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  "name": "TWICE OVER CLEAN, INC., Appellee, v. THE INDUSTRIAL COMMISSION et al. (Howard Haulk, Appellant)",
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    "parties": [
      "TWICE OVER CLEAN, INC., Appellee, v. THE INDUSTRIAL COMMISSION et al. (Howard Haulk, Appellant)."
    ],
    "opinions": [
      {
        "text": "JUSTICE KILBRIDE\ndelivered the opinion of the court:\nThis case is before us again following our supervisory order (188 Ill. 2d R. 383) directing the appellate court to reconsider its opinion setting aside an award of compensation to Howard Haulk (Twice Over Clean, Inc. v. Industrial Comm\u2019n, 337 Ill. App. 3d 805 (2003)) in the light of our decision in Sisbro, Inc. v. Industrial Comm\u2019n, 207 Ill. 2d 193 (2003). The appellate court vacated its original opinion (348 Ill. App. 3d 638, 639) and again set aside the Industrial Commission\u2019s award of compensation to Haulk, holding that \u201cin light of his susceptibility to a heart attack outside of work, he failed in the first instance to prove a \u2018sufficient causal connection\u2019 between his work and his injury.\u201d 348 Ill. App. 3d at 652. We granted Haulk\u2019s petition for leave to appeal (177 Ill. 2d R. 315). We allowed Rush University Medical Center, United Wisconsin Insurance Company, and IPC International Corporation to file an amicus curiae brief in support of Twice Over Clean. 155 Ill. 2d R. 345. We now reverse the judgment of the appellate court and affirm the judgment of the circuit court.\nBACKGROUND\nThe record reveals that Haulk was employed as a laborer for Twice Over Clean in Peoria, Illinois. He was assigned to an asbestos removal job in Minneapolis, Minnesota, in December 1996. On January 2, 1997, while performing heavy labor, he suffered chest pains. After he finished work, he went to his hotel and did not feel like eating. He again experienced chest pains and broke out in a cold sweat. He was taken by ambulance to Hennepin County Medical Center (the hospital), where he was admitted and diagnosed with an acute inferior myocardial infarction. Upon his release, he returned to Peoria, where he received additional care from his internist and a cardiologist.\nHaulk filed an application for adjustment of claim with the Industrial Commission (Commission), seeking compensation for his heart attack. The claim was heard before an arbitrator. The principal disputed issue was whether the injury arose out of and in the course of Haulk\u2019s employment.\nAt the hearing, Haulk testified that his work assignment on January 2, 1997, was to assist in the removal of 500 to 700 bags of asbestos, each weighing 45 to 50 pounds, located on the top floor of an unheated four- to five-story building in downtown Minneapolis. The temperature in the building was approximately five degrees Fahrenheit. Haulk carried the bags down the stairs and outside to a Dumpster located approximately 100 feet from the building, where he had to pile the asbestos bags high in the dumpster. While performing this task, Haulk was required to wear a large, air-pack-driven facial respirator and protective clothing. At about 2:30 p.m., while performing this work, he noticed pains in his chest, neck, and left shoulder. The pains subsided when he sat down and rested for 10 to 15 minutes, but returned when he resumed working. He left work around 4:30 p.m. The pains never stopped entirely, although they were more severe at times. Ultimately, he began having cold sweats and nausea, an ambulance was called, and he was taken to the hospital. Haulk denied experiencing chest pain prior to January 2, 1997.\nThe hospital records for Haulk\u2019s treatment were admitted in evidence. An unsigned resident\u2019s history and physical form, dated January 3, 1997, noted that Haulk was evaluated for chest pain beginning while he was \u201clifting items\u201d around 8 p.m. that evening and returning while he was in bed around 10 p.m. An admission data profile, also dated January 3, 1997, signed by the person preparing it, recited that Haulk described getting \u201cchest pain yesterday afternoon while loading a truck,\u201d but that it went away. A signed inpatient consultation stated that Haulk presented with an onset of acute chest pain while lifting weight. Narrative notes dated January 3, 1997, signed by a treating physician, referred to Haulk as a patient with \u201cangina x 4 wks.\u201d who experienced \u201csevere pain starting at about 10:00 p.m. today.\u201d A critical care flow sheet dated January 3, 1997, signed by a nurse, recorded that Haulk had chest pain with exertion in the morning that subsided on its own. Haulk was diagnosed with and treated for acute inferior myocardial infarction. Coronary angiography revealed a 90% obstruction in a portion of the right coronary artery. These records were sent to Haulk\u2019s internist in Peoria, Dr. Brian Cohen.