).

The Commission had relied on the language of §8(d)(2) to conclude that recovery under §8(e) should have no effect on an award under §8(d)(2), and vice versa, effectively permitting concurrent awards and denying the employer any credit. The circuit court agreed, adding that any ambiguity should be resolved in the claimant’s favor under the principle of liberal construction.

The appellate court disagreed. In its view, the language of §8(e) clearly precluded a claimant from recovering under both sections for the same injury to one body part. The court interpreted the language of §8(d)(2) as permitting an election — not a concurrent award — for a single injury. Specifically, the court concluded that §8(d)(2) permits a claimant to elect an award under either §8(e) or §8(d)(2) for an injury to a single body part, while also permitting recovery under both sections when a claimant sustains injuries to multiple, separate body parts in the same work accident.

Consistency with Prior Caselaw

The court grounded its conclusion in several lines of precedent. First, the court analogized to established caselaw holding that a claimant who sustains a scheduled loss may elect between a scheduled loss award under §8(e) and a wage differential award under §8(d)(1), but may not receive both. Citing Payetta v. Industrial Commission, 339 Ill.App.3d 718, 791 N.E.2d 682, 274 Ill.Dec. 590 (2d Dist. 2003), and General Electric Co. v. Industrial Commission, 89 Ill.2d 432, 433 N.E.2d 671, 60 Ill.Dec. 629 (1982), the court noted that this election principle reflects the understanding that an injured party will choose the award most likely to approximate the earnings loss the Compensation Act is designed to compensate. The Commission had distinguished those cases on the basis that §8(d)(1) contains an explicit exclusion for §8(e) claims, whereas §8(d)(2) does not. The appellate court acknowledged the difference in statutory language but concluded that the exclusionary language in §8(e) itself — prohibiting compensation under “any other provisions of this Act” (820 ILCS 305/8(e)) — resolved the issue.

Second, the court observed that both wage differential awards under §8(d)(1) and person-as-a-whole awards under §8(d)(2) serve to compensate injured workers for reduced earning capacity under certain circumstances. Given this functional similarity, the court concluded that the rationale prohibiting dual recovery under §§8(e) and 8(d)(1) applies equally to §§8(e) and 8(d)(2) when a single injury to one body part is at issue.

Third, the court distinguished its prior decisions in Beelman Trucking v. Illinois Workers’ Compensation Commission, 233 Ill.2d 364, 909 N.E.2d 818, 330 Ill.Dec. 796 (2009), and American Coal Co. v. Illinois Workers’ Compensation Commission, 2024 IL App (5th) 230815WC, 248 N.E.3d 493, 478 Ill.Dec. 868. In those cases, the claimants had sustained injuries to multiple body parts during a single work accident, warranting additional compensation under the Compensation Act. In Beelman Trucking, the supreme court permitted concurrent awards under §§8(e)(18) (loss of legs) and 8(e)(10) (loss of arm), reasoning that denying compensation beyond two members would leave additional losses uncompensated. In American Coal, this court extended that reasoning to permit concurrent awards under §§8(e)(18) and 8(d)(2) for nonscheduled injuries sustained in addition to the scheduled losses. The appellate court found those decisions consistent with its holding in Azcon Metals, noting that the present case involved only a single injury to one body part, and that allowing concurrent awards would result in impermissible double recovery.

Employer Entitled to Credit for Voluntary Payment

Having concluded that the claimant was entitled to compensation under only one statutory provision for his single injury, the court turned to the credit issue. The court held that the Commission erred by denying the employer’s credit request. The employer had promptly and voluntarily paid benefits under §8(e) following the work accident, providing the claimant with immediate financial relief. When the claimant subsequently elected to receive benefits under §8(d)(2), the Commission should have credited the employer for its prior voluntary payments.

The court cited World Color Press v. Industrial Commission of Illinois, 125 Ill.App.3d 469, 466 N.E.2d 270, 80 Ill.Dec. 818 (5th Dist. 1984), for the proposition that an employer may receive credit for overpayments absent a statutory bar, and Salisbury v. Illinois Workers’ Compensation Commission, 2017 IL App (3d) 160138WC, 78 N.E.3d 979, 413 Ill.Dec. 703, for the policy principle that encouraging prompt and voluntary payments of benefits furthers the purpose of the Compensation Act. The court emphasized that denying credit for good-faith payments would encourage administrative delays as employers attempt to resolve every ambiguity before paying benefits — a result inconsistent with the Compensation Act’s primary purpose of providing employees with prompt and definite compensation.

Practical Implications

This decision establishes several important principles for practitioners on both sides of the bar.

For employers and carriers, the decision confirms that when a single injury to one body part is involved, a claimant must elect between a scheduled loss award under §8(e) and a person-as-a-whole award under §8(d)(2). The employer who promptly and voluntarily pays benefits under §8(e) will be entitled to a credit against a subsequent §8(d)(2) award. This holding should encourage prompt payment of scheduled benefits, as employers need not fear that early payments will go uncredited if the claimant later elects a different form of permanent disability compensation. Practitioners should carefully document voluntary payments, including the statutory section under which they are made, the calculation methodology, and the dates of payment.

For claimants, the decision preserves the right to elect the more favorable remedy — but it forecloses the possibility of receiving both a scheduled loss award and a person-as-a-whole award for the same injury. Claimants and their counsel should carefully evaluate which remedy produces the greater benefit before making an election, particularly in cases involving amputations or other injuries that may qualify under both sections. The decision also reaffirms that concurrent awards remain permissible when a claimant sustains injuries to multiple, separate body parts in a single work accident, consistent with the rationale of Beelman Trucking, supra, and American Coal, supra.

Finally, the employer’s miscalculation of the scheduled loss payment in this case — paying 167 weeks for loss of a foot under §8(e)(11) when the below-knee amputation should have been compensated as a loss of a leg at 215 weeks under §8(e)(12) — serves as a reminder that correct classification of the injury under the appropriate subsection of §8(e) is critical. An incorrect classification may result in an underpayment that could affect the credit calculation or expose the employer to additional proceedings.

By: Kisa P. Sthankiya

The claimant in Aim National Lease v. Illinois Workers’ Compensation Commission, 2026 IL App (1st) 250494WC-U, ¶8, worked as a rental representative conducting “360 inspections” of trucks, which required walking around and climbing in and out of vehicles. On August 13, 2019, she tripped over a parking block during an inspection and fell, testifying that she felt throbbing pain in her left lower leg and shooting pain from her heel to her toes. 2026 IL App (1st) 250494WC-U at ¶9.

She was treated at Working Well Occupational Health, diagnosed with contusions and left foot and ankle sprains, and placed on light-duty restrictions. 2026 IL App (1st) 250494WC-U at ¶10. Although X-rays showed no fractures, she continued to experience swelling, antalgic gait, and pain and was referred to physical therapy. 2026 IL App (1st) 250494WC-U at ¶11.

Beginning in September 2019, Dr. James Hong, a podiatrist, treated her for persistent ankle pain, numbness, and tingling, diagnosing ankle sprain and neuritis, and prescribed therapy, medication, injections, and work restrictions. 2026 IL App (1st) 250494WC-U at ¶¶12 – 14. At subsequent visits in September and October 2019, the claimant continued to report sharp, shooting pain and neuritis-type symptoms, though some improvement was noted with gabapentin and therapy. 2026 IL App (1st) 250494WC-U at ¶¶13 – 14. Dr. Hong administered a steroid injection, adjusted medications, and maintained work restrictions while documenting ongoing nerve pain and reduced range of motion. 2026 IL App (1st) 250494WC-U at ¶14.

From October 24 through October 28, 2019, the claimant participated in a 30-mile cancer walk where participants had to walk 10 miles a day. 2026 IL App (1st) 250494WC-U at ¶18. The claimant testified that she did some walking during the event but spent most of the weekend riding around in a golf cart. Id.

On October 29, 2019, the claimant went to a physical therapy appointment and reported that she was slightly worse than the week prior due to being out of town but she felt 76-to-80-percent better and some improvements. 2026 IL App (1st) 250494WC-U at ¶19. The following therapy visit on October 30, 2019, she again noticed increased pain in the left heel since the weekend but also showed progress with strength, range of motion, flexibility, and function. 2026 IL App (1st) 250494WC-U at ¶20.

On November 21, 2019, the claimant followed up with Dr. Hong and complained of numbness, tingling, and shooting pain radiating from her ankle to her toes and calf. 2026 IL App (1st) 250494WC-U at ¶21. Dr. Hong’s examination revealed positive Tinel’s and Valleix’s signs in the tarsal tunnel, and he diagnosed neuritis/neuropraxia, left foot sprain, and possible plantar fasciitis. 2026 IL App (1st) 250494WC-U at ¶¶22 – 23. Because her symptoms were worsening and appeared structural, he ordered MRIs, increased medication, and modified restrictions. 2026 IL App (1st) 250494WC-U at ¶23.

MRIs of the left ankle were taken on December 14, 2019, and interpreted as largely negative, showing normal ligaments and tendons with only minor findings such as mild arthritis in the first MTP joint. 2026 IL App (1st) 250494WC-U at ¶24.

