Durand v. Industrial Commission ( 2006 )


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  •                     Docket No. 101109.
    IN THE
    SUPREME COURT
    OF
    THE STATE OF ILLINOIS
    DEANA DURAND, Appellant, v. THE INDUSTRIAL
    COMMISSION et al. (RLI Insurance Company, Appellee).
    Opinion filed October 19, 2006.
    JUSTICE FITZGERALD delivered the judgment of the
    court, with opinion.
    Chief Justice Thomas and Justices Freeman and Kilbride
    concurred in the judgment and opinion.
    Justice Garman dissented, with opinion, joined by Justice
    Karmeier.
    Justice Burke took no part in the decision.
    OPINION
    Deana Durand filed a claim for benefits under the Workers=
    Compensation Act (see 820 ILCS 305/1 et seq. (West 2004))
    after she developed carpal tunnel syndrome. The Illinois
    Industrial Commission 1 found that Durand=s injury manifested
    itself more than three years before she filed her claim, and thus
    her claim was time barred. See 820 ILCS 305/6(d) (West
    2004). The trial court confirmed the Commission=s decision,
    and the appellate court affirmed the trial court=s decision. The
    central issue in this case is whether the Commission=s decision
    was against the manifest weight of the evidence. For the
    reasons that follow, we reverse and remand.
    BACKGROUND
    In 1990, Durand was hired as a clerical worker at RLI
    Insurance Company (RLI), and in 1993, she became a policy
    administrator. As a policy administrator, Durand scanned
    insurance policies into a computer and typed on a computer
    keyboard for several hours each day. On January 29, 1998,
    Durand informed her supervisor that she noticed pain in her
    hands several months earlier, in September or October of
    1997, and that she believed the pain was work-related. Durand
    continued working, and the pain in her hands increased. She
    eventually sought medical help.
    Dr. Lestel Escorcia examined Durand on August 15, 2000.
    In her notes, Dr. Escorcia stated that Durand reported hand
    and wrist pain radiating up to her elbows and constant tingling
    and numbness in her fingers and hands. These symptoms had
    continued Aon and off@ for 12 years. Durand told Dr. Escorcia
    that she had worked at a computer keyboard for seven to eight
    years, and Dr. Escorcia concluded that Durand=s hand and
    wrist pain were Aprobably carpal tunnel.@ She referred Durand
    to Dr. Gregory Blume for a nerve study to confirm this
    preliminary diagnosis.
    1
    Effective January 1, 2005, the name of the Industrial Commission was
    changed to the AIllinois Workers= Compensation Commission.@ See 820
    ILCS 305/1(c) (West 2004). When it decided this case, it was still known as
    the Industrial Commission. We will use that name.
    Dr. Blume examined Durand on September 8, 2000. In his
    notes, Dr. Blume stated that Durand complained of Abilateral
    wrist and right elbow pain,@ as well as Asome numbness and
    tingling.@ These symptoms had progressed for two years,
    deteriorating when she worked and improving when she did
    not. Dr. Blume performed a nerve study, or EMG test, which
    revealed Avery mild or early right median nerve entrapment at
    the wrist (carpal tunnel syndrome).@ He concluded that Duran=s
    condition was, Aby history, *** very work-related.@
    Dr. Jay Pomerance examined Durand on November 6,
    2000, at the request of RLI=s insurer. In a November 8, 2000,
    letter, Dr. Pomerance stated that Durand mentioned Agradual
    onset,@ in mid-2000, of pain radiating from her right wrist, then
    numbness in her right fingers and thumb, and later numbness
    in her left fingers. According to Dr. Pomerance, Durand Adid
    have prior symptoms approximately eighteen months ago but
    these were not that bothersome to her.@ Dr. Pomerance
    reviewed the September 8, 2000, nerve study results and
    agreed with Dr. Blume=s diagnosis: AThe patient=s current
    clinical condition is consistent with a borderline right carpal
    tunnel syndrome along with pain in the left hand.@ Based on
    Durand=s description of her job, however, he suggested no
    activity restrictions. In a November 20, 2000, letter, written after
    viewing a videotape of Durand at work, Dr. Pomerance stated,
    AI would not expect this job to cause or aggravate upper
    extremity pathology such as carpal tunnel syndrome.@ There
    was no causal relationship, according to Dr. Pomerance,
    between Durand=s work activities and her carpal tunnel
    syndrome. Dr. Pomerance=s deposition testimony was
    consistent with his notes.
    Dr. Conner, an orthopedic surgeon, first examined Durand
    on November 29, 2000. In his notes, Dr. Conner stated that
    Durand had worked at RLI for more than nine years,
    performing Acontinuous computer entry work during her eight-
    hour shift.@ According to Dr. Conner, she Adeveloped problems
    with both arms six or seven months ago.@ Dr. Conner noted
    that Dr. Blume had performed a nerve study and diagnosed
    Durand with Amild early right median nerve entrapment or
    carpal tunnel syndrome.@ Dr. Conner=s impression was
    -3-
    A[b]ilateral carpal tunnel syndrome,@ which from her history
    apparently developed Asecondary to her work activity.@ Dr.
    Conner again examined Durand on December 20, 2000. In his
    notes, Dr. Conner stated that Durand had met with Dr.
    Pomerance:
    AFrom her description to me she tells me that 90% of
    her work was using the computer. In [Dr. Pomerance=s]
    letter this part of it was down played considerably, but
    on discussing it with her she tells me that the majority of
    her work is computer activity. Thus as I thought
    previously in my opinion her carpal tunnel [syndrome] is
    caused or aggravated by her work.@
    The following week, Durand scheduled surgery with Dr.