\nUpon his return to Peoria, Haulk consulted Dr. Cohen, who in turn referred him to a cardiologist, Dr. Frank Gold. Those doctors provided care for Haulk beginning January 16, 1997, and continuing until he was released to return to work on June 30, 1997.\nHaulk had recurring chest pain in February 1997, and was admitted by Dr. Cohen to Methodist Medical Center in Peoria, where he was seen in consultation by Dr. Mark Shima. The consultation record was admitted in evidence. Dr. Shima\u2019s impression was: \u201cAtypical resting chest discomfort which radiates to the back and the back of neck. Despite this, this is the same discomfort the patient feels that he had in the pre-infarction period of the day or so prior to an inferior infarct occurring in January of 1997 for which he underwent angioplasty at Hennepin County Hospital in Minnesota.\u201d Dr. Shima found no evidence of a myocardial infarction on the occasion of this February 1997 consultation.\nTwo written reports from Dr. Gold were admitted at the hearing. The first, dated January 16, 1997, was a letter to Dr. Cohen, confirming that Haulk clearly sustained a myocardial infarction and was not capable of returning to his duties as a laborer. Dr. Gold stated that, apart from smoking, Haulk had limited risk factors for coronary artery disease. He reported Haulk advised him that he underwent acute salvage angioplasty in Minneapolis, and that the doctors told him \u201cthere was a 50% residual stenosis.\u201d In the second report, dated April 10, 1997, Dr. Gold opined that Haulk was then totally disabled as a result of a myocardial infarction sustained while working in Minneapolis, Minnesota.\nThe report of Dr. Cohen, dated December 4, 1998, was admitted at the hearing. In the report, Dr. Cohen wrote: \u201cThe myocardial infarction that Howard Haulk, Jr. suffered at 9:00 EM. on January 2, 1997, in my medical opinion, was precipitated by the heavy lifting that he did all day long at work. He was actually experiencing the chest pain while doing the lifting, and probably was developing his heart attack at that time.\u201d\nThe evidence deposition of Dr. Cohen, taken on March 10, 1999, was admitted at the hearing. Dr. Cohen testified that he was board certified in internal medicine. Prior to January 13, 1997, he had seen Haulk on only two occasions in 1990, when he performed a physical examination and some follow-up studies. The examination revealed no problems. He and Dr. Gold both followed Haulk\u2019s progress after January 13, 1997. Dr. Cohen was primarily concerned with risk factors for coronary disease. He prescribed medication for elevated cholesterol and provided care through February 1999.\nDr. Cohen was asked to assume hypothetically that Haulk performed the work duties Haulk described in his testimony under those same conditions. He then was asked whether he had an opinion \u201cbased upon a reasonable degree of medical certainty as to whether the myocardial infarction that Mr. Haulk suffered as indicated in the records from the hospital in Minneapolis might or could have been caused by the physical activity engaged in on January 2nd, 1997.\u201d Dr. Cohen responded affirmatively and stated \u201cthat activity very likely could have led him to have a heart attack.\u201d He further opined, based on a review of enzyme studies taken on January 2 and 3, 1997, that Haulk\u2019s heart attack could have occurred around 2 p.m.\nOn cross-examination, Dr. Cohen conceded the arteriogram taken at the time of his initial workup in Minneapolis, showing a 90% occlusion of the right coronary artery, was \u201cvery significant\u201d and that any activity or no activity by a person having that degree of occlusion could put sufficient stress on the heart to result in a myocardial infarction. He testified that \u201canybody can experience a myocardial infarction at rest, really.\u201d He also agreed with the cross-examiner\u2019s statement that \u201ca person with that degree of occlusion is basically a heart attack waiting to happen.\u201d On redirect, Dr. Cohen stated that physical activity contributes to the risk of myocardial infarction in persons having Haulk\u2019s degree of occlusion, and the kind of lifting Haulk was doing in the afternoon is \u201ctremendous stress and causes a very high work load on the heart and the heart muscle.\u201d\nTwice Over Clean presented the evidence deposition of Dr. Gary N. Wilner of Evanston, Illinois, taken November 15, 1999. Dr. Wilner, who is board certified in both internal medicine and cardiovascular diseases, was engaged by Twice Over Clean to evaluate Haulk\u2019s medical records. He did not physically evaluate Haulk. In his opinion, Haulk\u2019s work activity was not a factor in his myocardial infarction, based on the enzyme levels he had at the time of his admission. Those levels were within normal limits, indicating the infarction had not occurred prior to the preceding five or six hours. He admitted on cross-examination that other studies might be found that would support a different conclusion.