At the employer’s request, the claimant underwent an independent medical exam (IME) on December 18, 2019, with orthopedic surgeon Dr. Kamran Hamid. 2026 IL App (1st) 250494WC-U at ¶25. He diagnosed ankle sprain and instability related to the work accident and suggested the claimant may have had complex regional pain syndrome (CRPS) or sympathetic mediated pain, though evaluation was complicated by medication use. Id. Dr. Hamid considered prior treatment reasonable, found that the claimant was not at maximum medical improvement (MMI), and recommended further MRI imaging due to poor quality of the December 14 images. 2026 IL App (1st) 250494WC-U at ¶26.

On December 19, 2019, Dr. Hong expressed concern about early CRPS and referred the claimant for pain management, recommending possible dorsal root ganglion (DRG) treatment while maintaining work restrictions and agreed with new MRI imaging. 2026 IL App (1st) 250494WC-U at ¶27.

Additional MRIs of the left tibia/fibula, left ankle, and foot in January 2020 showed mild edema, fluid, and bursitis but no major abnormalities. 2026 IL App (1st) 250494WC-U at ¶28. Dr. Hong continued to suspect early CRPS and recommended pain management due to persistent nerve pain and limited relief from medication. 2026 IL App (1st) 250494WC-U at ¶¶29 – 30.

In contrast, Dr. Kenneth Candido, who conducted an IME on January 28, 2020, opined that the claimant did not have CRPS but instead had tarsal tunnel syndrome and that she could return to full-duty work without restrictions. 2026 IL App (1st) 250494WC-U at ¶31. Based on his opinion, the employer denied further pain management treatment. Id.

With the employer’s consent, the claimant started treatment with Dr. Hamid in March 2020. 2026 IL App (1st) 250494WC-U at ¶32. He expressed concern of CRPS versus sympathetic mediated nerve pain and recommended pain clinic consultation, which the employer refused to approve. Id.

In April 2020, during a telemedicine visit with Dr. Hamid, claimant reported an increase in nerve pain. He reviewed the January 2020 MRIs as showing ligament tears and recommended surgical reconstruction but cautioned that pain management was necessary first due to likely CRPS exacerbation. 2026 IL App (1st) 250494WC-U at ¶33.

A third IME was performed by orthopedic foot specialist, Dr. Anand Vora, in May 2020. 2026 IL App (1st) 250494WC-U at ¶34. He found no instability or CRPS and concluded the claimant had reached MMI with only a resolved contusion, releasing her to full duty without further treatment. Id. Dr. Vora questioned the claimant’s reported symptoms based in part on records referencing her participation in the cancer walk in October 2019. 2026 IL App (1st) 250494WC-U at ¶35.

Meanwhile, the claimant began treatment with pain specialist Dr. Thomas Pontinen, who disagreed with the tarsal tunnel diagnosis and supported a diagnosis of CRPS based on symptom distribution and examination findings. 2026 IL App (1st) 250494WC-U at ¶36. After a lumbar sympathetic block in May 2020 resulted in approximately 90-percent pain relief, Dr. Pontinen concluded that the improvement strongly supported CRPS rather than tarsal tunnel syndrome. 2026 IL App (1st) 250494WC-U at ¶38.

The employer scheduled claimant for a reexamination with Dr. Candido in June 2020 that the claimant refused to attend. 2026 IL App (1st) 250494WC-U at ¶37. A meeting was held by the parties with the arbitrator, and, according to the employer, the arbitrator opined during that meeting that the IME should not proceed. Id.

Dr. Candido performed a record review in August 2020 and opined that claimant had sustained a neuropraxia of the posterior tibial nerve. 2026 IL App (1st) 250494WC-U at ¶39.

Dr. Hamid maintained his CRPS diagnosis and recommendation for surgery after pain control. 2026 IL App (1st) 250494WC-U at ¶40. Throughout 2020 and 2021, the claimant, under Dr. Pontinen’s care, continued lumbar sympathetic blocks with temporary relief. 2026 IL App (1st) 250494WC-U at ¶41.

In April 2021, Dr. Candido reaffirmed his view that no CRPS was present and that no further treatment or restrictions were necessary upon an updated examination and reviewing surveillance video. Id.

In January 2022, Dr. Matthew Jaycox, a pain management specialist who agreed with the CRPS diagnosis and noted that although an anterior talofibular tear had been confirmed, surgery was not feasible due to CRPS. 2026 IL App (1st) 250494WC-U at ¶42. He recommended neuromodulation treatment and referred the claimant to Dr. William Landphair to consider a DRG stimulator. Id. After consultation, the claimant proceeded with a DRG trial in March 2022. 2026 IL App (1st) 250494WC-U at ¶43.

The claimant reported greater than 80-percent pain relief following the trial and elected to proceed with permanent implantation. 2026 IL App (1st) 250494WC-U at ¶44. The permanent DRG was implanted on March 23, 2022, and subsequent follow-ups documented 90-percent or greater relief, decreased swelling, and significant functional improvement. 2026 IL App (1st) 250494WC-U at ¶45. By August 29, 2022, her pain had decreased to two out of ten, she was active with walking and swimming, and she continued to report substantial improvement. 2026 IL App (1st) 250494WC-U at ¶46.

The arbitrator found that the conditional ill-being was related and awarded medical expenses and prospective medical treatment. 2026 IL App (1st) 250494WC-U at ¶3. The employer appealed the decision to the Commission. The Commission denied some medical bills due to no evidence of supporting medical records. 2026 IL App (1st) 250494WC-U at ¶4. They affirmed the arbitrator’s denial to admit certain documents offered by the employer and denying a fourth IME. Id. The Circuit Court of Cook County subsequently affirmed the decision on appeal. 2026 IL App (1st) 250494WC-U at ¶5.

At trial, Arbitrator Amarillo found that the claimant proved her left foot and ankle condition was causally related to the August 13, 2019, work accident and credited the opinions of her treating physicians, concluding that the DRG implant’s success supported causation and the necessity of treatment. 2026 IL App (1st) 250494WC-U at ¶47. The arbitrator also found the claimant’s testimony credible and supported by objective findings, rejecting any suggestion that she was exaggerating her symptoms. 2026 IL App (1st) 250494WC-U at ¶48.

The arbitrator determined that the opinions of Dr. Candido and Dr. Vora were not credible or persuasive, noting inconsistencies with the medical evidence and treating physicians’ findings. 2026 IL App (1st) 250494WC-U at ¶¶49 – 50. The arbitrator specifically found Dr. Vora’s malingering theory unsupported, criticized his selective reliance on the record, and remarked negatively on his deposition demeanor. 2026 IL App (1st) 250494WC-U at ¶¶50 – 51. The arbitrator further rejected the employer’s experts’ assumption that the claimant had walked 30 miles shortly after cancer surgery. 2026 IL App (1st) 250494WC-U at ¶52.

The arbitrator held that the claimant’s medical treatment was reasonable and necessary and ordered the employer to pay the submitted medical bills paid by claimant’s private insurer pursuant to §§8(a) and 8.2 of the Workers’ Compensation Act, 820 ILCS 305/1, et seq. 2026 IL App (1st) 250494WC-U at ¶53. He also ordered the employer to authorize ongoing care, including Lyrica and maintenance of the DRG stimulator, but declined to award penalties or fees. 2026 IL App (1st) 250494WC-U at ¶¶54 – 55.

On appeal, the Commission modified the decision by disallowing certain unsubstantiated medical bills but otherwise affirmed, finding the remaining medical expenses reasonable, necessary, and causally related to the accident. 2026 IL App (1st) 250494WC-U at ¶56. The Commission also ordered payment for prospective care related to the DRG and Lyrica. 2026 IL App (1st) 250494WC-U at ¶57.

The Commission rejected the employer’s argument that it had been improperly denied a §12 IME, noting the employer had invited the arbitrator’s guidance and that the record did not support a finding of error. 2026 IL App (1st) 250494WC-U at ¶¶58 – 59. The Commission affirmed and adopted the arbitrator’s decision in all other respects. 2026 IL App (1st) 250494WC-U at ¶60.

The employer sought judicial review, and the Circuit Court of Cook County confirmed the Commission’s decision. 2026 IL App (1st) 250494WC-U at ¶61. The circuit court rejected the employer’s argument that it was not liable for group health insurer-paid “billed charged” on a “subrogation lien statement” because some of the charges were not substantiated by any medical bills from the claimant’s healthcare provider. 2026 IL App (1st) 250494WC-U at ¶62. The circuit court rejected the employer’s argument that it is liable to pay the lesser of the healthcare provider’s actual charges, the negotiated rate, or the amount identified in the fee schedule provided in §8.2 of the Act, 820 ILCS 305/8.2. Id. The employer maintained that such a determination cannot be made unless the healthcare providers’ bills are produced at the time of trial. Id.

1. Causation and Intervening Injury

The first issue the employer raised was regarding whether the October 2019 breast cancer walk that the claimant participated in was an independent intervening cause breaking the chain of causation.