    Conner.
    On January 12, 2001, Durand filed an application for
    benefits with the Industrial Commission, asserting that she had
    experienced Aserious and permanent@ injury to Aboth wrists and
    upper extremities@ from Arepetitive data entry@ for RLI. Durand=s
    application listed September 8, 2000, the date Dr. Blume
    performed the nerve study and conclusively diagnosed her
    carpal tunnel syndrome, as the date of the accident. Dr.
    Conner performed surgery to repair Durand=s right median
    nerve on February 12, 2001 and her left median nerve on June
    4, 2001.
    Dr. Robert Martin examined Durand on August 7, 2001, at
    the request of her attorney. In an October 29, 2001, evidence
    deposition, Dr. Martin testified that Durand told him she had
    worked at a computer keyboard for 62 hours each day for the
    past eight years. Two years earlier, she developed pain in both
    wrists, as well as numbness in her fingers. According to Dr.
    Martin, carpal tunnel syndrome generally manifests itself as
    Aeither numbness, tingling or pain and combinations thereof,@
    and these symptoms continue if the employee experiencing
    them continues to perform the same work. Dr. Martin testified
    that if Durand had experienced such symptoms in 1997, they
    Acertainly could have been@ a manifestation of carpel tunnel
    syndrome. Dr. Martin opined that Durand=s work activities
    contributed to her development of carpel tunnel syndrome.
    -4-
    On May 9, 2002, an arbitration hearing was held. Durand
    testified that she never had hand or wrist problems before she
    worked for RLI. On cross-examination, RLI=s attorney asked
    Durand about her January 29, 1998, conversation with
    coworker Karen Andell:
    AQ. *** [D]o you recall telling [Andell] *** that your
    symptoms in your hands, right and left, started in
    September or October of 1997?
    A. I could have.
    Q. Do you recall having a problem at that time?
    A. I guess I could have, but I didn=t know at the time
    what it was.
    Q. Do you recall telling Ms. Andell that you told your
    supervisor at that time that you believed the condition
    was work-related?
    A. This was back in =98?
    Q. Yes, January 29th, 1998, that you recall reporting
    the incidentB
    A. Oh, yes.
    Q. So, in your mind you believe that your condition
    back in September or October of =97 was work-related?
    A. Yes.
    Q. And your job duties remained the same
    thereafter; is that correct?
    A. Yes.@
    On redirect examination, Durand reiterated that she felt her
    pain was work-related in 1997:
    AQ. And that opinion that you gave, was that your
    opinion, was that an opinion that had been given to you
    by your doctor? How did you reach that opinion?
    A. It was my opinion, because of the pains I was
    having.
    Q. That was your expert opinion?
    A. Yes.@
    On re-cross-examination, Durand again discussed her
    symptoms in 1997. Durand repeated that she told her
    -5-
    supervisor that she was convinced her condition was work-
    related.
    Again, on redirect examination, Durand stated that, at that
    time, no doctor had diagnosed carpal tunnel syndrome. On re-
    cross-examination, RLI=s attorney asked:
    Q. Did you think you had carpel tunnel then from
    what you knew?
    A. I wasn=t sure because it wasn=t real constant and
    real severe at the time.
    Q. You had heard of carpel tunnel syndrome,
    though; is that correct?
    A. I think I might have heard of it.
    Q. And you knew people who had it or had had it?
    A. Yes.
    Q. And it was your belief that you had that condition
    and you felt that it was due to your job duties; is that
    correct?
    A. Yes.@
    In a June 4, 2002, decision, the arbitrator found that Durand
    sustained a repetitive-trauma accident caused by her work.
    Further, according to the arbitrator, AWhile [Durand] had
    experienced symptoms of carpal tunnel syndrome well before
    ***, the first time that she had received an EMG, and been
    officially diagnosed with carpal tunnel syndrome was
    September 8, 2000.@ The arbitrator decided that Durand=s
    claim fell within the limitations period and awarded her medical
    expenses, as well as weekly compensation for temporary total
    disability and permanent partial disability in her right and left
    hands.
    On July 18, 2002, RLI filed a petition for review, and on
    September 12, 2003, the Industrial Commission reversed the
    arbitrator=s decision. The Commission found that Durand used
    a keyboard for approximately six hours per day. The
    Commission reviewed her testimony about when her
    symptoms appeared. Durand stated four times during the
    arbitration hearing that she experienced pain in her hands and
    wrists in September or October of 1997 and that she believed
    -6-
    this pain was work-related. The Commission stated: AUpon
    reviewing the events of September 8, 2000, the Commission
    finds that with the exception of [Durand] undergoing an EMG
    test, there was no specific event that took place on that date.
    *** Based on [Durand=s] testimony, the Commission finds that
    the     September/October        date      is    the     date    of
    accident/>manifestation date= and said date was the date when
    the fact of the injury and its causal relationship to her
    employment was plainly apparent to [Durand] and to a
    reasonable person alike.@ Consequently, she filed her claim
    outside the three-year limitations period.