\nThe arbitrator found the heart attack arose out of and in the course of Haulk\u2019s employment and entered an award in his favor. The Commission affirmed and adopted the arbitrator\u2019s decision, with one commissioner dissenting. The circuit court of Peoria County confirmed the Commission\u2019s decision. The appellate court reversed, holding the evidence established that Haulk\u2019s physician agreed Haulk was a \u201cheart attack waiting to happen\u201d and could have suffered a heart attack even while at rest. Therefore, the normal daily activity exception applied to defeat Haulk\u2019s claim. Twice Over Clean, Inc., 337 Ill. App. 3d at 810-11.\nHaulk petitioned for leave to appeal to this court. We initially denied leave to appeal, but entered a supervisory order directing the appellate court to reconsider its opinion in the light of our recent pronouncement in Sis-bro. Twice Over Clean, Inc. v. Industrial Comm\u2019n, 205 Ill. 2d 650 (2003) (supervisory order). The appellate court vacated its opinion and issued a new opinion, again reversing the circuit court\u2019s judgment and setting aside the award of the Industrial Commission. 348 Ill. App. 3d at 652. This appeal followed.\nANALYSIS\nIn Sisbro, we rejected the argument that the \u201cnormal daily activity\u201d exception bars recovery when the claimant\u2019s physical condition has so deteriorated that the condition of ill-being could have been produced by normal daily activity, despite a causal connection between the work and the condition. Sisbro, 207 Ill. 2d at 208-09. Instead, we held \u201cwhether \u2018any normal daily activity is an overexertion\u2019 or whether \u2018the activity engaged in presented risks no greater than those to which the general public is exposed\u2019 are matters to be considered when deciding whether a sufficient causal connection between the injury and the employment has been established in the first instance.\u201d Sisbro, 207 Ill. 2d at 211-12. We observed this court has never initially found a causal connection to exist between work and injury and then, as a further analytical step, denied recovery based on a \u201c \u2018normal daily activity exception.\u2019 \u201d Sisbro, 207 Ill. 2d at 212. We then analyzed the evidence of record and concluded the manifest weight of the evidence supported the Commission\u2019s decision awarding compensation, despite testimony by respondent\u2019s expert witness that claimant\u2019s condition was the result of the normal degenerative process of his preexisting diabetic condition. Sisbro, 207 Ill. 2d at 215. We held:\n\u201cWhen an employee with a preexisting condition is injured in the course of his employment, serious questions are raised about the genesis of the injury and the resulting disability. The Commission must decide whether there was an accidental injury which arose out of the employment, whether the accidental injury aggravated or accelerated the preexisting condition or whether the preexisting condition alone was the cause of the injury. *** However, the Commission\u2019s decision must be supported by the record and not based on mere speculation or conjecture. If there is an adequate basis for finding that an occupational activity aggravated or accelerated a preexisting condition, and, thereby, caused the disability, the Commission\u2019s award of compensation must be confirmed.\u201d Sisbro, 207 Ill. 2d at 215.\nFrom our review of the record, we then determined that a legitimate inference arose from the evidence before the Commission that the claimant\u2019s occupational activity was a causative factor in hastening the onset of his disabling condition. Accordingly, we confirmed the Commission\u2019s award of compensation. Sisbro, 207 Ill. 2d at 215.\nSisbro established the standard for reviewing the Commission\u2019s findings where a preexisting condition may be a cause of the disability. Thus, we will apply that standard in determining whether the record supports a legitimate inference that Haulk\u2019s occupational activity was a causative factor in hastening the onset of his disabling myocardial infarction, considering as a factor the preexisting 90% occlusion of his right coronary artery and the likelihood his heart attack could have occurred even without activity. The Commission is entitled to draw reasonable inferences from the evidence, and we will not disregard those inferences unless the Commission\u2019s decision is against the manifest weight of the evidence. City of Des Plaines v. Industrial Comm\u2019n, 95 Ill. 2d 83, 90 (1983).\nHere, the appellate court majority held the normal daily activity limitation bars compensation, based entirely on the admission of Haulk\u2019s treating expert, Dr. Cohen, that \u201c \u2018any activity or no activity could put sufficient stress on the heart to result in a myocardial infarction\u2019 \u201d and his agreement with the cross-examiner\u2019s statement that the claimant was a \u201c \u2018heart attack waiting to happen.