The court noted that every natural consequence flowing from a work-related injury is compensable unless an independent intervening accident completely breaks the chain of causation between the original injury and the subsequent condition, as recognized in National Freight Industries v. Illinois Workers’ Compensation Commission, 2013 IL App (5th) 120043WC, ¶26, 993 N.E.2d 473, 373 Ill.Dec. 167. 2026 IL App (1st) 250494WC-U at ¶69. To relieve an employer of liability, the intervening cause must entirely sever the causal connection rather than merely contribute to the claimant’s condition, as explained in Global Products v. Workers’ Compensation Commission, 392 Ill.App.3d 408, 411, 911 N.E.2d 1042, 1046, 331 Ill.Dec. 812 (1st Dist. 2009). Id. A non-work-related accident that only aggravates a weakened condition does not break the causal chain, and other incidents that aggravate the claimant’s condition are legally irrelevant, as held in Teska v. Industrial Commission, 266 Ill.App.3d 740, 640 N.E.2d 1, 3, 203 Ill.Dec. 574 (1st Dist. 1994), and Vogel v. Industrial Commission, 354 Ill.App.3d 780, at 821 N.E.2d 807, 813, 290 Ill.Dec. 495. Id. So long as a “but-for” relationship exists between the original work injury and the subsequent condition, the employer remains liable, consistent with Global Products, supra, 911 N.E.2d at 1046. Id.

The court upheld the Commission’s rejection of the employer’s argument that the claimant’s participation in a breast cancer charity walk constituted an independent, intervening cause of her subsequent left leg, foot, heel, and ankle conditions. 2026 IL App (1st) 250494WC-U at ¶72. They noted that the Commission found implausible the employer’s assertion that the claimant walked 30 miles one week after major breast cancer surgery, crediting her testimony that she did not complete the full distance and spent most of the event riding in a golf cart due to postoperative pain. Id. Because the Commission found the claimant credible, the court noted it was entitled to rely on her testimony regarding the extent of her activity. Id.

Although the employer pointed to therapy and treatment records reflecting a temporary increase in heel pain and new clinical findings after the event, the court concluded that this evidence did not compel a finding of an independent intervening cause. 2026 IL App (1st) 250494WC-U at ¶¶73 – 74. The post-event therapy records also documented substantial overall improvement, including increased strength, range of motion, ambulation tolerance, and decreased pain frequency and intensity. 2026 IL App (1st) 250494WC-U at ¶74.

The court further emphasized that neither the medical records nor expert testimony supported a finding that the charity walk broke the causal chain. 2026 IL App (1st) 250494WC-U at ¶75. The treating physicians consistently attributed the claimant’s lower extremity conditions, including CRPS, to the August 13, 2019, work accident. Id. The employer’s reliance on testimony that plantar fasciitis could be aggravated by prolonged standing was insufficient. Id.

Even assuming there had been a post-walk aggravation, the court held that such evidence, at most, demonstrated a contributing aggravation of a preexisting work-related injury — not a complete break in causation. 2026 IL App (1st) 250494WC-U at ¶76. The record contained no medical testimony establishing that walking alone was the sole cause of her disabling conditions. Id. To the contrary, citing Vogel the court held that the evidence supported a “but-for” causal relationship between the original work injury and the claimant’s subsequent condition, and thus the employer failed to establish an independent intervening cause. Id.

2. Medical Bills and Group Health Payments

The most important issue on appeal was regarding the medical bill award by the Commission.

First, the employer argued that the Commission erred in awarding the claimant medical expenses for physical therapy treatments related to her left shoulder. 2026 IL App (1st) 250494WC-U at ¶78. The employer correctly noted that the claimant’s case involved injuries to her left lower leg, foot, ankle, and heel — not her shoulder. Id. Nevertheless, the Commission awarded payment for several physical therapy sessions in November and December 2019 that appeared to involve shoulder treatment alone. Id. The court agreed that these shoulder-related expenses should not have been awarded. Id.

The employer also argued that the Commission improperly awarded certain medical expenses despite the absence of supporting medical bills in the record. 2026 IL App (1st) 250494WC-U at ¶79. After the employer refused to pay for pain management treatment following Dr. Candido’s January 2020 IME report, the claimant’s private group health insurer, Blue Cross Blue Shield (BCBS), began covering those treatments. 2026 IL App (1st) 250494WC-U at ¶80. The claimant introduced medical bills from her providers and a “Consolidated Statement of Benefits” from BCBS covering medical treatments from January 5, 2021, through November 1, 2022. Id. The employer asserted that BCBS prepared this document in connection with a subrogation lien claim. Id.

The “Consolidated Statement of Benefits” listed total amounts billed for each date of service but did not itemize the specific treatments performed. 2026 IL App (1st) 250494WC-U at ¶81. The document reflected that BCBS paid a total of $208,342.16 in benefits, including approximately $169,000 to Rush Surgicenter for services on March 23, 2022, approximately $30,000 to Rush Oak Park Hospital for services on March 10, 2022, and payments for anesthesiology services on both dates. Id. After determining that the claimant’s medical expenses were reasonable and necessary, the Commission awarded $204,559.62 — the amount identified in the BCBS statement — minus certain medical bills lacking corresponding treatment records. Id.

The employer contended that this award was improper because the BCBS statement showed only amounts BCBS claimed to have paid for unspecified services and was unsupported by the medical providers’ actual bills. 2026 IL App (1st) 250494WC-U at ¶83. The employer argued that without the providers’ actual medical bills in evidence, there was a failure of proof and no basis for liability for the bill. Id. The employer further maintained that, even if it were liable for some treatments, the actual bills were necessary to determine the correct amount owed under §8(a) of the Act. 2026 IL App (1st) 250494WC-U at ¶84. According to the employer, §8(a) requires payment at the lesser of the negotiated rate, the provider’s charge, or the statutory fee schedule rate under §8.2, and such a comparison could not be made without the actual bills. Id.

The court rejected these arguments. 2026 IL App (1st) 250494WC-U at ¶85. It explained that §8(a) requires payment at the negotiated rate if applicable, or otherwise at the lesser of the provider’s charge or the fee schedule rate. Id. Because BCBS had already paid the providers, the amount BCBS had paid constituted the “negotiated rate” under §8(a), which the employer was required to pay. Id. The court noted that analysis of actual charges versus the fee schedule is only necessary when the medical bills have not yet been paid by a third-party insurer. Id.

However, the court identified a discrepancy between the BCBS “Consolidated Statement of Benefits” and a separate BCBS spreadsheet that itemized charges and payments. 2026 IL App (1st) 250494WC-U at ¶86. Although both documents reflected the same amounts billed by providers, they listed dramatically different amounts paid by BCBS. Id. For example, while both documents showed Rush Surgicenter billed $169,119.60 on March 23, 2022, the Consolidated Statement recorded a payment of $168,526.34, whereas the spreadsheet listed only $50,059.40 as paid. Id. The Commission did not address this discrepancy, and the claimant did not explain it. Id.

Accordingly, the court remanded the matter to the Commission to resolve the discrepancy and determine the actual amount BCBS paid for the services at issue. 2026 IL App (1st) 250494WC-U at ¶87. The court held that only the amount actually paid by BCBS should be awarded. Id.

3. Arbitrator’s Actions Regarding the Employer’s Fourth IME Request

The employer contended that the arbitrator improperly interfered with its statutory right to obtain a fourth IME on June 23, 2020, by ruling that the examination should not proceed. 2026 IL App (1st) 250494WC-U at ¶89. The court rejected this argument, noting that the employer itself invited the arbitrator’s involvement by requesting guidance after the claimant refused to attend the scheduled IME. 2026 IL App (1st) 250494WC-U at ¶90. In an email to the arbitrator, the employer’s counsel expressly asked for a prompt discussion and indicated that “if that is what you decide,” thereby submitting the issue to the arbitrator for determination. Id. Having requested the arbitrator’s opinion, the employer could not later claim error based on that involvement. Id.

The court further observed that no transcript of the discussion existed and as a result, the record did not permit meaningful review of the alleged procedural error. 2026 IL App (1st) 250494WC-U at ¶91.

The court remanded the case back to the Commission to disallow any charges for treatments to the claimant’s left shoulder and to determine the amount that BCBS paid the claimant’s healthcare providers for medical services relating to the claimant’s work-related injuries, and to award the claimant that amount. 2026 IL App (1st) 250494WC-U at ¶93. The remainder of the Commission was affirmed.

PRACTICE POINTER: Proving and Defending Medical Bills When Group Insurance Has Paid

Ultimately, the significance of this case is the second issue the court addressed on appeal. This case reinforces that in group-health-paid claims, the dispositive figure is the actual negotiated amount paid. Additionally, the record should be clear to either sustain or defeat a medical expense award.

This case underscores the evidentiary and strategic importance of properly substantiating medical expenses when a claimant’s group health insurer has made payments for medical bills. For petitioner’s counsel, reliance on a consolidated insurer statement alone may be insufficient if discrepancies exist between the consolidated statement of benefits reflecting a paid amount and the actual medical bills. Practitioners should ensure the record clearly establishes (1) the services rendered via medical records, (2) medical bills, and (3) the actual amount paid for medical treatment when a group health insurer has made payments.

