Repetitive Injuries: An Employer’s Proactive Approach to Defending and Preventing Claims

August 2025

Janna M. Miller Midura and Alyson J. Long

Repetitive trauma injuries are common not only in the general population but also in workers’ compensation cases. According to recent CDC research, 9% of adults in the United States reported experiencing a repetitive strain injury in the past three months (¹). Among that percentage, 44% needed to limit their usual activity for at least 24 hours and, of those who limited activity, 51% ultimately consulted a physician (²). Many of these injuries occur at work, resulting in workers’ compensation cases. Repetitive strain injuries commonly affect occupations such as assembly line and manufacturing workers, office workers/data entry personnel, and healthcare practitioners. The types of injuries commonly seen as a result are carpal tunnel claims, tendinitis, and neck/shoulder/lumbar strain injuries.

The Illinois Supreme Court set the standard for recovery for repetitive trauma claims in the landmark case Peoria County Belwood Nursing Home v. Industrial Commission, 115 Ill. 2d 524, 505 N.E.2d 1026 (1987). This case established that repetitive trauma claims, or claims that have developed gradually over time due to repetitive work activity, are recoverable under the Illinois Workers’ Compensation Act. The Court held that it is not necessary to trace the injury to one specific accident date, time, or place. Rather, the date of the injury is the date on which the injury “manifests itself,” or the date on which the injury and causal connection to the petitioner’s employment would become plainly apparent to a reasonable person.

If these injuries are common and if they develop gradually over time due to repetitive work activities, how does an employer work to combat and defend these cases? Repetitive injury cases are unique because they often pose questions regarding causation. These cases also frequently pose notice issues, as petitioners will often delay reporting or receiving treatment. Employers can defend against such claims by challenging the direct causal link between the injury and the repetitive work activities and specific job duties, highlighting potential alternative causes, or arguing that the injury was pre-existing and not aggravated by work.

Fortunately, the Illinois Supreme Court in Peoria County Belwood Nursing Home v. Industrial Commission, did emphasize that the proof requirements in a repetitive-trauma claim are no less stringent than those for claims alleging a specific date, place, and cause of injury. After selecting an appropriate accident date, a petitioner must show that the injury is work-related and not the result of a normal degenerative aging process.1 This two-fold test requires that petitioners 1) produce medical opinions relating the pathology to work, and 2) show that the risk of injury due to repetitive work is greater than the risk faced by the general public.

We suggest exploring the following strategies to defend against a repetitive trauma claim after a claim is filed:

• Perform a Medical Canvass to review the extent of an employee’s prior medical treatment. Often times, medical records from prior to the date of injury can show that the condition was pre-existing to such an extent that it is difficult for an Arbitrator to determine that an injury is related to a work injury, as opposed to the result of a normal, pre-existing aging process. The Commission has relied on a petitioner’s prior medical history to analyze medical causation. In Deborah Sillman v. City of Chicago, 10 IL. W.C. 18749 (Ill. Indus. Com'n Sept. 19, 2018), the Commission heavily discussed Petitioner’s treatment between 2002 and 2011, including medical treatment preceding the date of alleged injury, as relied upon by the petitioner’s treating physician to form his opinion. The Commission ultimately found that Petitioner’s condition of ill-being was pre-existing and that any aggravation of her condition from the alleged work accident was fleeting. By performing a Medical Canvass, we can find records that support our defense that the petitioner’s repetitive trauma condition was not caused by the work-related incident.
• Provide evidence of alternative causes of the injury. Does the employee engage in activities outside of his/her work that can explain the source of the injury? To provide proof of outside activities that could be a source of the repetitive stress, it is essential to conduct surveillance and perform a social media check of petitioner. One might be surprised to find that the injured worker is a boxer or plays soccer regularly. Information regarding physical activities outside of work could further support an employer’s contention that the petitioner’s condition stems from an alternative source.
• Perform a thorough job analysis. Providing a detailed assessment of the employee’s job duties to a medical professional, either in an independent medical examination or through cross examination of a treating physician, allows for an employer to evaluate the physician’s knowledge of the physicality of the petitioner’s profession and the nature of the repetitive work. This is essential to a defense, given that the second prong of the Peoria County test requires strict evaluation of the repetitive nature of the petitioner’s job duties, especially when the movement alleged by the petitioner is one commonly performed in everyday life (i.e. bending over)(³).
• Provide medical evidence showing a lack of a direct link between the alleged repetitive trauma injury and the employee’s work activities. In repetitive injury cases, an Arbitrator’s decision will often hinge on the credibility of the physician’s opinion. Because of this, providing an examining physician with ample resources to allow them to form a credible and convincing medical opinion puts the employer in the best position possible when submitting that report to an arbitrator. Video from a job site showing how an employee’s work is performed, including the specific work activities that the employee alleges that they engage in on a repetitive basis, is a particularly excellent tool. Have the doctor review the job duties video and provide an opinion, on a reasonable degree of medical certainly, regarding whether the force and repetition level of the activities the employee engaged in, along with the length of time performing the activity on a daily or monthly basis, could cause the alleged repetitive trauma injury is an important part of a case defense. Providing video proof which demonstrates that the employee's duties did not involve excessive or repetitive motions, or that the employee's workstation was ergonomically sound, can help in the defense of a repetitive trauma claim. While there is no specific percentage of time required for a task to be considered repetitive, having a medical opinion to dispute evidence of frequency and duration of the activity can go a long way in defending against a repetitive trauma claim.
• Depose the treating physician regarding their knowledge of the employee’s job duties. Challenging the treating physician’s knowledge of the repetitive nature – or lack thereof – of the employee’s job can work to illustrate defects in the employee’s theory of causation in the case. In a recent Illinois Appellate Court decision, Brian Borst v. Illinois Workers Compensation Commission, Il. App. 2d (2024), 230124WC-U, the employer successfully asserted a defense against such a claim by aggressively questioning the treating physician in a deposition regarding the employee’s job duties with an ergonomic job analysis, causing the Arbitrator to conclude the doctor could not establish a causal connection between the petitioner’s job duties and the alleged repetitive trauma injury to a reasonable degree of medical certainty.

A strong defense against a repetitive trauma case can go a long way. In order to take a proactive approach even before a workers’ compensation case is filed, employers can take steps to prevent workplace repetitive strain claims. There are strategies that can be employed prior to a claim being filed. One approach that employers can take is to conduct ergonomic assessments of workstations and implement measures to minimize strain. Such an approach can include:

• Providing training on proper lifting techniques and body mechanics.
• Providing ergonomic equipment and training employees on proper posture and techniques.
• Implementing break policies and encouraging employees to take frequent breaks.

While taking the steps suggested above cannot necessarily prevent a case in being filed, they can help to put the employer in the best position possible to defend a repetitive trauma workers compensation case.

Footnotes:

^{1. Questions for Matthew Garnett, Health Statistician and Lead Author of “Repetitive Strain Injuries in Adults in the Past 3 Months: United States, 2021.” ↩}
^{2. Id. ↩}
^{3. See Darling v. Indus. Comm'n of Illinois, 176 Ill. App. 3d 186, 195, 530 N.E.2d 1135, 1142 (1988). ↩}