    One commissioner wrote a concurring opinion, and one
    commissioner wrote a dissenting opinion. The concurring
    commissioner noted:
    AThe fact that on September 8, 2000, a medical
    diagnosis was attached to [Durand=s] condition does not
    indicate that [her] condition or its cause were, for
    >manifestation= reasons, then newly apparent or
    reasonably should have been. Insofar as the records ***
    or her testimony *** are concerned, we only can
    determine that Dr. Blume believed there was a work
    related cause. There is no evidence that on September
    8, 2000, this was conveyed to [Durand]. The statement
    to Karen Andell indicates [Durand], as early as 1997,
    was fully aware of her hand condition, knew about
    carpal tunnel syndrome, knew people who had it, felt
    she had it and that it was due to her job duties ***. A
    reasonable person with such knowledge and experience
    would then have known both of her condition and its
    relationship to her work.@
    The dissenting commissioner observed that Durand
    Acontinued to perform essentially the same job activities for
    several years preceding the onset of her symptoms in late
    1997 to the time she finally sought medical treatment in August
    2000.@ According to the dissenting commissioner, there is no
    authority for the proposition that the earliest onset of symptoms
    is the manifestation date. In fact, such a rule is contrary to the
    axiom that the Workers= Compensation Act should be liberally
    -7-
    construed to accomplish its purposes. The dissenting
    commissioner concluded:
    AAt best, the majority has used the date Petitioner
    became aware of a potential disability as the
    manifestation date. Their narrow interpretation
    penalizes her for giving her employer notice of a
    potential disability, for not immediately seeking medical
    attention, and for continuing to perform her regular work
    for the same employer, notwithstanding a suspicion that
    she might be developing work related carpal tunnel
    syndrome. I fail to see what legitimate policies are
    served by their interpretation.@ (Emphasis in original.)
    Durand filed a judicial review complaint, and the trial court
    confirmed the Commission=s decision. The appellate court
    affirmed the trial court=s decision. 
    358 Ill. App. 3d 239
    . Illinois
    law, asserted the appellate court, Adoes not require that a
    claimant=s injury must have been diagnosed by a physician or
    that a physician have opined that the injury is causally related
    to her employment. [Citation.] Rather, manifestation of a
    repetitive trauma injury occurs when the fact of injury and
    causation would have become plainly apparent to a reasonable
    
    person.@ 358 Ill. App. 3d at 244
    . Here, Durand testified that in
    1997 she felt pain in her wrists and believed this pain was
    work-related, even though she Awasn=t sure@ that she had
    carpal tunnel 
    syndrome. 358 Ill. App. 3d at 245
    . The appellate
    court found Asufficient evidence@ to support the Commission=s
    finding that Durand=s injury manifested itself in 1997; her claim
    was filed more than three years later and was thus 
    time-barred. 358 Ill. App. 3d at 245
    .
    Justice Holdridge, joined by Justice Donovan, 
    dissented. 358 Ill. App. 3d at 245
    (Holdridge, J., dissenting, joined by
    Donovan, J.). Justice Holdridge noted that Durand filed her
    claim on January 12, 2001; he thus looked back three years to
    January 12, 
    1998. 358 Ill. App. 3d at 246
    (Holdridge, J.,
    dissenting, joined by Donovan, J.). Although Durand informed
    her supervisor of her general pain in 1997, it was Aon and off,@
    and not Areal constant and real 
    severe.@ 358 Ill. App. 3d at 246
    (Holdridge, J., dissenting, joined by Donovan, J.). According to
    Justice Holdridge, Durand=s Aintermittent discomfort@ left her
    -8-
    unsure she even had carpal tunnel syndrome, and her Amere
    belief that she had the condition@ was insufficient to make it
    plainly apparent to a reasonable 
    person. 358 Ill. App. 3d at 246
    (Holdridge, J., dissenting, joined by Donovan, J.). Justice
    Holdridge asserted that the date of the accident or
    manifestation date was not before January 12, 1998, and
    Durand=s claim was 
    timely. 358 Ill. App. 3d at 246
    (Holdridge,
    J., dissenting, joined by Donovan, J.).
    We granted Durand=s petition for leave to appeal. 177 Ill. 2d
    R. 315(a).
    ANALYSIS
    Durand raises two issues: (1) whether the Industrial
    Commission=s decision setting the date of the accident on an
    unspecified date in either September or October 1997 was
    against the manifest weight of the evidence; and (2) whether
    this decision was contrary to Illinois law.
    The Industrial Commission is the ultimate decisionmaker in
    workers= compensation cases, and it is not bound by any
    decision made by the arbitrator. Cushing v. Industrial Comm=n,
    
    50 Ill. 2d 179
    , 181-82 (1971). Instead, the Commission must
    weigh the evidence presented at the arbitration hearing and
    determine where the preponderance of that evidence lies. See
    Steiner v. Industrial Comm=n, 
    101 Ill. 2d 257
    , 260 (1984);
    Wagner Castings Co. v. Industrial Comm=n, 
    241 Ill. App. 3d 584
    , 594 (1993) (Ait is solely within the province of the
    Commission@ to weigh the evidence (emphasis in original)). A
    reviewing court will not reverse the Commission unless its
    decision is contrary to law (see Butler Manufacturing Co. v.
    Industrial Comm=n, 
    85 Ill. 2d 213
    , 216 (1981)) or its fact
    determinations are against the manifest weight of the evidence
    (see Shockley v. Industrial Comm=n, 
    75 Ill. 2d 189
    , 193 (1979)).
    A reviewing court will not reweigh the evidence, or reject
    reasonable inferences drawn from it by the Commission,
    simply because other reasonable inferences could have been
    drawn. See International Harvester v. Industrial Comm=n, 
    93 Ill. 2d
    59, 65 (1982); Benson v. Industrial Comm=n, 
    91 Ill. 2d 445
    ,
    450 (1982). Fact determinations are against the manifest
    -9-
    weight of the evidence only when an opposite conclusion is
    clearly apparentBthat is, when no rational trier of fact could
    have agreed with the agency. See D.J. Masonry Co. v.
    Industrial Comm=n, 
    295 Ill. App. 3d 924
    , 930 (1998).