For respondent’s counsel, it is important to scrutinize the medical bills to the actual medical treatment records for discrepancies to determine what they are obligated to pay under the award. Further, this decision highlights that once a group health insurer has paid medical providers at a negotiated rate, the employer is obligated to pay the actual amount paid for the medical service and not the amount paid listed on the Consolidated Statement of Benefits in the lien itemization. If the medical bills remain unpaid, the fee schedule would apply. Respondent’s counsel should scrutinize the Consolidated Statement of Benefits and the actual medical bill to determine the accurate amount paid. If the petitioner fails to admit this information into evidence, the respondent should present the evidence to determine the actual amount paid and clearly raise the issue to preserve it for review.

By: Jigar S. Desai

In a January 27, 2026, Rule 23 order, the Illinois Appellate Court, Second District, Workers’ Compensation Commission Division, addressed the compensability of injuries sustained by a traveling employee who was assaulted by third parties while making deliveries. Avila v. Illinois Workers Compensation Commission, 2026 IL App (2d) 250093WC-U. The court reversed the Commission’s denial of benefits and reinstated the arbitrator’s compensability findings, holding that the Commission’s application of the aggressor defense and its causation analysis were against the manifest weight of the evidence. The court further remanded the case for the Commission to consider whether penalties and attorneys’ fees should be imposed.

Although the decision is nonprecedential, it provides a detailed illustration of how courts analyze street-risk exposures, the aggressor defense, and intervening acts in the context of traveling employees.

Factual Background

Jose Avila worked as a delivery driver for Amazon. On August 1, 2023, while performing his delivery route in Aurora, Avila was driving his truck on a residential street when a black SUV abruptly cut in front of him at close range. The maneuver was sufficiently sharp that Avila had to brake suddenly. Avila testified that the SUV nearly struck a woman who was unloading groceries on the side of the road.

After the near-collision, Avila honked his horn and gestured toward the driver of the SUV. He then stopped his delivery truck and momentarily remained in the area. According to Avila, his purpose in stopping was not to pursue a confrontation with the driver of the SUV but to check on the woman who had nearly been struck and to ensure that she was not injured. The dash camera footage showed Avila stopping his vehicle while a pedestrian remained in the parkway near the truck.

While Avila was stopped, individuals associated with the SUV began yelling at him. The driver of the SUV exited his vehicle and walked toward Avila. Avila testified that he felt threatened because he was still seated and buckled in his truck with the door open, and the approaching individual was on the side of the open door. Avila unbuckled his seat belt and exited the truck. The video footage showed Avila and the SUV driver meeting briefly near the truck, at which point the driver of the SUV punched Avila. Others joined in the scuffle. The physical altercation was brief and partially out of camera view. The woman who was almost struck intervened and calmed the initial confrontation.

After the initial confrontation, Avila returned to his truck and drove away. As he was leaving, he yelled words and made nonverbal gestures to the individuals who had attacked him. Avila stated that he did this out of frustration, but not in a threatening manner.

The dash camera footage showed him continuing along his delivery route through a residential neighborhood for several minutes. Approximately four to five minutes later, and two to three blocks away from the location of the initial encounter, Avila parked his truck to make another delivery. As he walked toward the delivery location, a maroon sedan pulled up near the truck. Several individuals exited the vehicle, including the driver of the SUV from the earlier incident. Avila was attacked from behind, knocked to the ground, and beaten and kicked by multiple assailants. During the assault, one of the attackers took a chain from Avila’s neck.

Avila reentered his truck after the second assault. Dash camera footage showed visible blood on his face and head. He appeared to photograph the fleeing assailants and then stumbled near the passenger side of the vehicle. Emergency medical services transported him to the hospital, where he was treated for facial fractures, dental injuries, head trauma, and related symptoms. He later received follow-up dental treatment and medical care for headaches and psychological symptoms related to the assault.

Procedural History

The case proceeded to arbitration. The employer argued that Avila was the aggressor and his recovery was therefore barred. The arbitrator disagreed and found that Avila’s injuries arose out of and in the course of his employment as a traveling employee and were causally related to the assaults. The arbitrator concluded that the risks of street encounters were incidental to his job duties and that, in any event, the second assault occurred while he was actively making a delivery. The arbitrator awarded temporary total disability benefits, medical benefits, prospective care, penalties, and attorneys’ fees.

On review, the Commission unanimously reversed. The Commission found that Avila was the aggressor in the first incident based on his gestures, conduct, and decision to exit his truck. The Commission further concluded that the second assault would not have occurred but for Avila’s conduct during the first encounter, thereby negating the causal connection to employment.

The circuit court reversed the Commission, finding that the aggressor determination as to the first incident, and the conclusion that the second assault was merely a continuation of the first, were against the manifest weight of the evidence. The employer appealed to the appellate court.

The Appellate Court’s Analysis

The appellate court affirmed the circuit court’s decision. The court began by reaffirming that an injury must arise out of and in the course of employment in order to be compensable. The “in the course of” element concerns the time, place, and circumstances of the injury, while the “arising out of” element requires a causal connection between the employment and the injury. The court noted that injuries sustained by traveling employees are analyzed under more liberal standards because such employees are exposed to the risks of the street as an inherent aspect of their work.

In the Course of Employment

With respect to the “in the course of” requirement, the court had little difficulty concluding that Avila satisfied this element. At the time of the second assault, Avila had resumed his delivery route and was actively engaged in making a delivery. The evidence showed that he had disengaged from the earlier confrontation, driven away, and returned to his work duties. Accordingly, the court found that Avila was within the time and space boundaries of his employment when the injury occurred.

Arising Out of Employment

The court then turned to the “arising out of” element. The Commission had concluded that Avila’s injuries did not arise out of his employment because the assaults stemmed from a personal dispute initiated by his conduct during the traffic encounter.

The appellate court rejected that characterization. It emphasized that Avila’s job as a delivery driver required him to travel public roadways and interact with traffic and members of the public. The risks inherent in street travel, including the possibility of confrontations with other motorists, are risks to which Avila was exposed by virtue of his employment. The court cited established precedent recognizing that assaults on traveling employees by third parties may be compensable when the employment places the employee in a position of increased exposure to such risks.

The Aggressor Defense

The appellate court devoted significant attention to the Commission’s application of the aggressor defense. The court reiterated that an employee who becomes the aggressor in a physical altercation may be found to have departed from the course of employment, thereby breaking the causal connection between employment and injury.

However, the court emphasized that aggressor status is a fact-intensive determination that must be evaluated based on the totality of the circumstances. The mere fact that an employee exchanges words, gestures angrily, or exits a vehicle does not, by itself, establish that the employee became the aggressor in a subsequent physical confrontation.

Reviewing the dash camera footage and testimony, the court found that the Commission’s conclusion that Avila was the aggressor in the first encounter was against the manifest weight of the evidence. The video did not show Avila initiating physical violence, and the evidence showed that the other driver approached Avila’s truck and struck the first blow. While Avila’s conduct may have contributed to a tense encounter, the court concluded that the record did not support a finding that he escalated the encounter into a physical fight so as to forfeit the protections of the Workers’ Compensation Act (Compensation Act), 820 ILCS 305/1, et seq.

Causation and the Second Assault

The court further rejected the Commission’s conclusion that the second assault was merely a continuation of the first encounter and therefore remained personal in nature. The appellate court emphasized that there was a meaningful temporal and spatial break between the two incidents. Avila had left the scene of the initial confrontation, driven several blocks, and resumed performing his delivery duties. The second attack occurred at a different location, several minutes later, and involved assailants who pursued Avila and initiated a new, unprovoked assault while he was making a delivery.

In addressing causation, the court explained that the Compensation Act does not require that employment be the sole cause of an injury. It is sufficient that the employment be a contributing cause. The court rejected the Commission’s “but for” reasoning that the second assault would not have occurred but for Avila’s earlier conduct. The court noted that such a broad conception of causation would improperly transform many workplace injuries into noncompensable events whenever a claimant’s prior conduct could be traced as part of the chain of events. Instead, the proper inquiry is whether the injury can fairly be traced to a risk of employment, as opposed to a purely personal risk. Here, Avila’s exposure to public street risks as a delivery driver, combined with the fact that he was engaged in work duties at the time of the second assault, supported compensability.

Standard of Review

Finally, the appellate court underscored the standard of review applicable to Commission findings. While the Commission’s factual determinations are entitled to deference, they will be reversed when an opposite conclusion is clearly apparent from the record. The court concluded that the Commission’s findings regarding aggressor status and causation were contrary to the clear weight of the evidence presented.

This decision highlights the importance of carefully separating multiple incidents when analyzing causation. When an employee disengages from an initial confrontation and later sustains injuries in a separate encounter, the later event may be deemed an independent intervening act rather than a continuation of the earlier dispute. Practitioners should analyze temporal separation, geographic separation, and whether the claimant had resumed job duties at the time of injury.

For employers and carriers, the aggressor defense remains viable, but it requires a close examination of the totality of the circumstances. Evidence of verbal provocation or angry gestures may be insufficient, standing alone, to establish that a claimant was the aggressor when the other party initiates physical violence. Video evidence should be reviewed carefully, and the absence of audio may limit the ability to draw firm conclusions about verbal threats or provocations.

For claimants, the case underscores the significance of the traveling employee doctrine and the street-risk doctrine. Employees whose jobs place them in public settings are exposed to risks that may be deemed incidental to employment, including assaults by third parties. Demonstrating that the employee was engaged in job duties at the time of injury remains central to compensability.

