Six Challenges Facing Attorneys with Medical Causation in Personal Injury And Workers’ Compensation Cases

Attorneys handling personal injury and workers’ compensation cases often encounter barriers that make obtaining a solid medical causation opinion difficult. These challenges can hinder the accuracy and clarity of the causation analysis required for a successful case. Below are six key obstacles that attorneys must navigate to ensure a thorough and reliable causation assessment.

1. Complaints That Don’t Make Sense
   In many cases where a client’s complaints don’t align with the injury, serious medical issues may be involved, often identified by the treating physician or specialist. A thorough analysis can reveal missing links that lead to a correct diagnosis. Treating physicians are skilled at ruling out serious illnesses, but identifying the precise cause can be challenging, especially with chronic pain. In some cases, the underlying issue is not actively pursued if deemed ongoing or non-urgent. Our review helps clarify these complexities and ensures all contributing factors are considered.

2. Changes in the Client’s Story
   It is common for clients to change their story over time, and it can even be suspicious if they don’t. People naturally recall new details and forget others as time passes. Memory issues, especially after a traumatic injury, can affect the client’s ability to accurately recall events, and memory decline may occur later, further altering their account. Attorneys should understand that these changes are often normal and work to clarify the timeline without assuming inconsistency or dishonesty.

3. The Client Is Not Helpful
   A client’s uncooperative behavior or lack of responsiveness may stem directly from the injury. Factors such as attention deficits, anxiety, frustration, anger, memory loss, or cognitive issues can result from the injury itself, hindering the client’s ability to assist in the case. We address this by thoroughly evaluating the client’s medical history, consulting with family members and healthcare providers, and reviewing their employment history to better understand any modifications or changes. This comprehensive approach helps identify the root causes and provides valuable insight into the client’s condition.

4. The Treating Physician Is Not Helpful
   Treating physicians may be reluctant to engage in causation discussions because they feel they have no stake in the legal outcome or are concerned about liability. Additionally, most physicians are not trained to analyze causation, which can make them uncomfortable responding to attorney requests. Despite this, their opinions are highly valuable in causation analysis. We address this by interviewing treating physicians, allowing us to incorporate their medical insights into the legal analysis, which ultimately strengthens the case.

5. Fragmented Medical Records
   Fragmented medical records often reflect the disjointed care patients receive. Treating physicians may be unaware of crucial records from other providers, and the sharing of records between groups doesn’t always occur. Physical therapy records and urgent care documentation, for example, may be missed, further complicating causation analysis. We address this by meticulously reviewing the client’s current records, consulting with the client to identify any missing pieces (such as names of other specialists or referrals made by the primary care physician), and ensuring all necessary records are gathered for a comprehensive understanding of the case.

6. Dunning-Kruger Effect
   The Dunning-Kruger effect occurs when individuals overestimate their knowledge or expertise. In legal cases, both clients and medical professionals may fall into this cognitive bias, leading to overconfidence in their understanding of medical or legal complexities. This can result in flawed reasoning and unrealistic expectations. Attorneys must be aware of this bias and ensure they rely on accurate medical facts and expert opinions rather than assumptions or overconfident assessments from non-experts.