    Section 6(d) of the Workers= Compensation Act provides
    that an injured employee must file a workers= compensation
    claim Awithin 3 years after the date of the accident.@ 820 ILCS
    305/6(d) (West 2004). When the accident is a discrete event,
    the date of the accident is easy to determine: it is, obviously,
    the date that the employee was injured. When the accident is
    not a discrete event, this date is harder to specify. An
    employee who suffers a repetitive-trauma injury still may apply
    for benefits under the Act, but must meet the same standard of
    proof as an employee who suffers a sudden injury. See AC&S
    v. Industrial Comm=n, 
    304 Ill. App. 3d 875
    , 879 (1999); Nunn v.
    Industrial Comm=n, 
    157 Ill. App. 3d 470
    , 480 (1987). That
    means, inter alia, an employee suffering from a repetitive-
    trauma injury must still point to a date within the limitations
    period on which both the injury and its causal link to the
    employee=s work became plainly apparent to a reasonable
    person. Williams v. Industrial Comm=n, 
    244 Ill. App. 3d 204
    ,
    209 (1993). Setting this so-called manifestation date is a fact
    determination for the Commission. Palos Electric Co. v.
    Industrial Comm=n, 
    314 Ill. App. 3d 920
    , 930 (2000).
    Here, Durand argues that the Commission=s finding that her
    injury occurred sometime in September or October 1997 was
    against the manifest weight of the evidence. She contends that
    September 8, 2000, the date she was conclusively diagnosed
    with carpel tunnel syndrome, was the date of the accident;
    consequently, her January 12, 2001 claim was timely. Durand
    also argues that the Commission=s finding was unfair,
    unrealistic, and contrary to law. According to Durand, Illinois
    cases have looked at the date when the employee requires
    medical treatment or becomes unable to work in determining
    when an injury manifested itself. Durand asserts that an injury
    in a carpal tunnel syndrome workers= compensation case
    cannot be established before the employee seeks medical
    consultation to confirm such a condition. RLI responds that the
    -10-
    Commission=s findings were consistent with Illinois law and
    were not against the manifest weight of the evidence.
    Initially, we reject Durand=s argument that the decisions
    below were contrary to Illinois law. The appellate court, the trial
    court, and the Industrial Commission all employed the correct
    standard in determining when her injury manifested itself. That
    standard comes from Peoria County Belwood Nursing Home v.
    Industrial Comm=n, 
    115 Ill. 2d 524
    (1987). In Peoria County, an
    employee in a nursing home laundry room experienced pain,
    numbness, and tingling in her hands and fingers on October 4,
    1976, and consulted a neurologist regarding these symptoms
    the next day. The employee continued to work for nearly a
    year, then underwent outpatient carpal tunnel surgery on
    August 23, 1977. She filed a workers= compensation claim the
    next day, alleging that she developed carpal tunnel syndrome
    as a result of her work. The arbitrator awarded temporary and
    permanent total disability benefits. The Industrial Commission
    affirmed that decision; the trial court, in turn, confirmed the
    Commission=s decision. The appellate court affirmed the trial
    court=s decision.
    This court framed the issue as Awhether an injury sustained
    as a result of work-related repetitive trauma is compensable
    under the Workers= Compensation Act without a finding that the
    injury occurred as a result of one specific incident traceable to
    a definite time, place and cause.@ Peoria County Nursing
    
    Home, 115 Ill. 2d at 527
    . We stated that the purpose behind
    the Workers= Compensation Act is best served by allowing
    compensation where an injury is gradual but linked to the
    employee=s work. Peoria 
    County, 115 Ill. 2d at 529
    . We
    continued:
    ARequiring complete collapse in a case like the
    instant one would not be beneficial to the employee or
    the employer because it might force employees needing
    the protection of the Act to push their bodies to a
    precise moment of collapse. Simply because an
    employee=s work-related injury is gradual, rather than
    sudden and completely disabling, should not preclude
    protection and benefits. *** To deny an employee
    benefits for a work-related injury that is not the result of
    -11-
    a sudden mishap *** penalizes an employee who
    faithfully performs job duties despite bodily discomfort
    and damage.@ Peoria 
    County, 115 Ill. 2d at 529
    -30.
    We then discussed the limitations period. The employer
    argued that the employee=s claim was time-barred because the
    injury was not traceable to a specific date. Peoria 
    County, 115 Ill. 2d at 530
    . We agreed with the appellate court that the date
    of the injury in a repetitive-trauma compensation case is the
    date when the injury manifests itselfBAthe date on which both
    the fact of the injury and the causal relationship of the injury to
    the claimant=s employment would have become plainly
    apparent to a reasonable person.@ Peoria 
    County, 115 Ill. 2d at 531
    , citing 1B A. Larson, Workmen=s Compensation '39.50
    (1985). The employee experienced pain, numbness, and
    tingling in her hands and fingers on October 4, 1976; these
    symptoms were severe enough that she sought medical
    treatment the next day. Peoria 
    County, 115 Ill. 2d at 531
    . Thus,
    October 4 was the last day that the employee worked before
    the fact of her injury and its causal connection to her work
    became apparent. Peoria 
    County, 115 Ill. 2d at 531
    . We
    concluded that because she filed her claim less than three
    years later, her claim was timely. Peoria 
    County, 115 Ill. 2d at 531
    .