By: Kisa P. Sthankiya

In Safeway Scaffolding/Safeway Services, LLC v. Illinois Workers’ Compensation Commission, 2025 IL App (5th) 250298WC-U, the claimant sought benefits pursuant to §19(b) of the Workers’ Compensation Act, 820 ILCS 305/1, et seq., for injuries sustained to his low back. The claimant was employed as an insulator and sustained an undisputed low back injury on October 26, 2018. He underwent an L4 through S1 lumbar spine fusion surgery on February 11, 2019, and was authorized to return to work on May 17, 2019, with a 20-pound lifting restriction and to avoid repetitive bending, stooping, or twisting.

On June 6, 2019, a light duty assignment was made commencing on June 10, 2019. The claimant testified that he did not appear on June 10, 2019, due to a flood that caused bridge and ferry closures causing a 4-hour drive to work, and he had a 30-minute sitting restriction. He also testified that the job was a sham offer based on his situational experience. The respondent’s witness testified that the light duty job assignment was within the claimant’s restrictions and consisted of necessary tasks and was not a sham. He also testified that the position required making and trimming bandings. The job did not require any lifting.

Dr. Coyle amended the restrictions on July 2, 2019, to include 30 pounds lifting and intermittent sitting, standing, and walking every 30 minutes.

On July 7, 2019, the claimant contacted the employer and left a voicemail that he would return to work in a light-duty capacity. The employer did not respond to this call.

The claimant continued to treat thereafter until October 14, 2019, when he was released to maximum medical improvement by Dr. Coyle. He recommended the claimant seek physiatrist treatment if necessary.

Thereafter, the claimant was examined by Dr. Wayne at respondent’s request. He opined that the claimant could have returned to work light duty on May 17, 2019, and full duty as of October 14, 2019.

On January 10, 2020, the respondent sent an email offering to bring the claimant back to work full duty consistent with Dr. Wayne’s opinions. There was no restriction on driving, and they believed the claimant could pull over if he had issues driving to work.

The claimant testified that he wanted to proceed with additional treatment as recommended by Dr. Coyle. He understood he had been offered a job to return to work full duty. However, he did not believe he would be able to perform the job of an insulator and requested vocational rehabilitation services.

The arbitrator determined that the claimant had sustained a compensable accident and that his condition was causally related but that no further treatment was necessary. Medical benefits were awarded through the date of maximum medical improvement (MMI) of October 14, 2019. The arbitrator believed the petitioner could return to work full duty based on both Dr. Coyle and Dr. Wayne’s inability to find any explanation for the claimant’s alleged low-back pain when sitting. He also found significant Dr. Wayne’s findings of symptom magnification and Dr. Coyle’s opinions that the claimant did very well after surgery, could walk seven miles a day, and was in excellent health and physical condition. Prospective medical treatment was denied. Additionally, the arbitrator denied the claimant temporary total disability (TTD) after his refusal to return to work in a light-duty assignment after July 8, 2019. The arbitrator also denied vocational rehabilitation benefits.

The Commission affirmed and adopted the arbitrator's decision with certain modifications. On review, the circuit court of Madison County found that the Commission’s award of TTD benefits and its denial of maintenance benefits and vocational rehabilitation were against the manifest weight of the evidence. The court concluded that the claimant had not declined the light-duty job offered by the respondent.

On appeal, the respondent raised two principal issues. First, the Commission’s finding that the claimant’s refusal for light-duty work restrictions was not against the manifest weight of the evidence. Secondly, the Commission’s decision to deny maintenance and vocational rehabilitation services should be upheld.

The central issue before the court was whether the Commission’s denial of TTD benefits after July 8, 2019, was against the manifest weight of the evidence. Relying on Gallentine v. Industrial Commission, 201 Ill.App.3d 880, 559 N.E.2d 526, 147 Ill.Dec. 353 (2d Dist. 1990), and Presson v. Industrial Commission, 200 Ill.App.3d 876, 558 N.E.2d 127, 146 Ill.Dec. 164 (5th Dist. 1990), the court emphasized that the dispositive inquiry is whether the claimant’s unemployment results from medical incapacity or from a voluntary refusal of available work. Safeway, supra, 2025 IL App (5th) 250298WC-U at ¶27. They noted that the record supported the Commission’s conclusion that the claimant never intended to return to work for the respondent, notwithstanding repeated offers of light-duty and, later, full-duty employment. The claimant’s failure to report to work on June 10, 2019, his characterization of the position as a “sham,” and his lack of response to subsequent job offers collectively undermined his claim for continued TTD. They noted that the record supported that the job offer was not a sham given the respondent’s testimony. They noted that despite the offer that light duty work continued to be available, the claimant never presented for a light duty assignment.

Significantly, the court rejected the claimant’s argument that the absence of MMI was dispositive. While MMI often marks the natural endpoint of TTD, the court reiterated that it is not a prerequisite to the termination of TTD benefits. An employee who is medically capable of working within restrictions and who declines an offer for light duty work is not temporarily totally disabled within the meaning of the Workers’ Compensation Act, even if additional treatment is contemplated. 2025 IL App (5th) 250298WC-U at ¶54, citing Interstate Scaffolding, Inc. v. Illinois Workers’ Compensation Commission, 236 Ill.2d 132, 923 N.E.2d 266, 276, 337 Ill.Dec. 707 (2010) (TTD benefits may be “suspended or terminated if the employee refuses work falling within the physical restrictions prescribed by his doctor”).

The court also gave substantial deference to the Commission’s credibility determinations. The Commission reasonably discounted the claimant’s explanations for failing to report to work, particularly where certain restrictions were imposed only after the job offer was made and where medical evidence contradicted the claimant’s assertions regarding his inability to drive or sit. The Commission’s rejection of the “sham job” characterization was likewise supported by detailed testimony regarding the job’s duties and its consistency with the claimant’s restrictions.

Viewed collectively, the decision reinforces the evidentiary burden on claimants to demonstrate not only ongoing medical need but a genuine inability to work. It also confirms that well-documented, bona fide light-duty offers that have been declined can serve as a defense to a claim for TTD benefits.

The second issue concerned whether Commission’s original decision denying maintenance and vocational rehabilitation benefits was against the manifest weight of the evidence. The claimant argued that vocational rehabilitation was necessary because he could not return to his pre-injury job as an insulator and that the respondent failed to accommodate his restrictions. The court rejected this argument, holding that the Commission’s decision was not against the manifest weight of the evidence.

The court began by reiterating that vocational rehabilitation and maintenance are not automatic entitlements under §8(a) of the Workers’ Compensation Act. The claimant may only receive maintenance benefits while engaged in a prescribed vocation rehabilitation program. Rather, they are awarded where a work-related injury results in diminished earning capacity and where rehabilitation is reasonably likely to restore or increase that capacity. 2025 IL App (5th) 250298WC-U at ¶65, citing National Tea Co. v. Industrial Commission, 97 Ill.2d 424, 54 N.E.2d 672, 676, 73 Ill.Dec. 575 (1983). Importantly, maintenance benefits are incidental to participation in an approved vocational rehabilitation program and are payable only while the employee is actively engaged in such a program. Safeway, supra, 2025 IL App (5th) 250298WC-U at ¶65, citing Euclid Beverage v. Illinois Workers’ Compensation Commission, 2019 IL App (2d) 180090WC, ¶29, 124 N.E.3d 1027, 429 Ill.Dec. 517.

Here, the Commission found that vocational rehabilitation was neither necessary nor appropriate because the claimant was capable of returning to work within his restrictions and had been offered suitable employment by the respondent. The record demonstrated that the claimant’s skills and physical abilities were sufficient to obtain employment without additional training, particularly given medical opinions supporting a return to full duty. Moreover, the claimant’s failure to accept light-duty work supported the conclusion that he lacked the requisite intent to return to work — a factor that independently weighs against an award of vocational rehabilitation.

The court also distinguished this case from situations in which an employer refuses to provide suitable work after an employee expresses a willingness to return. Unlike cases such as Otto Baum Company, Inc. v. Illinois Workers’ Compensation Commission, 2011 IL App (4th) 100959WC, 960 N.E.2d 583, 355 Ill.Dec. 701, the evidence in this case showed that the respondent consistently maintained the availability of work within the claimant’s restrictions and communicated that availability through counsel as documented in an email. Safeway, supra, 2025 IL App (5th) 250298WC-U at ¶65. The claimant’s failure to respond to or pursue those offers precluded a finding that vocational rehabilitation was necessary.

The Commission’s original decision was reinstated and the matter remanded with directions.

Positive Drug Tests and Penalty Exposure After Ramirez v. IWCC, What Employers and Carriers Should Know When Managing Early Claims - Jigar Desai

In Ramirez v. Illinois Workers’ Compensation Commission (2025 IL App (1st) 242467WC), the Illinois Appellate Court recently issued an important decision for employers and carriers handling post-accident drug tests.

The case involved an injured employee who tested positive for marijuana after a work accident. The employer delayed benefits, arguing the positive test raised questions about impairment. Ultimately, the Appellate Court ruled that the employer acted unreasonably in withholding benefits because the drug test lacked supporting evidence to show impairment under the Illinois Workers’ Compensation Act.