\u2019 \u201d 348 Ill. App. 3d at 651-52. As the dissent in the appellate court points out, however, the majority made no reference to the extensive testimony establishing that Haulk\u2019s symptoms began during his performance of heavy labor under extreme temperature conditions. 348 Ill. App. 3d at 654 (Goldenhersh, J., dissenting). The majority further ignored Dr. Cohen\u2019s testimony that physical activity contributes to the risk of heart attack in persons having Haulk\u2019s degree of coronary artery occlusion, and that the heavy labor he was performing when his symptoms began \u201cis tremendous stress and causes a very high work load on the heart and heart muscle.\u201d\nThe appellate court majority held that \u201cin light of his susceptibility to a heart attack outside of work, he failed in the first instance to prove a \u2018sufficient causal connection\u2019 between his work and his injury.\u201d 348 Ill. App. 3d at 652. This conclusion completely ignores competent testimony in the record establishing that Haulk\u2019s work activity contributed to his risk of heart attack and that his symptoms began while he was performing tremendously stressful heavy labor. From this testimony a reasonable inference arises that the work activity was a contributing cause of the heart attack, even considering the 90% occlusion of a portion of Haulk\u2019s right coronary artery. Thus, the Commission\u2019s determination that a sufficient causal connection was demonstrated is not against the manifest weight of the evidence. If a causal connection between the work activity and the injury is shown by competent testimony, no \u201climitation\u201d or \u201cexception\u201d to compensation can be imposed to defeat a right to recovery.\nIn Rock Road Construction Co. v. Industrial Comm\u2019n, 37 Ill. 2d 123 (1967), we affirmed an award of compensation for a fatal heart attack. The decedent, an asphalt truck driver, was found dead in his truck after the truck went out of control, lightly struck a guardrail, and came to rest. He had previously suffered two myocardial infarctions, carried nitroglycerin pills, and cold weather bothered him. Rock Road, 37 Ill. 2d at 125-26. The record established that the fatal heart attack occurred shortly after the decedent finished rolling up and down his tarpaulin and dumping a load of asphalt. Rock Road, 37 Ill. 2d at 127-28. Conflicting expert medical testimony was offered, one expert supporting the existence of a causal relationship between the work activity and the heart attack, and three others denying any causal connection. One of the experts believed decedent\u2019s death was inevitable, regardless of his work activity. Rock Road, 37 Ill. 2d at 126. We observed it was likely that the ultimate result of decedent\u2019s heart condition would have been death at some indeterminate future date, and possibly occurring in a situation wholly unrelated to work or exertion. Nevertheless, we found the Commission\u2019s finding of compensable injury was not against the manifest weight of the evidence, noting conflicting evidence of the extent of deterioration of the decedent\u2019s condition. Rock Road, 37 Ill. 2d at 128.\nSimilarly, in County of Cook v. Industrial Comm\u2019n, 69 Ill. 2d 10 (1977), we confirmed an award of compensation for a fatal heart attack when the victim had a prior history of myocardial infarction and died following a period of an unusually busy workload in his office. We held the employee need only prove that some act or phase of the employment was a causative factor of the resulting injury, explaining that \u201c[t]he mere fact that an employee might have suffered a fatal heart attack, even if not working, is immaterial.\u201d County of Cook, 69 Ill. 2d at 17-18.\nWe acknowledged the limitation that compensation will be denied when it is shown that the employee\u2019s health has so deteriorated that any normal daily activity is an overexertion, but stated the application of this limitation presented a question of fact for the Commission. County of Cook, 69 Ill. 2d at 18.\nAs in Rock Road, the record in this case raised a reasonable likelihood that Haulk\u2019s heart attack was inevitable and could have occurred in circumstances unrelated to work activities. The testimony of Dr. Cohen, however, also provided a reasonable basis for the inference that Haulk\u2019s heavy labor put extreme stress on his heart, and this stress was in fact a cause of his myocardial infarction. Under the standard we announced in Sis-bro, it was the Commission\u2019s function to decide whether, considering the extent of Haulk\u2019s right coronary artery occlusion and its predicted effect, his preexisting condition was aggravated or accelerated by the work activity, thus sufficiently establishing a causal relationship between the work activity and the injury.\nTwice Over Clean concedes in its brief that if Haulk\u2019s history of the onset of symptoms is accurate, then Dr. Cohen\u2019s opinion on causal connection based on that history had adequate foundation and is entitled to be given weight by the trier of fact. Twice Over Clean also concedes in its brief that if Haulk\u2019s testimony is accurate, the arbitrator\u2019s reliance on that history is supported by the manifest weight of the evidence.