    The appellate court has applied Peoria County in several
    carpal tunnel syndrome cases, and some of these cases
    provide useful insight regarding how to determine the
    manifestation date. In Oscar Mayer & Co. v. Industrial Comm=n,
    
    176 Ill. App. 3d 607
    (1988), an employee cut meat at a
    slaughterhouse for 15 years. In 1981, he experienced
    numbness, tingling, and burning in his hands and elbows. The
    employer=s doctor examined the employee and performed an
    EMG test. The doctor told the employee that he suffered from
    bilateral carpal tunnel syndrome, and the employee refused
    surgery, opting for more conservative treatment. A year later,
    the employee=s doctor performed a second EMG test, which
    indicated that the employee=s condition was deteriorating.
    Another year later, the doctor performed a third EMG test,
    which confirmed that the employee=s condition was still
    deteriorating. The employee had surgery on May 12, 1983. On
    -12-
    April 5, 1984, the employee filed a workers= compensation
    claim, listing his date of injury as the date he had surgery. The
    arbitrator awarded benefits to the employee, but the trial court
    reversed, concluding that the employee failed to prove that the
    date he had surgery was the date of accident.
    The appellate court reversed the trial court. Oscar 
    Mayer, 176 Ill. App. 3d at 608
    . According to the appellate court, the
    employee acknowledged that he knew of his injury and its
    relationship to his work before he had surgery. Oscar 
    Mayer, 176 Ill. App. 3d at 608
    . The appellate court, however, refused
    to read Peoria County narrowly:
    ABy their very nature, repetitive-trauma injuries may
    take years to develop to a point of severity precluding
    the employee from performing in the workplace. An
    employee who discovers the onset of symptoms and
    their relationship to the employment, but continues to
    work faithfully for a number of years without significant
    medical complications or lost working time, may well be
    prejudiced if the actual breakdown of the physical
    structure occurs beyond the period of limitation set by
    statute. [Citation.] Similarly, an employee is also clearly
    prejudiced in the giving of notice to the employer
    [citation] if he is required to inform the employer within
    45 days of a definite diagnosis of the repetitive-
    traumatic condition and its connection to his job since it
    cannot be presumed the initial condition will necessarily
    degenerate to a point at which it impairs the employee=s
    ability to perform the duties to which he is assigned.
    Requiring notice of only a potential disability is a useless
    act since it is not until the employee actually becomes
    disabled that the employer is adversely affected in the
    absence of notice of the accident.@ (Emphasis in
    original.) Oscar 
    Mayer, 176 Ill. App. 3d at 611
    .
    The appellate court stated that Afact of the injury@ is not
    synonymous with Afact of discovery.@ Oscar Mayer, 
    176 Ill. App. 3d
    at 611, citing Peoria 
    County, 115 Ill. 2d at 531
    . That is, the
    date on which the employee notices a repetitive-trauma injury
    is not necessarily the manifestation date. Instead, the date on
    which the employee became unable to work, due to physical
    collapse or medical treatment, helps determine the
    -13-
    manifestation date. Oscar 
    Mayer, 176 Ill. App. 3d at 611
    . The
    appellate court noted that the standard remains flexible: AJust
    as we reject [the employer=s] contention the date of discovery
    of the condition and its relation to the employment necessarily
    fixes the date of accident, we reject any interpretation of this
    opinion which would permit the employee to always establish
    the date of accident in a repetitive-trauma case by reference to
    the last date of work.@ Oscar Mayer, 
    176 Ill. App. 3d
    at 612.
    Where the employer concedes that the injury was work-related
    and that the employee continued to work until the day before
    surgery, the Commission could reasonably conclude that that
    day was the date of accident. Oscar 
    Mayer, 176 Ill. App. 3d at 611
    ; but see Casteneda v. Industrial Comm=n, 
    231 Ill. App. 3d 734
    , 738 (1992) (holding that an employee=s Alast day of
    exposure to repetitive trauma is not, in and of itself, the day of
    accident for the purposes of repetitive injury cases@).
    In Three AD@ Discount Store v. Industrial Comm=n, 198 Ill.
    App. 3d 43 (1989), an employee buffed floors for a discount
    store. After five months, the employee noticed swelling in his
    hands and shooting pains in his right arm. He visited his
    doctor, who prescribed pain medication. At that time, he was
    also being treated by an endocrinologist for a diabetic
    condition. The employee experienced more severe pain, then
    numbness and tingling in his fingers and hands. The
    endocrinologist referred him to a neurologist. On June 27,
    1984, the neurologist performed an EMG test and sent a report
    that the employee had carpal tunnel syndrome to the
    endocrinologist. The endocrinologist discussed the
    neurologist=s report with the employee and referred him to an
    orthopedic surgeon. The orthopedic surgeon examined the
    employee on July 10, 1984, and scheduled surgery for August
    1984. The employee then informed his supervisor that he had
    carpal tunnel syndrome and that it was work-related, and he
    continued to work until August 10, 1984. He later filed a
    workers= compensation claim.
    The arbitrator rejected this claim, finding that the employee
    failed to offer any evidence about when his injury occurred.
    The arbitrator concluded that if there was a work-related injury,
    it occurred when the employee first noticed swelling and pain,
    not when he left work in August 1984. The Commission
    reversed the arbitrator=s findings. The Commission decided
    -14-
    that the employee=s injury was work-related and that it
    manifested itself when he left work. The Commission awarded
    benefits to the employee, and the trial court confirmed this
    decision.
    The appellate court initially reversed the trial court=s
    decision, but on rehearing affirmed. Three AD@ Discount 
    Store, 198 Ill. App. 3d at 47
    . The appellate court stated that the
    evidence established that the endrocrinologist discussed the
    neurologist=s report with the employee, but did not establish
    that the endocrinologist ever told the employee that his
    condition was work-related. Three AD@ Discount Store, 198 Ill.
