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Joyce Peters (the decedent) fell while working for BuildersSquare on October 28, 1998, and died shortly afterward. Herhusband, Ralph Peters (Peters), filed a claim against BuildersSquare seeking medical expenses, burial expenses, and deathbenefits under section 7 of the Workers' Compensation Act (820ILCS 305/7 (West 2000)). The matter proceeded to an arbitrationhearing where the arbitrator found that the decedent suffered acompensable accident, and that the accident was a causativefactor in her death. Accordingly, the arbitrator awarded Peters$28,827.30 in medical expenses, $4,200 in burial expenses, and$316.30 per week in death benefits.

Builders Square appealed to the Illinois IndustrialCommission (Commission), which reversed the arbitrator'sdecision. The Commission found that Peters failed to prove (1)accidental injuries arising out of the decedent's employment, and(2) a causal connection between the decedent's work and herdeath. Peters appealed to the Peoria County circuit court, whichreversed the Commission's decision and remanded for entry of anorder consistent with the arbitrator's findings. Builders Squarethen filed this appeal claiming the circuit court erred inreversing the Commission's decision. We agree. Accordingly, wereverse the circuit court's judgment and reinstate theCommission's decision.

The decedent's pre-existing medical records document anincident in September of 1993 where she fell and injured herright ankle. Peters testified that he was not aware of thedecedent having any problems with dizziness or passing out. Tohis knowledge, the decedent was never diagnosed with arrhythmia. However, their daughter said the decedent experienced anintermittent fast heart rate, and the medical records document acardiac test in 1995 or 1996 where she wore a heart monitor for24 hours. Apparently the test did not lead to treatment ormedication for heart problems. A medical record from March of1997 indicates that the decedent inexplicably lost approximately40 pounds in just a few months. She also sustained threeadditional falls in 1998: once while carrying groceries up somestairs, once after slipping on wet grass in a ditch, and onceafter tripping on a ledge while carrying laundry.

The decedent was 54 years old when she fell at Builder'sSquare. She worked in the lawn and garden department withBernard Beever (a coworker and long-time friend), who witnessedthe incident. Beever testified that the decedent was using anExacto knife to open boxes of merchandise stacked on two pallets. The pallets were four feet square and approximately six incheshigh. The boxes were stacked one-high on the pallets and wereapproximately two to three feet tall. The decedent bent over theboxes while performing her work. She was in an aisleapproximately 10 feet wide with metal shelves on both sides.

Beever spoke with the decedent for approximately fiveminutes before she fell. She appeared completely normal at thattime; particularly, she did not exhibit signs of paleness,slurred speech, perspiration, confusion, or imbalance. Aftertheir conversation, the decedent asked Beever to retrieve apallet jack. When Beever had walked approximately 10 feet fromthe decedent to retrieve the jack, he turned around and saw herstraighten up. After straightening up, she staggered two orthree steps backward into the metal shelving and then collapsedface first on the concrete floor. Beever did not know if thedecedent was holding her Exacto knife when she fell. Afterhitting the ground, the decedent shook violently for threeseconds and began looking pale. She had not looked pale when shestraightened up and staggered backward. Beever testified thatthe aisle was open to the general public, and there was no objecton the floor--or defect in the floor--that caused the decedent totrip.

The decedent was ultimately taken to Saint Francis MedicalCenter where she underwent a CT scan, EKG monitoring, and surgeryby Doctor William Olivero. The surgical procedure involved aleft frontal craniotomy with evacuation of a subdural hematoma. The decedent's post-operative diagnosis was an acute leftsubdural hematoma with a diffuse subarachnoid hemorrhage. Shedied shortly after the surgery. The EKG monitoring did notreveal evidence of a heart malfunction or arrhythmia.

Doctor Olivero testified that a subdural hematoma is a bloodclot between the brain and the dura. He said 99% of all subduralhematomas are caused by trauma. In addition to her hematoma, thedecedent exhibited venous bleeding along the floor of the middlefossa. Doctor Olivero explained that venous bleeding is morelikely to stem from trauma than from other causes. In hisopinion, the decedent's death was caused by a combination of thehematoma and the subarachnoid hemorrhage. He stated: "The morelikely thing is that both of them were caused by trauma, sincethey happened at the same time." He did not know why thedecedent staggered and fell in the first place.

Doctor Robert Collins (a neurologist retained by Peters)reviewed the decedent's medical records and concluded that hersubdural hematoma and subarachnoid hemorrhage resulted fromtrauma. The doctor did not know why the decedent staggered andfell in the first place. However, he believed the cause was notlikely idiopathic because the decedent experienced no priorproblems with fainting, dizziness, or vertigo.

Doctor David Schenker (retained by Builders Square) opinedthat the decedent's fall resulted from an idiopathic conditionsuch as cardiac arrhythmia or a cerebral hemorrhage. He believedthe decedent's prior falls raised the possibility of anarteriovenous malformation that was not detected by the CT scan. In his view, such a condition could cause episodic falls based ontransient cerebral ischemia, seizure activity, or bleeding.

