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Perez v. The Illinois Workers' Compensation Commission

Court of Appeals of Illinois, Second District, Workers' Compensation Commission Division

January 9, 2018

ROCIO PEREZ, Appellant,
v.
THE ILLINOIS WORKERS' COMPENSATION COMMISSION et al. (TFN, Inc., d/b/a Wendy's, Appellee).

         Appeal from the Circuit Court of Kane County. No. 16-MR-751 Honorable David R. Akemann, Judge, Presiding.

          JUSTICE HARRIS delivered the judgment of the court, with opinion. Presiding Justice Holdridge and Justices Hoffman, Hudson, and Overstreet concurred in the judgment and opinion.

          OPINION

          HARRIS, JUSTICE

         ¶ 1 On September 10, 2007, claimant, Rocio Perez, filed an application for adjustment of claim pursuant to the Workers' Compensation Act (Act) (820 ILCS 305/1 to 30 (West 2006)), seeking benefits from the employer, TFN Inc. Following a hearing, the arbitrator determined claimant's condition of ill-being in her left knee was not causally connected to her work accident on June 19, 2007.

         ¶ 2 In May 2012, the Illinois Workers' Compensation Commission (Commission) affirmed the arbitrator's decision. On judicial review, in January 2013, the circuit court of Kane County confirmed the Commission's decision. In March 2014, this court reversed the circuit court's decision, finding that (1) the Commission abused its discretion in admitting the causation opinions of the employer's independent medical expert and (2) the Commission's finding that claimant failed to meet her burden of proving that her conditions of ill-being were causally connected to a workplace accident was against the manifest weight of the evidence. See Perez v. Illinois Workers' Compensation Comm'n, 2014 IL App (2d) 130220WC-U.

         ¶ 3 In March 2015, the Commission issued a decision on remand, awarding 43/7 weeks' temporary total disability (TTD) benefits and $288 per week for a period of 43 weeks for the loss of use of claimant's left leg. The Commission also ordered the employer to pay claimant's medical expenses in accordance with sections 8(a) and 8.2(e) of the Act, without specifying the amount. 820 ILCS 305/8(a), 8.2(e) (West 2006). In November 2015, the circuit court of Kane County entered an order remanding the matter to the Commission to determine the amount owed for medical expenses.

         ¶ 4 In June 2016, the Commission issued a decision on remand, ordering the employer to pay $17, 857.96 for medical expenses under sections 8(a) and 8.2(e) of the Act (820 ILCS 305/8(a), 8.2(e) (West 2006)), representing the total amount of $17, 597.86 paid by claimant's husband's health insurance provider under its group health insurance plan "and deductibles/copays of $260.00." On judicial review, in January 2017, the circuit court of Kane County affirmed the Commission's decision. Claimant appeals.

         ¶ 5 We affirm.

         ¶ 6 I. BACKGROUND

         ¶ 7 At arbitration, claimant, the assistant manager at a Wendy's restaurant, testified she sustained a workplace injury in her left knee when she slipped and fell on a wet floor on June 19, 2007. She subsequently underwent medical treatment, including physical therapy and surgery, for a lateral meniscal tear in her left knee.

         ¶ 8 Claimant testified that her medical expenses were either paid by Cigna, her then husband's medical insurance carrier, or paid out-of-pocket. The employer submitted an exhibit listing medical payments made by Cigna, showing payments of $17, 597.96 and copayments of $260. On April 4, 2011, the parties entered into a stipulation reflecting fee schedule amounts for claimant's medical services, which totaled $37, 767.32, but with the caveat that "[the employer] disputes the fee schedule is the appropriate basis for calculating [the] amount of medical, if compensable."

         ¶ 9 On April 25, 2011, the arbitrator issued a decision, finding claimant's condition of ill-being in her left knee was not causally connected to her work accident on June 19, 2007. The Commission affirmed the arbitrator's decision. On January 31, 2013, the circuit court of Kane County confirmed the Commission.

         ¶ 10 Claimant appealed to this court, which reversed the circuit court's judgment and concluded that (1) the Commission abused its discretion in admitting the causation opinions of the employer's independent medical expert and (2) the Commission's finding that claimant failed to meet her burden of proving that her conditions of ill-being were causally connected to a workplace accident was against the manifest weight of the evidence. See Perez v. Illinois Workers' Compensation Comm'n, 2014 IL App (2d) 130220WC-U.

         ¶ 11 On March 17, 2015, the Commission issued its decision on remand, awarding 43/7 weeks' TTD benefits and $288 per week for a period of 43 weeks for the loss of use of claimant's left leg. The Commission also ordered the employer to pay claimant's medical expenses in accordance with sections 8(a) and 8.2(e) of the Act, without specifying the amount. 820 ILCS 305/8(a), 8.2(e) (West 2006). On November 12, 2015, the circuit ...


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