    App. 3d at 47-48. The employee learned that his injury was
    work-related sometime in the month before he informed his
    supervisor and left work. Three AD@ Discount Store, 198 Ill.
    App. 3d at 48. The appellate court concluded that a reasonable
    person would have been on notice that this condition was
    work-related and medically disabling on July 10, 1984. Three
    AD@ Discount 
    Store, 198 Ill. App. 3d at 48
    . After reviewing
    Oscar Mayer, the appellate court stated:
    AAn employee who continues to work on a regular basis
    despite his own progressive ill-being should not be
    punished merely for trying to perform his duties without
    complaint. On the other hand, it is not this State=s policy
    to encourage disabled workers to silently push
    themselves to the point of medical collapse before
    giving the employer notice of an injury.@ Three AD@
    Discount 
    Store, 198 Ill. App. 3d at 49
    .
    The facts must be closely examined in repetitive-injury cases to
    ensure a fair result for both the faithful employee and the
    employer=s insurance carrier. Three AD@ Discount Store, 198 Ill.
    App. 3d at 49.
    RLI argues, and we agree, that fairness and flexibility are
    the common themes in these cases. Indeed, the rule in Peoria
    County is broad enough to accommodate unique scenarios
    presented in different cases, and the Commission should
    weigh many factors in deciding when a repetitive-trauma injury
    manifests itself. But despite RLI=s repeated invocations of
    flexibility, it asks us to limit the inquiry in this case to only one
    fact: the unspecified date in September or October 1997 on
    which Durand first noticed her hand and wrist pain, opined it
    -15-
    could be carpal tunnel syndrome, and guessed it may bear
    some relation to her work, but declined to mention it to her
    supervisor for at least three months.
    As the appellate court correctly noted in Oscar Mayer, ATo
    always require an employee suffering from a repetitive-trauma
    injury to fix, as the date of accident, the date the employee
    became aware of the physical condition, presumably through
    medical consultation, and its clear relationship to the
    employment is unrealistic and unwarranted.@ Oscar Mayer, 
    176 Ill. App. 3d
    at 610. The inquiry is not so narrow. Professor
    Larson=s workers= compensation treatise provides a summary
    of the case law:
    AThe practical problem of fixing a specific date for
    the accident has generally been handled by saying
    simply that the date of accident is the date on which
    disability manifests itself. Thus, in [Ptak v. General
    Electric Co., 
    13 N.J. Super. 294
    , 
    80 A.2d 337
    (1951)],
    the date of a gradually acquired [back] strain was
    deemed to be the first moment the pain made it
    impossible to continue work, and in [Di Maria v. Curtiss-
    Wright Corp., 
    23 N.J. Misc. 374
    , 
    44 A.2d 688
    (1945)],
    the date of accident for gradual loss of use of the hands
    was held to be the date on which this development
    finally prevented claimant from performing his work.
    However, for certain purposes the date of accident may
    be identified with the onset of pain occasioning medical
    attention, although the effect of the pain may have been
    merely to cause difficulty in working and not complete
    inability to work.@ 3 L. Larson, Larson=s Workers=
    Compensation Law '50.05, at 50B11-50B12 (2005).
    In short, courts considering various factors have typically
    set the manifestation date on either the date on which the
    employee requires medical treatment or the date on which the
    employee can no longer perform work activities. See Peoria
    County Belwood Nursing Home v. Industrial Comm=n, 138 Ill.
    App. 3d 880, 887 (1985), aff=d, 
    115 Ill. 2d 524
    (1987) (holding
    that determining the manifestation date is a question of fact
    and that Athe onset of pain and the inability to perform one=s
    job, are among the facts which may be introduced to establish
    -16-
    the date of injury@). A formal diagnosis, of course, is not
    required. The manifestation date is not the date on which the
    injury and its causal link to work became plainly apparent to a
    reasonable physician, but the date on which it became plainly
    apparent to a reasonable employee. See General Electric Co.
    v. Industrial Comm=n, 
    190 Ill. App. 3d 847
    , 857 (1989).
    However, because repetitive-trauma injuries are progressive,
    the employee=s medical treatment, as well as the severity of
    the injury and particularly how it affects the employee=s
    performance, are relevant in determining objectively when a
    reasonable person would have plainly recognized the injury
    and its relation to work. See Oscar Mayer, 
    176 Ill. App. 3d
    at
    610.
    Against this legal background, the question before us is
    simply whether the date chosen by the Commission was
    against the manifest weight of the evidence adduced at the
    arbitration hearing. We believe it was.
    According to RLI, Durand admitted that she knew about
    carpal tunnel syndrome and even suspected she had it in
    September or October 1997. RLI contends that Durand
    presented no evidence to show that she changed her mind
    about her injury or its relation to her work, and concludes that
    the manifestation date was in 1997. RLI essentially asks us to
    rely on Aexpert@ medical testimony from a layperson, Durand,
    and ignore her testimony about her intermittent pain and how it
    affected her performance.
    At the arbitration hearing, Durand testified that she told her
    supervisor about her hand and wrist pain in September or
    October of 1997, but she Adidn=t know at the time what it was,@
    even though she believed it was work-related. Durand reached
    that Aexpert opinion@ based solely on the pain she was having,
    not on any doctor=s advice. Durand later reiterated that she
    Awasn=t sure@ her pain was carpal tunnel syndrome Abecause it
    wasn=t real constant and real severe@ in 1997. She then
    testified that she Amight have heard of@ carpal tunnel syndrome
    and knew people who had had it, and so surmised that she too
    had developed work-related carpal tunnel syndrome. Durand
    was never reassigned to other work, and she never sought
    -17-
    medical treatment for her hand and wrist pain until August 15,
    2000, when she visited Dr. Escorcia.