Doctor William Buckingham (also retained by Builders Square)opined that the decedent suffered a cardiac rhythm disturbance,which caused her to faint and fall. He supported his opinion bystating that the decedent had experienced past syncopal episodeswith associated pallor. The doctor explained that heart monitorslike the one the decedent wore in 1995 or 1996 do not detect allheart conditions. Such monitors will not indicate a cardiaccondition unless they happen to be worn at the moment of acardiac event. Accordingly, the doctor explained that testingmust last longer than 24 hours to provide a reliable diagnosis.

Doctor Buckingham also observed that the decedent's body wasaffected by a particular rash. In his experience, the rashimplicated systematic lupus erythematosis as another possibleidiopathic factor in the decedent's fall.

After considering this evidence, the arbitrator found thatthe decedent sustained a compensable unexplained fall. Accordingto the arbitrator:

"Multiple reasonable inferences can be made from theevidence to explain [the decedent's] fall. [Her] footcould have got stuck underneath the pallet, causingher to fall backward. [She] could have been startledby something she found when she opened the box. [She]could have lost her grip on the cardboard box when shewas opening the box causing her to fall backwards."

The arbitrator also found that the "accidental occurrence" was acausative factor in the decedent's death. The Commissionreversed the arbitrator's decision, attributing the incident toan idiopathic condition with no increased risk from theemployment. The circuit court reversed the Commission'sdecision, describing the finding of an idiopathic condition asspeculative and conjectural.

Since different inferences can be drawn from the evidencepresented at the arbitration hearing, we will not disturb theCommission's decision unless it is against the manifest weight ofthe evidence. William G. Ceas & Company v. Industrial Comm'n,261 Ill. App. 3d 630 (1994); Oldham v. Industrial Comm'n, 139Ill. App. 3d 594 (1985). "In order for the decision to beagainst the manifest weight of the evidence, a review of therecord must disclose that the conclusion opposite to that reachedby the Commission was clearly the proper result." Stapleton v.Industrial Comm'n, 282 Ill. App. 3d 12, 16 (1996).

A workers' compensation claimant bears the burden ofproving, inter alia, an accidental injury "arising out of *** theemployment." 820 ILCS 305/2 (West 2000). This requirementpertains to the origin of an accident. Ceas, 261 Ill. App. 3d630. Accordingly, Illinois courts have divided workplace fallsinto distinct origin-based categories. A fall originating froman unknown neutral source is deemed "unexplained," while a falloriginating from an internal and personal condition of theemployee is deemed "idiopathic." Oldham, 139 Ill. App. 3d 594. The "arising out of" requirement is generally satisfied withunexplained falls but not with idiopathic falls.⁽¹⁾ Stapleton, 282Ill. App. 3d 12.

To a certain degree, however, the label "unexplained" is amisnomer in this context. A claimant's burden of proof requiresmore than merely showing inability to explain why a falloccurred. In addition to such inability, a claimant must presentevidence supporting a reasonable inference that the fall stemmedfrom an employment-related risk. After all, the "arising out of"requirement contemplates "a causal connection between theaccidental injury and some risk incidental to or connected withthe activity an employee must do to fulfill [her] duties." Stapleton, 282 Ill. App. 3d at 15. Awarding compensation for apurely unexplained fall would eviscerate this requirement.

Illinois courts have consistently applied the standard thisway. For example, in Sears, Roebuck & Co. v. Industrial Comm'n,78 Ill. 2d 231 (1979), a deceased employee was discovered lyingnear his forklift with a fractured skull. The Commission foundthat his fall arose out of his employment, and the Supreme Courtaffirmed the Commission's decision. However, rather than merelyresting on the fact that no one knew why the employee fell, theCourt noted that the Commission had authority to draw reasonableinferences from the evidence presented at the arbitrationhearing. The evidence included a showing that the forklift wasnot equipped with a "dead man's brake." Sears, 78 Ill. 2d at233. Thus, the Commission could have inferred an employment-related risk connected to the fall. In other cases awardingcompensation for so-called unexplained falls, this court hasconsistently identified facts supporting similar inferences. See, e.g., Knox County YMCA v. Industrial Comm'n, 311 Ill. App.3d 880 (2000) (claimant could not grab railings on stairwaybecause her hands were occupied holding items connected to herwork); General Motors Corp. v. Industrial Comm'n, 179 Ill. App.3d 683 (1989) (claimant had to negotiate potholes while drivingforklift); Chicago Tribune Co. v. Industrial Comm'n, 136 Ill.App. 3d 260 (1985) (floor where claimant slipped and fell couldhave contained ice and water); see also Nabisco Brands, Inc. v.Industrial Comm'n, 266 Ill. App. 3d 1103 (1994) (claimant had tocarry three heavy knives on stairway).

Such a standard is essential to avoid conflict withIllinois' disavowal of the positional risk doctrine (see Brady v.Louis Ruffolo & Sons Construction Co., 143 Ill. 2d 542 (1991)). Professor Larson aptly explains the situation as follows:

"If an employee falls *** for no discoverable reason,the injury resembles that from stray bullets and otherpositional risks in this respect: The particular injurywould not have happened if the employee had not beenengaged upon an employment errand at the time. In apure unexplained-fall case, there is no way in which anaward can be justified as a matter of causation theoryexcept by a recognition that this but-for reasoningsatisfies the arising requirement." 1 A. Larson & L.Larson, Larson's Workers' Compensation Law