The Court reinstated penalties and attorney fees, emphasizing that a positive test alone — without concentration levels, expert interpretation, or other factual context — does not justify delay or denial of benefits.

Why It Matters

Most employers and insurers do not require immediate defense representation or guidance when a claim is first reported. A drug test result often arrives within days of an accident, and claim handlers must decide whether to pay or delay benefits before counsel becomes involved.

Ramirez clarifies that the Commission and Courts expect any delay or denial based on a drug test to rest on objective, documented evidence. Without that foundation, employers risk exposure to penalties under Sections 19(k), 19(l), and 16 of the Illinois Workers’ Compensation Act.

Key Takeaways from Ramirez

1. A Positive Test Alone Is Not Enough.
• The Court made clear that a test result — even if it shows THC or another controlled substance — cannot by itself prove intoxication or justify a denial.
• To rely on the intoxication defense under Section 11, the employer must show the employee was impaired at the time of injury and that impairment caused the accident.
2. Reasonableness Is the Standard for Penalties.
• If benefits are delayed, the employer must demonstrate a reasonable, fact-based justification for doing so.
• In Ramirez, the absence of details such as test type, concentration levels, timing, or observed impairment made the delay unreasonable.
3. Documentation Is Everything.
• The decision emphasizes recordkeeping: contemporaneous notes, witness observations, and clear timelines can make the difference between a defensible claim and penalty exposure.

Best Practices for Employers and Claims Handlers

1. Secure a Properly Documented Drug Test.  Section 11 provides that no compensation is payable if an employee’s intoxication is the proximate cause of the injury or if the employee was so intoxicated that the intoxication constituted a departure from employment. However, the statute also establishes strict evidentiary requirements. 

A rebuttable presumption of intoxication arises only when:

·       There is 0.08% or more alcohol by weight in the employee’s blood, breath, or urine, or

·       There is any evidence of impairment due to unlawful or unauthorized use of cannabis, controlled substances, or intoxicating compounds, or

·       The employee refuses to submit to testing.

·       To rely on this presumption, the employer must prove that the test was performed by an accredited or certified testing laboratory and followed Commission rules for collection, chain of custody, split testing, documentation, and analytical procedures.  Tests that do not meet these standards are inadmissible, as confirmed in Ramirez v. IWCC (2025 IL App (1st) 242467WC).

2. Obtain the testing lab’s certification, chain-of-custody forms, and the collector’s documentation.
3. Confirm that split testing was used and that the sample was handled according to recognized procedures.
4. Request quantitative results, not just “positive” or “negative.” THC, for example, must include concentration levels to assess impairment.

5.     Retain copies of all documentation, including consent forms, lab certifications, and test methodology.

6. Document Observations Immediately.
• Have supervisors and co-workers record any signs of impairment (odor, behavior, coordination, etc.) at or near the time of injury.
• A short written statement can later establish the factual basis for your initial claim decision.
7. Record the Employer’s Rationale for Delay.
• If benefits are temporarily withheld pending investigation, document the reasons clearly — e.g. “awaiting certified test results” or “reviewing chain of custody documentation.”
• Make sure the claim file shows the decision was based on evidence, not assumption.
8. Communicate Early and Clearly.
• Notify the employee (and the insurer, if applicable) that the claim is under investigation.
• Avoid blanket denials.  Instead, frame the delay as an effort to gather additional information.
9. Consult Counsel Promptly.
• Once results are confirmed, seek legal input before issuing a denial.  Counsel can assess whether the test meets statutory standards and whether sufficient evidence exists to assert intoxication as a defense.
10. Do Not Overlook Other Evidence.
• Review surveillance footage, witness statements, and equipment logs.
• Often, the best defense to penalty exposure is showing a well-documented, balanced investigation — even if the claim is later found compensable.

The Ramirez decision does not eliminate the intoxication defense — it simply reminds employers that the defense must be supported by admissible and credible evidence. A positive test result can still be relevant, but it must be contextualized and properly documented.

For claims professionals and employers, the message is clear:  Investigate promptly, document thoroughly, and justify every delay with evidence. Doing so not only protects against penalties but also strengthens the employer’s credibility when the case eventually reaches defense counsel or the Commission.

Final Thought

In Illinois, the window between an accident and counsel involvement is often the most critical. Ramirez teaches that what happens in those first few weeks — how the employer documents the event, tests, and communications — will often determine whether the case is defensible later.

A structured, evidence-driven response to post-accident drug tests is no longer just best practice; after Ramirez, it is a legal necessity.

Collateral Estoppel Bars Relitigation of Causation: City of Zion Police Department v. Illinois Workers’ Compensation Commission – Jigar Desai

In City of Zion Police Department v. Illinois Workers’ Compensation Commission, 2025 IL App (2d) 240758WC-U, the Appellate Court affirmed the Circuit Court’s reversal of the Illinois Workers’ Compensation Commission, holding that claimant James Labonne was collaterally estopped from relitigating causation for his right wrist injury.

Labonne, a police detective, claimed bilateral wrist injuries after performing a “burpee” exercise during firearms training. He sought workers’ compensation benefits under the Illinois Workers’ Compensation Act (“Act”). Respondent argued that Labonne had already litigated the issue before the Zion Police Pension Board, which denied “line-of-duty” disability benefits but awarded “non-duty” benefits. Labonne did not appeal the Pension Board’s decision, which became final.

The Commission initially awarded benefits, finding collateral estoppel did not apply. On review, however, the Circuit Court determined that the Pension Board’s decision conclusively resolved causation, accident timing, and credibility issues. The Appellate Court affirmed, noting that:

• The Pension Board’s determination that the injury did not occur during an act of duty was identical to the causation issue under the Act.
• The decision was final and binding; Labonne had a full and fair opportunity to litigate the issues before the Pension Board.
• Collateral estoppel applied because Labonne had been a party to both proceedings and the issues were necessarily decided.

Impact on Workers’ Compensation Law:  Labonne underscores that prior administrative decisions — such as Pension Board determinations — can bar subsequent workers’ compensation claims when the issues are identical, the decision is final, and the claimant had a full and fair opportunity to litigate. In particular, it aligns with prior case law equating “duty” determinations under the Pension Code with “arising out of and in the course of employment” determinations under the Act.

Best Practices for Employers and Claims Handlers

1. Check Pension or Other Prior Decisions Early:  Review any prior pension, insurance, or administrative determinations before investigating a workers’ compensation claim. These can provide defensible grounds to challenge causation or accident-related claims.
2. Document Reporting and Treatment Delays:  In Labonne, failure to promptly report the injury and inconsistent medical records supported the Pension Board’s finding. Clear documentation of reporting and treatment timelines can be critical evidence.
3. Evaluate Collateral Estoppel Opportunities:  If a claimant has litigated a similar issue in another forum, consult counsel to assess whether collateral estoppel can bar or limit workers’ compensation benefits.
4. Confirm Claimant’s Party Status and Opportunity to Litigate:  Collateral estoppel applies only if the claimant was a party (or in privity) and had a full and fair opportunity to contest the prior proceeding. Ensure these elements exist before asserting the defense.
5. Coordinate Evidence Across Forums: Keep track of medical records, depositions, and other evidence presented in pension hearings or related administrative proceedings; this may streamline defenses in workers’ compensation proceedings.

Labonne reinforces that prior adjudications, including Pension Board determinations, can decisively impact workers’ compensation claims.  Prompt review of prior decisions, thorough documentation of injury reporting and treatment, and strategic use of collateral estoppel can protect employers from unnecessary exposure.

By: Kisa P. Sthankiya

In Panda Express, Inc. v. Illinois Workers’ Compensation Commission, 2025 IL App (4^th)  240771WC-U, the Workers’ Compensation Division of the Illinois Appellate Court reversed the decision of the Circuit Court of Boone County and reinstated the decision of the Commission. 

The claimant on September 25, 2018 was training new workers on how to properly transfer hot oil from the fryer to the disposal area.  The hot oil spilled onto the claimant’s feet, primarily onto his left foot and ankle.  It also splashed onto his right foot. 

The claimant was treated for his burns which were assessed to be at the third degree.  The claimant was hospitalized through October 9, 2018.  At discharge, his final diagnoses were a third degree burn of multiple sites of the left ankle and foot, second degree burn of multiple sites of the right ankle and foot and cellulitis of the left lower limb. 

The claimant treated through May 8, 2019 when he was released to return back to work full duty. 

At the time of trial, claimant was no longer working a second job transporting gutters to local building sites.  The claimant admitted that the right foot burns were less severe and had “kind of disappeared.”  However, the burns to his left foot were primarily on the top and side of the left foot.  The size of the skin graft was approximately 8” x 4” in size.  The skin graft area was markedly different from the surrounding skin with shiny appearance and no hair growth.  The right foot also exhibited circular burn areas on the top of the foot and ankle.  The burn areas on the feet and left leg were shown to the arbitrator and counsel.  Photographs were also submitted into evidence of the burns.