    Dr. Escorcia noted that Durand reported her pain began 18
    months earlier, or a year after she spoke to her supervisor, but
    the pain was Aon and off.@ Dr. Blume noted that Durand
    reported her pain began two years before he examined her on
    September 8, 2000, and progressed when she worked. Dr.
    Pomerance noted that Durand reported Agradual onset@ of
    hand and wrist pain in mid-2000; she had symptoms
    approximately 18 months earlier, Abut these were not that
    bothersome to her.@ Similarly, Dr. Conner noted that Durand
    reported problems in her arms in mid-2000. Dr. Martin stated
    Durand=s carpal tunnel syndrome could have manifested itself
    with her hand and wrist pain in 1997, but gave no indication
    whether he reached that conclusion using the Peoria County
    standard.
    If Durand would have filed a claim in 1997, she certainly
    would have had difficulty proving her injury. Her description
    and understanding of the hand and wrist pain was sketchy and
    equivocal. At that time, it was not so constant or severe that it
    warranted medical treatment or reassignment to different work.
    As Justice Holdridge suggested in his dissent, Athe
    circumstances signal periodic discomfort leading to doubt
    about the existence of a distinct 
    injury.@ 358 Ill. App. 3d at 246
    (Holdridge, J., dissenting, joined by Donovan, J.). The record
    strongly suggests that this doubt lingered until 2000, when
    Durand=s pain finally necessitated medical treatment. A
    reasonable person would not have known of this injury and its
    putative relationship to computer keyboard work before that
    time, and it was against the manifest weight of the evidence to
    conclude otherwise. Durand=s claim was timely. We decline to
    penalize an employee who diligently worked through
    progressive pain until it affected her ability to work and required
    medical treatment.
    However, we must remand this cause to the Industrial
    Commission. RLI, relying on testimony from Dr. Pomerance,
    disputed whether Durand=s work activities caused her injuries.
    The Commission decided this case solely on the limitations
    period issue, and did not weigh the evidence on causation. We
    -18-
    decline to usurp this function of the Commission, based upon
    the paper record before us.
    CONCLUSION
    For the reasons that we have stated, we reverse the
    judgments of the appellate and circuit courts, set aside the
    decision of the Industrial Commission, and remand this matter
    to the Commission for further proceedings.
    Appellate court judgment reversed;
    circuit court judgment reversed;
    Commission decision set aside;
    cause remanded.
    JUSTICE BURKE took no part in the consideration or
    decision of this case.
    JUSTICE GARMAN, dissenting:
    Claimant=s testimony before the arbitrator more than
    adequately supports the Commission=s conclusion that
    claimant=s carpal tunnel syndrome and its relationship to her
    employment would have been Aplainly apparent to a
    reasonable person@ (Peoria County Belwood Nursing Home v.
    Industrial Comm=n, 
    115 Ill. 2d 524
    , 531 (1987)) in September or
    October of 1997. In reversing the Industrial Commission=s
    decision that the claim at issue was barred by the Workers=
    Compensation Act=s three-year statute of limitations (820 ILCS
    305/6(d) (West 2004)), the majority misapplies the deferential
    manifest weight of the evidence standard of review and
    obliquely modifies the test set forth in Peoria County for
    determining the manifestation date of a claimant=s injury.
    Consequently, I dissent.
    The evidence presented to the Commission regarding the
    date claimant=s injury manifested itself included her testimony
    before the arbitrator (slip op. at 4-5) and the medical notes and
    deposition testimony of the five physicians who examined her
    (slip op. at 2-4). Claimant=s testimony contains four admissions
    -19-
    that she was aware of her injury and its relationship to her
    employment in September or October of 1997, at which time
    she reported her hand and wrist problems to her supervisor.
    The medical evidence reveals various conflicting estimates by
    claimant of the time period when she first noticed the onset of
    her hand and wrist pain.
    The majority acknowledges that the Commission=s
    determination of the date claimant=s injury manifested itself
    must be given deference on review (slip op. at 8-9) and states
    that the Commission applied the correct legal standard in
    making that determination (slip op. at 10). Accordingly, the
    Commission=s determination that claimant=s injury manifested
    itself more than three years before the date she filed her
    application for benefits should be upheld.
    As the majority notes, a reviewing court will not reverse a
    factual determination of the Commission unless it is against the
    manifest weight of the evidence. Shockley v. Industrial
    Comm=n, 
    75 Ill. 2d 189
    , 193 (1979). To that end, a reviewing
    court must not reweigh the evidence, or reject reasonable
    inferences drawn from it by the Commission, simply because
    other reasonable inferences could have been drawn.
    International Harvester v. Industrial Comm=n, 
    93 Ill. 2d
    59, 65
    (1982). Setting the date of a claimant=s injury is a factual
    determination for the Commission (Palos Electric Co. v.
    Industrial Comm=n, 
    314 Ill. App. 3d 920
    , 930 (2000)), and that
    determination is governed by the standard this court set forth in
    Peoria County: the date of injury in a case involving repetitive
    trauma is the date when the injury Amanifests itself,@ meaning
    Athe date on which both the fact of the injury and the causal
    relationship of the injury to the claimant=s employment would
    have become plainly apparent to a reasonable person@ (Peoria
    
    County, 115 Ill. 2d at 531
    ).
