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Docket No. 90385-Agenda 29-March 2001.

DARWIN BAGGETT, Appellant, v. THE INDUSTRIAL 
COMMISSION et al. (Marion Community School District No. 2, 
Appellee).

This case requires us to examine the elements of proofnecessary to establish a viable workers' compensation claim for aphysical injury induced by job-related stress. Claimant, DarwinBaggett, filed a claim alleging that workplace stress caused him tosuffer a heart attack, leading to extensive brain damage. While thearbitrator found in Baggett's favor, the Industrial Commission(Commission) rejected his claim. The circuit court of WilliamsonCounty then set aside the Commission's findings. The appellatecourt vacated the circuit court's order and reinstated theCommission's decision. No. 5-99-0053WC (unpublished orderunder Supreme Court Rule 23).

We allowed Baggett's petition for leave to appeal todetermine whether the Commission erred by requiring Baggett (1)to prove that his injury occurred in the course of and arose out ofhis employment by showing (a) a greater degree of stress thancoworkers, and (b) unusual and increased stress in the workplaceat the time of injury; and (2) to prove a strict, scientific causalrelationship between stress and the physical cause of injury. Wefind that the Commission erred. Accordingly, we reverse thejudgment of the appellate court and affirm the circuit court'sjudgment.

I. BACKGROUND

On March 13, 1990, Baggett, a high school industrial artsteacher for the Marion school district (District), collapsed at work.Baggett's collapse was caused by upper gastrointestinal tractbleeding, resulting in reduced blood volume. The reduced bloodvolume led to a myocardial infarction, cardiac arrest, and resultinganoxic brain damage, rendering Baggett permanently and totallydisabled. Baggett then filed a claim under the Workers'Compensation Act (Act) (820 ILCS 305/1 et seq. (West 1998)).

On November 9, 1994, an arbitrator conducted a hearing onBaggett's claim. Fourteen witnesses testified on Baggett's behalf,including his wife, former students, fellow faculty members, andfriends in the community. In general, those witnesses testifiedabout Baggett's supervisory duties, other job demands, timedeadlines, and the hazardous nature of the construction activitiesinvolving young students. Most of the witnesses confirmed thatBaggett worked under stressful conditions and stated that theyobserved the effects of such stress upon Baggett.

A number of witnesses supported the District's contentionthat all teachers labored under varying degrees of stress. Witnessesalso observed that Baggett was not working under anysignificantly different type of stress than other teachers and thatthere was no change of stress demonstrated at or near the time ofthe collapse. The District presented evidence that Baggett was anervous person in general, that Baggett was involved in substantialnonschool activity contributing to his overall stress levels, and thathe may have been more susceptible to mental stress than hiscoworkers.

Five doctors provided varying medical testimony as towhether stress caused Baggett's injury. Dr. Robert Morgan,Baggett's family physician, testified that Baggett suffered from astomach disorder likely caused by stress. Dr. Clifford Talbert, Jr.,a cardiovascular specialist, attended to Baggett at the hospital afterBaggett's collapse. Dr. Talbert explained that Baggett's heartattack was caused by loss of blood resulting from a peptic ulcer.Dr. Wilfred Lee, a gastrointestinal specialist, also examinedBaggett after the collapse. Dr. Lee concluded that stress can be acausative factor of the bleeding but that the bleeding could havealso been caused by other factors.

Dr. Ralph Graff, a specialist in gastrointestinal diseases anddisorders, reviewed Baggett's medical records and the depositionsof the other physicians, and indicated that Baggett's condition wasmore likely a result of an acute ulcer in the upper gastrointestinalarea. Dr. Graff pointed out that in contrast to an acute ulcer, achronic ulcer would leave scars. The records showed no chroniculcer scars. Thus, Dr. Graff stated that the he needed to know theprecise location of the bleeding to find a causal connectionbetween the stress and the bleeding.

Consistent with Dr. Graff's opinions, Dr. Virginia Weaver, aspecialist in occupational medicine, testified that she could notfind a causal connection between the stress and the bleedingcondition. Dr. Weaver testified that the medical records did notconclusively indicate the precise location of the bleeding. Absentmedical documentation of the precise location of the bleeding, thebleeding could have been caused by one of several factors. Dr.Weaver also stated that no scientific studies on a population basisshowed a causal connection between stress and peptic ulcers.

Upon hearing the preceding evidence, the arbitrator found thatBaggett's injuries arose out of, and were suffered in the course of,his employment. Additionally, the arbitrator determined thatBaggett was entitled to benefits for permanent total disability andmedical expenses.

The District rejected the arbitrator's decision and soughtreview by the Commission. On April 3, 1997, the Commissionreversed the arbitrator's award, finding that Baggett failed to proveeither that he sustained an accidental injury arising out of, and inthe course of, his employment or that a causal relationship existedbetween the accident of March 13, 1990, and his medicalcondition of ill-being. Specifically, the Commission found asfollows:

"The commission finds that [Baggett] failed to prove hewas subjected to a greater degree of emotional strain thanthat to which all workers are occasionally subjected. Theevidence presented by [Baggett] failed to show that [his]job provided unusual stress in general, and no increasedstress around the time of his collapse, on March 13,1990.Therefore, the Commission reverses the [d]ecision of the[a]rbitrator and finds that [Baggett] failed to prove anaccident arising out of and in the course of [his]employment on March 13, 1990."