The arbitrator found that claimant had sustained disfiguring injuries to both of his feet and his left leg, and awarded 58 weeks of disfigurement benefits pursuant to Section 8(c) of the Act.   Specifically, the arbitrator awarded 10 weeks of disfigurement of the left leg, 3 weeks of disfigurement of the right foot and 45 weeks of disfigurement of the left foot.  The five factors under Section 8.1(b) were not addressed as the arbitrator noted he was not awarding any permanency under that provision.  The Commission affirmed and adopted the arbitrator’s decision in its entirety.

The employer appealed the Commission’s decision to the Circuit Court of Boone County who held that the claimant was not entitled to benefits for disfigurement under Section 8(c) of the Act because that section does not authorize benefits for disfiguring injuries to the feet.  The Circuit Court held that the foot was not covered under the list of body parts under Section 8(c).  Relying on the medical dictionary definition of leg, the Circuit Court could not conclude that the foot would be considered as part of the leg below the knee.  The Circuit Court instead awarded PPD benefits under Section 8(d)(2) of the Act. 

On appeal to the Appellate Court, the employer challenged the Commission award for benefits for disfigurement to the claimant’s feet under Section 8(c) because disfigurement of the foot was not listed as a compensable injury under the section.  The employer further argued that benefits under Section 8(d)(2) only applied if the claimant had sustained serious and permanent injury “not covered by either Section 8(c) or 8(e).”  The employer further argued that the claimant failed to present evidence of impairment of his foot which would have entitled him to benefits under Section 8(e). 

The key issue presented to the court was whether the foot is included within the definition of “leg below the knee” under Section 8(c) of the statute.  The court had to ascertain and give affect to the intent of the legislature.  The best indicator of the legislature’s intent was the plain language of the statute itself which would be given its plain and ordinary meaning. 

The court reviewed the definition of the leg under multiple sources including website citations to RxList, Health Line, Meriam Webster online dictionary, Britannica and Wikipedia.  They noted that all of these sources included the foot as part of the leg.  The court rejected the employer’s argument that the medical textbook definition should be followed which defines the leg as a part of the body extending from below the knee to only the ankle. The court noted that words in legislative enactment should be given their commonly understood meaning as used by the public as opposed to the meaning ascribed to the word by medical specialists.  The various sources that the court had cited explicitly distinguished the common understanding of the word from the specialized medical terminology and included the foot as part of the leg.  

The court addressed the employer’s argument that Section 8(e) of the Act showed that the legislature did not intend to define the foot as part of the leg because it listed them as separate body parts under that section.  The court distinguished 8(e) from 8(c) as 8(e) covered impairment and not disfigurement.  They noted that impairment differs according to the body part that is injured.  Whereas disfigurement could be equally harmful wherever it occurs. 

The court reversed the judgment of the Circuit of Boone County and reinstated the Commission’s decision awarding benefits for disfigurement of the left foot, right leg and left leg under Section 8(c) of the Act.   

By: Jigar S. Desai

In Ryba v. Illinois Workers’ Compensation Commission, 2025 IL App (2d) 230596WC-U, the Workers’ Compensation Commission Division of the Illinois Appellate Court for the Second District reversed the circuit court and reinstated the decision of the Commission.

Mary Catherine Ryba, the claimant, filed two applications for adjustment of claim in 2016 under the Workers’ Compensation Act, 820 ILCS 305/1, et seq., seeking benefits for work-related back injuries sustained while employed by Libertyville Manor Extended Care. 2025 IL App (2d) 230596WC-U at ¶4. The employer filed several motions for hearing in 2018 and 2019. After several procedural delays, the case was set for a hearing on February 18, 2020. Id. The claimant failed to appear for trial, and the arbitrator dismissed the case for want of prosecution.

On April 29, 2021 — 436 days later — the claimant moved to reinstate the case. 2025 IL App (2d) 230596WC-U at ¶5. The claimant argued she never received notice of the dismissal. Her counsel also cited a lack of receipt of a notice of case dismissal. Her counsel also claimed there were disruptions caused by the COVID-19 pandemic, as well as a death in the legal team’s family.

Despite the significant delay, the arbitrator reinstated the case. The arbitrator primarily based the decision to allow reinstatement on the claimant’s counsel’s claim that his office never received a written notice of the dismissal and the fact that the Commission was shut down during the period when the case was dismissed and the date a petition to reinstate was due. 2025 IL App (2d) 230596WC-U at ¶7. The arbitrator also found it significant that the Commission had suspended the mandatory trial “Red Line” from March 2020 to November 2021. Id. The arbitrator then proceeded to hear the case and awarded benefits to Ryba.

The Commission affirmed the arbitrator’s findings in full, including the decision to reinstate. The employer appealed to the circuit court.

The circuit court reversed. The circuit court found the arbitrator lacked jurisdiction to vacate the dismissal with prejudice because the statutory 60-day period to file for reinstatement had passed. 2025 IL App (2d) 230596WC-U at ¶8. The circuit court noted that the notice of dismissal was sent to all parties on February 19, 2020, and that caselaw confirms receipt of notice is established upon the date of mailing with confirmation of the sender. Id. See also Talmage v. Union Cent. Life Ins. Co., 315 Ill.App.623, 43 N.E.2d 575 (1st Dist. 1942); Tabor & Co. v. Gorenz, 43 Ill.App.3d 124, 356 N.E.2d 1150, 1 Ill.Dec. 868 (2d Dist. 1976).

The circuit court also found that even if the Commission had jurisdiction, the factual determination of the arbitrator did not support reinstatement, and found that the Commission failed to consider evidence against reinstatement.

On appeal to the appellate court, a number of issues were presented:

1. Did the arbitrator and the Commission have jurisdiction to reinstate a case dismissed for want of prosecution more than 60 days after the dismissal?

2. Did the Commission abuse its discretion in allowing reinstatement based on the claimant’s denial of notice and surrounding circumstances?

3. Were any of the employer’s additional challenges to the merits of the award preserved for appellate review?

The appellate court reversed the circuit court and reinstated the Commission’s decision in full.

The appellate court held that under Illinois law, a party’s denial of receipt of a dismissal notice creates an issue of fact. Therefore, the Commission was within its authority to assess credibility and determine that the 60-day reinstatement clock had not begun to run. 2025 IL App (2d) 230596WC-U at ¶8. The court cited Talmage, supra, in affirming that any determination of whether notice of dismissal was received is a factual issue and therefore the province of the Commission. The appellate court noted the claimant’s denial of receipt of notice rebutted the presumption of mail delivery of notice and created a question of fact for the Commission to decide. The appellate court therefore concluded that the arbitrator and Commission had jurisdiction.

The court found no abuse of discretion in the Commission’s decision to reinstate. The appellate court found the unique combination of the COVID-19 pandemic, procedural confusion regarding the “Red Line,” and personal hardship experienced by the claimant’s counsel supported the Commission’s conclusion that reinstatement was warranted despite the delay. 2025 IL App (2d) 230596WC-U at ¶15. The appellate court was unable to say the Commission’s decision was arbitrary, fanciful, or unreasonable. The court reiterated that it was not its role to reweigh evidence or substitute its judgment for that of the Commission.

Finally, the appellate court rejected the employer’s arguments that the appellate court review the award of the arbitrator. The employer did not raise these issues before the circuit court. The appellate court found the failure to raise issues as to the award resulted in their forfeiture, citing Fernandes v. Industrial Commission, 246 Ill.App.3d 261, 615 N.E.2d 1191, 1197, 186 Ill.Dec. 134 (4th Dist. 1993).

This case reaffirms the principle that when receipt of notice is denied, the presumption of delivery can be rebutted, and jurisdictional timelines under administrative rules may not bar relief if material factual disputes exist. The court also emphasized the broad discretion afforded to the Commission in managing procedural matters, especially under exceptional circumstances such as the COVID-19 pandemic.

By: Jigar S. Desai:

n Singleton v. Illinois Workers’ Compensation Commission, 2025 IL App (1st) 240120WC-U, the First District Appellate Court affirmed the dismissal of a workers’ compensation appeal for want of jurisdiction, emphasizing the strict, jurisdictional nature of statutory deadlines for filing a circuit court review of a Commission decision.

Rashun Singleton filed two applications for adjustment of a claim in 2016 and 2018, alleging a work-related injury from Singleton’s employment with Amita Health/Advent Health. The cases were consolidated. In July 2019, both claims were dismissed for want of prosecution. Singleton filed multiple motions to reinstate, all of which were denied by the arbitrator. The Commission affirmed the arbitrator’s denial on January 31, 2023. 2025 IL App (1st) 240120WC-U at ¶¶5 – 6.

That same day, the Illinois Workers’ Compensation Commission sent notice of its decision to both parties via its CompFile system. Singleton, representing herself, did not file a petition for judicial review in the circuit court until March 1, 2023 — well outside the 20-day statutory deadline.

Amita moved to dismiss the appeal for lack of subject-matter jurisdiction under §2-619(a)(1) of the Illinois Code of Civil Procedure, 735 ILCS 5/2-619(a)(1). The circuit court agreed and dismissed the petition. Singleton’s subsequent motions to vacate and reconsider were denied.

The issues before the appellate court included the following:

1. whether the 20-day period to seek judicial review under §19(f)(1) of the Workers’ Compensation Act, 820 ILCS 305/1, et seq., began on January 31, 2023, when electronic notice was sent via CompFile;

2. whether the method of notice (email) complied with the statutory requirement for notice; and

3. whether Singleton’s late filing could be excused on equitable grounds.