    In this case, it was reasonable for the Commission to
    conclude, based on the evidence described above, that the fact
    of claimant=s injury and its relationship to her employment
    would have been plainly apparent to a reasonable person in
    September or October of 1997. To begin with, the evidence
    was sufficient for the Commission to reasonably conclude that
    the fact of claimant=s injury and its relationship to her
    employment were actually apparent to her in September or
    -20-
    October of 1997. Claimant admitted no less than four times in
    her testimony before the arbitrator that she was aware of her
    injury and its relationship to her employment at that time. In
    evaluating the evidence before it, it was unquestionably within
    the province of the Commission to give weight to that
    uncontradicted testimony and discount the conflicting accounts
    of the onset of claimant=s pain that she gave to her physicians.
    To the extent the majority questions the reasonableness of
    claimant=s actual belief in September or October of 1997 that
    she was injured and the injury was related to her employment, I
    would again emphasize this court=s limited role as a reviewing
    tribunal in this case. See International Harvester, 
    93 Ill. 2d
    at
    65. Claimant testified that she experienced no hand or wrist
    problems before working at RLI Insurance Company, that she
    had no hobbies involving the intensive use of her hands, that
    she did not use a computer outside of work, and that she was
    generally aware of the nature of carpal tunnel syndrome at the
    time she reported her hand and wrist problems to her
    supervisor. Based on this testimony, the Commission could
    reasonably have inferred that claimant=s belief in September or
    October of 1997 that her hands and wrists were injured and the
    injury was related to her employment was a reasonable one.
    Indeed, even Dr. Robert Martin, the physician who examined
    claimant at the request of her attorney, testified at his
    evidentiary deposition that if she experienced symptoms such
    as Anumbness, tingling or pain and combinations thereof@ in
    1997, those symptoms Acertainly could have been@ a
    manifestation of carpal tunnel syndrome.
    The majority attempts in part to justify its reevaluation of the
    evidence by relying on General Electric Co. v. Industrial
    Comm=n, 
    190 Ill. App. 3d 847
    , 857 (1989), for the proposition
    that A[t]he manifestation date is not the date on which the injury
    and its causal link to work became plainly apparent to a
    reasonable physician, but the date on which it became plainly
    apparent to a reasonable employee.@ Slip op. at 15; see also
    slip op. at 16 (ARLI essentially asks us to rely on >expert=
    medical testimony from a layperson, Durand, and ignore her
    testimony about her intermittent pain and how it affected her
    performance. *** Durand reached that >expert opinion= based
    solely on the pain she was having, not on any doctor=s
    -21-
    advice@). Notably, in General Electric, the appellate court
    determined that the evidence supported the conclusion that the
    claimant=s injury and its connection to her employment would
    have been plainly apparent to a reasonable person on the date
    the claimant noticed a Asharp pain@ in her shoulder while
    working, not on the subsequent date when a physician opined
    that the claimant=s condition and her work were causally
    related. General 
    Electric, 190 Ill. App. 3d at 857
    . More
    importantly, while I agree as a general matter that it would be
    unfair to expect employees to diagnose their injuries and
    discern the relationship between their injuries and their
    employment with the expertise of trained physicians, this
    proposition is inapposite here. Based on the evidence
    presented to the Commission, I fail to see why it could not
    reasonably have concluded that a reasonable person in
    claimant=s circumstances would have been aware she was
    injured and that the injury was employment related. The only
    way to maintain this position is to do as the majority has done:
    secondguess the Commission=s interpretation of claimant=s
    testimony and suggest it was unreasonable for her to be aware
    of her condition until she was formally diagnosed.
    The majority cites no authority for the proposition that the
    manifestation date of a claimant=s injury must be determined on
    the basis of a formal medical evaluation. In fact, the majority
    emphasizes that Afairness and flexibility are the common
    themes@ of cases that have applied the Peoria County standard
    and acknowledges that Athe Commission should weigh many
    factors in deciding when a repetitive-trauma injury manifests
    itself.@ Slip op. at 14. I have no quarrel with permitting the
    Commission to weigh numerous factors in determining when a
    repetitive-trauma injury manifests itself. It strikes me as
    somewhat ironic, however, that the majority=s resolution of this
    case actually appears to narrow the permissible scope of the
    Commission=s inquiry in setting a manifestation date. The
    majority declares that claimant=s injury did not manifest itself
    until sometime in 2000, when claimant=s pain necessitated
    medical treatment. Slip op. at 17. Thus, the de facto rule
    established by this case seems to be that, regardless of a
    claimant=s actual and reasonable awareness of an injury=s
    manifestation, corroborative medical treatment is necessary
    -22-
    before it can be said that a reasonable person would plainly
    recognize the injury and its causal relationship to his or her
    employment. This rule creates a puzzling inconsistency,
    because while the majority claims to maintain a totality of the
    circumstances approach to determining a repetitive-trauma
    injury=s manifestation date, it seems to have made the medical
    diagnosis of such an injury the determinative factor in that
    inquiry.
    Claimant is to be commended for continuing to work after
    the onset of her symptoms. As the majority notes, claimant
    Adiligently worked through progressive pain until it affected her
    ability to work and required medical treatment.@ Slip op. at 17.
    Claimant=s persistence, however, should not excuse her from
    her obligation to file a timely application for benefits. I fear the
    majority has allowed this equitable consideration to become
    the driving force behind its decision to reverse the judgment of
    the Commission, and that it has done so at the expense of
    obscuring the heretofore straightforward analysis used in
    reviewing the Commission=s determination of a manifestation
    date. For the reasons set forth above, I would affirm the
    judgment of the appellate court, which upheld the circuit court=s
    confirmation of the Commission=s decision to deny claimant=s
    application for benefits.
    JUSTICE KARMEIER joins in this dissent.
    -23-