The Commission further found that:

"[Baggett] failed to prove that his present condition of ill-being is causally related to [his] alleged injury on March13, 1990. The evidence presented by [Baggett] failed toshow what the actual source of bleeding whichpresumably occurred in the upper gastrointestinal tractarea was, or any scientific correlation between the stressand the gastrointestinal bleeding. Therefore, thecommission reverses the [d]ecision of [a]rbitrator as tocausal connection and finds that [Baggett] failed to provethat a causal connection exists between [the] allegedaccident on March 13, 1990, and [his] present conditionof ill-being."

Additionally, contrary to the express stipulation of the parties, theCommission found that Baggett was not permanently and totallydisabled.

On December 13, 1998, upon judicial review, the circuit courtset aside the Commission's order and adopted the arbitrator'sconclusions, finding that the Commission's decision contradictedthe manifest weight of the evidence. Specifically, the circuit courtruled that the Commission imposed improper standards of proof,requiring Baggett to introduce evidence relating to issues ofincreased and unusual stress, a scientific correlation between stressand gastrointestinal bleeding, and the precise source of bleeding.

The appellate court then reversed the circuit court's judgmentand reinstated the Commission's decision. In effect, the appellatecourt limited its inquiry to whether the medical testimonysupported the Commission's determination. The appellate courtfailed to address whether the Commission used improper standardsin reaching its decision. Two justices dissented and filed astatement that this case involves a substantial question warrantingconsideration by this court. 177 Ill. 2d R. 315(a).

We allowed Baggett's petition for leave to appeal todetermine whether the Commission erred by requiring Baggett to(1) prove that his injury occurred in the course of and arose out ofhis employment by showing (a) a greater degree of stress than thatexperienced by coworkers, and (b) unusual and increased stress inthe workplace at the time of injury; and (2) prove a strict, scientificcausal relationship between stress and the physical cause of injury.

II. ANALYSIS 

As a threshold matter, the parties disagree as to the properstandard of review. Baggett argues that the Commission usedimproper legal standards to make its factual determinations, andtherefore a de novo standard is appropriate. The District disagreesand argues that the Commission did not consider improper factors.Instead, the District contends that the Commission simply basedits decision on Baggett's failure to prove a greater degree ofemotional stress than experienced by the general public and a lackof proof of the causal connection between the bleeding and stress.Therefore, the District maintains that we should apply a deferentialstandard.

We agree with Baggett. Ordinarily, reviewing courts examinethe Commission's factual findings under a deferential standard.See Saunders v. Industrial Comm'n, 189 Ill. 2d 623 (2000)(addressing whether the Commission's decision contradicted themanifest weight of the evidence). Whether a claimant must provecertain elements to establish a compensable claim is purely aquestion of law and it is therefore reviewed de novo. See P.R.S.International, Inc. v. Shred Pax Corp., 184 Ill. 2d 224, 234 (1998)(stating that legal questions are reviewed without deference).Thus, findings based on application of incorrect conclusions oflaw are not entitled to deference.

A. The Element of an Injury in the Course of and Arising Out ofEmployment

To be compensable under the Act, the injury complained ofmust be one "arising out of and in the course of the employment."820 ILCS 305/2 (West 1998). An injury "arises out of" one'semployment if it originates from a risk connected with, orincidental to, the employment, involving a causal connectionbetween the employment and the accidental injury. Parro v.Industrial Comm'n, 167 Ill. 2d 385, 393 (1995). An injury issustained "in the course" of employment when it occurs duringemployment, at a place where the worker may reasonably performemployment duties, and while a worker fulfills those duties orengages in some incidental employment duties. Parro, 167 Ill. 2dat 393. Although the ultimate determination of those issuesdepends upon an assessment of the facts and circumstances ofeach particular case, that assessment must be made under ourestablished legal standards. Orsini v. Industrial Comm'n, 117 Ill.2d 38 (1987).

In determining whether the injury occurred in the course of,and arose out of, his employment, the District argues, Baggettmust show that his employment presented a greater degree ofstress than his coworkers experienced and that such stress reachedan unusual and increased level at the time of his injury. Wedisagree.

The case at bar involves a physical injury allegedly inducedby mental stress in the workplace. That sort of injury is one ofthree "mental injury" types of cases commonly described as a"mental-physical" injury. There are two other kinds of mentalinjury cases: "physical-mental" and "mental-mental" injuries. A"physical-mental" case involves a claim that physical stress is acausative factor of a mental injury. A "mental-mental" caseinvolves a claim that mental stress is a causative factor of mentalinjury. 2 A. Larson, Worker's Compensation Law