The appellate court affirmed the circuit court’s dismissal for lack of jurisdiction. The court held:

1. The 20-day filing deadline began when notice was sent via CompFile. Under §19(f)(1) of the Illinois Code of Civil Procedure, judicial review must be initiated within 20 days of receiving notice of the Commission’s decision — not the decision itself. Here, notice was deemed received on January 31, 2023, when the CompFile system generated and sent emails to the parties. The court took judicial notice of these public records.
   
   
2. Electronic notice is valid when the party subscribes to CompFile. The court rejected Singleton’s argument that §19(i) of the Workers’ Compensation Act required personal or mailed notice. By registering with CompFile and consenting to electronic service, Singleton agreed to receive notice via email. Under 50 Ill.Admin. Code §9015.50(c), such service is deemed complete upon transmission.
   
   
3. Late filing is jurisdictional and cannot be excused. The court reaffirmed that the statutory filing period is jurisdictional. Absent strict compliance, the circuit court lacks subject-matter jurisdiction. Singleton’s argument that the email may have gone to Singleton’s spam folder was irrelevant under existing caselaw. 2025 IL App (1st) 240120WC-U at ¶17.

The Singleton decision is a reminder that while the Illinois Workers’ Compensation Commission may exercise discretion in certain procedural matters, the statutory deadlines for initiating judicial review in circuit court are strictly jurisdictional. The appellate court reinforced the following:

1. Receipt of electronic notice via CompFile satisfies the statutory requirement for notice if the party has registered for the system.

2. The statutory 20-day window to seek circuit court review under 820 ILCS 305/19(f)(1) begins on the date notice was issued, not on the date of receipt of the decision itself or a party’s actual knowledge.

3. Jurisdiction cannot be conferred by equitable arguments, such as misunderstanding or inadvertent delay.

Comparison to Ryba: Different Rules at Different Levels

In May’s FLASHPOINTS, we analyzed the appellate court’s decision in Ryba v. Illinois Workers’ Compensation Commission, 2025 IL App (2d) 230596WC-U. In Ryba, the appellate court affirmed the Commission’s reinstatement of a claim when the motion to reinstate was filed well after the 60-day period provision of the Workers’ Compensation Act.

The Ryba and Singleton decisions present a clear contrast in how timing issues are treated, depending on whether the matter remains before the Commission or has moved into the judicial review phase.

In Ryba, the appellate court allowed reinstatement of a claim long after the 60-day reinstatement period had passed. The court emphasized that when factual disputes exist — such as denial of notice — the Commission retains discretion to resolve those facts and, when appropriate, toll deadlines. The decision acknowledged the Commission’s broader procedural discretion, particularly during unusual periods like the COVID-19 pandemic.

By contrast, Singleton confirms that once a case moves into the judicial review phase, the jurisdictional lines are strictly drawn. The 20-day filing period under §19(f)(1) of the Workers’ Compensation Act is not a discretionary deadline — it is a jurisdictional bar. Unlike in Ryba, factual disputes such as whether an email went to a spam folder are irrelevant if notice was properly issued and the statutory clock began.

The key distinction lies in statutory discretion vs. jurisdictional mandates:

1. The Commission has discretion to determine factual disputes regarding notice and may permit reinstatement based on equitable considerations (Ryba).

2. The circuit court’s jurisdiction under §19(f)(1) is strictly limited by statute, and equitable considerations cannot extend the deadline (Singleton).

Practitioners must understand the procedural posture of a workers’ compensation case and the implications it has on applicable deadlines. Before the Commission, factual disputes over notice and good cause may allow some leeway. But once a decision is final and the case moves into judicial review, strict compliance with statutory deadlines is essential. Electronic notice is deemed sufficient, and failure to act within 20 days will likely prove fatal to the appeal, as it did in Singleton.

By: Kisa P. Sthankiya

The Illinois Supreme Court issued in Bitner v. City of Pekin 2025 IL 131039  on September 18, 2025 finding that the Illinois Public Employee Disability Act (PEDA), does not prohibit a city from withholding employment taxes from PEDA benefits.

The plaintiffs in the case were both police officers working for the City of Pekin and injured in the line of duty in separate accidents. Both employees received PEDA benefits pursuant to Section 1(b) of PEDA.  Section 1(b) provides:

Whenever an eligible employee suffers any injury in the line of duty which causes him to be unable to perform his duties, he shall continue to be paid by the employing public entity on the same basis as he was paid before the injury, with no deduction from his sick leave credits, compensatory time for overtime accumulations or vacation, or service credits in a public employee pension fund during the time he is unable to perform his duties due to the result of the injury, but not longer than one year in relation to the same injury. (5 ILCS 345/1(b) (West 2018)

During the time that the plaintiffs received PEDA benefits, the City continued to pay the plaintiffs in the same manner as they were paid prior to their injury and withheld employment taxes (Federal, State, Social Security and Medicare).  The plaintiffs filed a suit in circuit court of Tazewell County alleging that by withholding the employment taxes, the City violated the Illinois Wage Payment and Collection Act (Wage Act) (820 ILCS 115/1 et seq. (West 2018).

Cross Motions for Summary Judgment were filed. The circuit court ruled in favor the plaintiff and entered a judgment to recoup the withheld taxes from the City. The ruling was appealed to the appellate court. The appellate court determined that based on the plain language of Section 1(b) did not prohibit the City from withholding unemployment taxes. They did not reach a conclusion on whether the only remedy was to seek a refund of the improperly withheld taxes from the IRS. The appellate court reversed and remanded the case.

The Supreme Court allowed leave to appeal. There were multiple issues decided at the circuit court and appellate level. However, the only issue before the Illinois Supreme Court in the case was whether the Appellate Court erred in its interpretation of Section 1(b).

Relying on language from prior appellate decisions, including Gibbs v. Madison County Sheriff’s Department, 326 Ill. App. 3d 473 (2001), the plaintiffs argued that section 1(b) provides for the “continuation of full pay” and that “full pay” should be interpreted to mean gross pay without employment tax deductions. The Court noted, however, that the phrase “full pay” appears nowhere in Section 1(b). The proper starting point for statutory interpretation, it emphasized, is the plain language of the statute itself. Section 1(b) expressly provides that an eligible employee, “shall continue to be paid by the employing public entity on the same basis as he was paid before the injury, with no deduction from his sick leave credits, compensatory time for overtime accumulations or vacation.” 5 ILCS 345/1(b).

The Court concluded that the phrase “on the same basis” was unambiguous and required disability payments be processed in the same manner as the employee’s pre-injury wages. Thus, if the employer routinely withheld employment taxes before the injury, those same deductions must continue post-injury in order to comply with section 1(b).

The statutory language in section 1(b) also lists specific items that cannot be deducted—sick leave, compensatory time, and vacation credits—but does not mention  employment taxes. Applying the interpretive maxim expressio unius est exclusio alterius, the Court held that the legislature’s express inclusion of certain prohibited deductions impliedly excludes others. Accordingly, the omission of employment tax withholding from the list indicates that such withholdings are permissible.

Plaintiffs argued that this reading produced an absurd or unjust result because, in their view, PEDA benefits are exempt from federal income tax, and therefore the withholding of employment taxes unlawfully reduces the benefit. The Court was unpersuaded by their argument. It observed that plaintiffs had provided no authority—no IRS ruling, federal statute, or regulation—establishing that section 1(b) payments are tax-exempt. Even if such payments were ultimately non-taxable, the Court reasoned, any excess withholding would not deprive the employee of funds owed under the Act. Rather, the proper remedy would be for the employee to claim a tax refund from the IRS or adjust his W-4 withholding status.

Additionally, the Court underscored the administrative practicality of its interpretation. They noted that public employers often face operational challenges in administering pay for police officers and firefighters who move in and out of PEDA status, sometimes for short periods. Requiring employers to continually assess taxability and alter withholding practices would create unnecessary complexity and potential compliance issues. Section 1(b), by directing that pay continue “on the same basis” as before the injury, actually simplifies administration and ensures uniformity. The Court noted that other jurisdictions, such as Massachusetts and North Carolina, have adopted similar frameworks requiring payment of “in the same manner” as regular compensation for disability payments.

The Court held that nothing in section 1(b) prohibits public employers from withholding employment taxes from disability payments. The employer, therefore, did not violate the statute by continuing to process payroll in the same manner as pre-injury compensation. The appellate court’s judgment reversing the circuit court was affirmed.

This decision reinforces that PEDA does not create an enhanced or tax-exempt benefit beyond continuation of ordinary salary. Payments should be issued from the regular payroll system and subject to the same withholdings as the employee’s pre-injury compensation.

The decision also reiterates that questions regarding whether disability payments are taxable, or whether withholdings were appropriate, are matters between the employee and the Internal Revenue Service. Per the decision, ff an employee believes the payments are exempt from taxation, the appropriate recourse is to adjust tax withholding by submitting a new W-4 form or to seek a refund directly from the IRS. This clarification protects municipalities from unwarranted demands for reimbursement and reinforces that PEDA’s purpose is to ensure income continuity, not to provide a tax-exempt benefit.