\nTwice Over Clean claims the history testified to by Haulk is inaccurate because it conflicts with his description of the onset of symptoms given to hospital personnel at the time of his admission. Twice Over Clean contends those descriptions were contemporaneous with Haulk\u2019s January 2, 1997, cardiac event and, thus, were made at a time when the desire for proper diagnosis and treatment outweighed any motive to testify falsely for gain. Accordingly, Twice Over Clean argues Haulk\u2019s testimony contradicting the hospital records should be disregarded.\nIn Horath v. Industrial Comm\u2019n, 96 Ill. 2d 349 (1983), this court held the Commission\u2019s decision denying compensation was not against the manifest weight of the evidence, despite the undisputed expert medical testimony establishing a causal connection between the injury and the claimant\u2019s disability. The Commission\u2019s opinion noted the claimant gave a different account of his symptoms to treating physicians immediately after the injury than he gave to the doctor who testified at the hearing. Horath, 96 Ill. 2d at 356. We held the finding regarding causation involved the credibility of the claimant. The assessment of credibility is a function of the Commission, not the reviewing court. Thus, the Commission did not err in rejecting medical opinions based on testimony found not credible. Horath, 96 Ill. 2d at 356-57.\nIt is true, as Twice Over Clean argues, that some of the descriptions in the medical records reflect a different account of the onset of symptoms than Haulk\u2019s testimony-before the arbitrator, particularly as to timing. However, the nature and progression of the symptoms as described in both the records and Haulk\u2019s testimony are similar. Only the record indicating the attack was preceded by intermittent chest pain for four weeks sharply contradicts Haulk\u2019s denial of prior chest pain in his testimony. The hypothetical question posed to Dr. Cohen did not, however, include an assumption that Haulk had no prior chest pain. In addition, Dr. Cohen was asked on cross-examination the significance of intermittent chest pain for a period of about a month. He stated it was consistent with stable angina, a symptom of coronary artery disease, but added that other sources of chest pain, including heartburn and muscle strain can mimic angina. Regardless of whether Haulk had prior intermittent pain owing to heart disease or some other cause, it is undisputed that Haulk\u2019s right coronary artery occlusion preceded his heart attack.\nWe cannot say, based on this record, that the arbitrator\u2019s acceptance of Haulk\u2019s testimony is without foundation or based on speculation and conjecture. There was, accordingly, a reasonable basis for acceptance of Dr. Cohen\u2019s opinion based on that testimony. We hold, therefore, that the decision of the Commission is not against the manifest weight of the evidence.\nCONCLUSION\nThere is an adequate basis in the record to conclude that the work activity described by Haulk aggravated or accelerated his preexisting coronary artery disease and was, accordingly, a cause of the myocardial infarction resulting in his disability. The \u201cnormal daily activity limitation,\u201d while relevant to the question of causation, cannot be applied as a matter of law to defeat Haulk\u2019s claim. It was, therefore, error for the appellate court to reverse the judgment of the circuit court and set aside the decision of the Commission on the ground that Haulk failed to prove a sufficient causal connection between his work and the injury because of his susceptibility to a heart attack outside of work. Accordingly, we reverse the appellate court\u2019s judgment and affirm the judgment of the circuit court.\nAppellate court judgment reversed; circuit court judgment affirmed.\nNow known as the Illinois Workers\u2019 Compensation Commission. See Pub. Act 93 \u2014 721, eff. January 1, 2005.",
        "type": "majority",
        "author": "JUSTICE KILBRIDE"
      }
    ],
    "attorneys": [
      "J. Kevin Wolfe and R. Wayne Harvey, of Harvey & Stuckel, Chrtd., of Peoria, for appellant.",
      "Allen C. Mueller, of Livingstone, Mueller, O\u2019Brien & Davlin, EC., of Springfield, for appellee.",
      "Eugene F. Keefe, of Chicago, for amici curiae Rush University Medical Center et al."
    ],
    "corrections": "",
    "head_matter": "(No. 98748.\nTWICE OVER CLEAN, INC., Appellee, v. THE INDUSTRIAL COMMISSION et al. (Howard Haulk, Appellant).\nOpinion filed March 24, 2005.\nJ. Kevin Wolfe and R. Wayne Harvey, of Harvey & Stuckel, Chrtd., of Peoria, for appellant.\nAllen C. Mueller, of Livingstone, Mueller, O\u2019Brien & Davlin, EC., of Springfield, for appellee.\nEugene F. Keefe, of Chicago, for amici curiae Rush University Medical Center et al."
  },
  "file_name": "0403-01",
  "first_page_order": 415,
  "last_page_order": 429
}
