causal relationship in independent medical exams

What is a causal relationship in an independent medical exam?

The determination of causal relationship is a concept that is addressed in standard medical education as a means of understanding the origin of a disease or disease process in order to facilitate and direct treatment. This is not how causal relationship is used  in an Independent Medical Examination . A doctor-patient relationship is not established in an Independent Medical Examination and no treatment is provided.

In a medicolegal environment, such as an Independent Medical Examination , I  may be asked to express an opinion “to a reasonable degree of medical certainty” ( see my previous post ) regarding the causal relationship between a certain diagnosis and a specific injury . An accurate  diagnosis and a reasonable  description of the injury are paramount to providing this opinion. Because doctor-patient relationship is not established in an Independent Medical Examination,  no treatment is provided but treatment options can be recommended.

A variation of opinion between providers regarding causal relationship is not unusual where there is an inadequate or inaccurate diagnosis and/or when the history of injury is incomplete or variable. Even when the diagnosis and history are similar between Examiners , some disagreements may occur in the matter of causal relationship. This is often seen when there is pre-existing  condition in the body part that is being evaluated , for example , a knee injury in a claimant with pre-existing arthritis. It is then that the legal system must make the final causal relationship determination through appropriate administrative procedures.

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