Five Questions Every Attorney Should Ask Before Relying on an Injury Causation Opinion

By Dr. Steven B. Ross, DC, FASBE, DAAPM

Chiropractic Physician | Fellow, American Academy of Applied Spinal Biomechanical Engineering | Diplomate, American Academy of Pain Management.

Strong cases are built on objective analysis, not assumptions.

Two experts review the same accident.

They examine the same medical records, review the same diagnostic imaging, and consider the same reported mechanism of injury. Yet they arrive at very different conclusions.

How is that possible?

The answer often lies in the methodology used to evaluate injury causation.

In personal injury litigation, a medical diagnosis alone does not establish whether a particular event caused an injury. Determining causation requires a comprehensive evaluation that considers biomechanics, medical history, clinical findings, injury mechanisms, and accepted scientific principles.

Before relying on an expert opinion, attorneys should ask several important questions to determine whether the opinion is objective, well supported, and capable of withstanding scrutiny.

1. Is the Injury Consistent With the Reported Mechanism?

One of the first questions any attorney should ask is whether the reported mechanism of injury is capable of producing the condition being claimed.

Every injury occurs because forces are transferred through the human body. Understanding those forces requires more than simply reviewing medical records. It requires evaluating the biomechanics of the event itself.

Factors that should be considered include:

• Direction of impact

• Magnitude of force

• Occupant position

• Tissue tolerance

• Body movement during the event

• Energy transfer

When the reported mechanism is inconsistent with the claimed injury, additional investigation may be necessary before reaching conclusions regarding causation.

2. Do the Medical Findings Support the Opinion?

Objective medical findings should support every causation opinion.

Diagnostic imaging, physical examination findings, clinical history, and functional limitations all contribute valuable information. However, these findings must be interpreted within the context of the reported event.

For example, imaging may identify a disc herniation or degenerative changes, but imaging alone cannot determine when those findings developed or whether they were caused by a specific incident.

The critical question is whether the available medical evidence supports a logical and scientifically defensible connection between the reported event and the diagnosed condition.

3. Were Pre-Existing Conditions Properly Evaluated?

Many patients have underlying degenerative changes or previous injuries before an accident occurs.

The existence of a pre-existing condition does not necessarily eliminate the possibility that a new injury occurred. Likewise, the presence of a new diagnosis does not automatically establish that the reported incident was responsible for the condition.

A thorough causation analysis should consider:

• Previous injuries

• Degenerative findings

• Prior symptoms

• Functional status before the incident

• Changes following the reported event

Distinguishing between a pre-existing condition and an aggravation of that condition is often one of the most important aspects of injury evaluation.

4. Were Alternative Explanations Considered?

Objective expert opinions should evaluate all reasonable explanations rather than focusing solely on one conclusion.

A scientifically sound analysis considers whether factors other than the reported incident could reasonably account for the patient's condition.

These may include:

• Natural degeneration

• Previous trauma

• Occupational factors

• Recreational activities

• Underlying medical conditions

Considering alternative explanations strengthens the credibility of an expert opinion by demonstrating a comprehensive and unbiased evaluation of the available evidence.

5. Is the Opinion Grounded in Accepted Scientific Principles?

Perhaps the most important question is whether the expert's conclusions are supported by accepted scientific methodology.

An opinion should be based on:

• Objective medical evidence

• Biomechanical principles

• Clinical experience

• Relevant scientific literature

• A logical explanation connecting the evidence to the conclusions

Well-supported opinions are transparent in their reasoning and capable of withstanding careful examination during deposition or trial.

Common Pitfalls in Injury Causation Analysis

Several common misconceptions can weaken an otherwise strong case.

One is assuming that a diagnosis automatically proves causation. While a diagnosis identifies a medical condition, it does not explain how or when that condition developed.

Another is relying exclusively on diagnostic imaging. MRI and CT findings provide valuable information, but they represent only one component of a comprehensive causation analysis.

Finally, overlooking pre-existing conditions or failing to consider alternative explanations may lead to conclusions that are difficult to defend when challenged.

Building Stronger Cases Through Better Questions

Attorneys are not expected to perform medical or biomechanical analyses themselves. However, asking thoughtful questions early in the litigation process can help identify whether an expert opinion is supported by objective evidence and accepted scientific principles.

Before relying on an injury causation opinion, consider asking:

• Is the reported mechanism capable of producing the claimed injury?

• Do the objective medical findings support the conclusion?

• Were pre-existing conditions adequately evaluated?

• Were alternative explanations considered?

• Is the opinion based on accepted scientific methodology?

These questions help ensure that expert opinions are evaluated not only for their conclusions but also for the reasoning that supports them.

Key Takeaways

• A medical diagnosis does not automatically establish injury causation.

• Objective causation analysis requires evaluating biomechanics, medical history, clinical findings, and scientific evidence.

• Pre-existing conditions and alternative explanations should always be considered.

• Strong expert opinions are supported by methodology, not assumptions.

• Asking the right questions early can strengthen case evaluation and improve decision-making throughout the litigation process.

About the Author

Dr. Steven B. Ross, DC, FASBE, DAAPM is a chiropractic physician, spinal biomechanical injury analyst, Independent Medical Examiner, and expert witness with more than 40 years of clinical experience. His practice focuses on injury causation analysis, spinal biomechanics, chiropractic and medical malpractice, independent medical examinations, and evidence-based medical-legal consulting.