AMA Protocol for Evaluating Injury-Relatedness and Work-Relatedness

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In the civil litigation and workers’ compensation fields, medical experts are often called on to give opinions about whether a particular medical condition was caused or contributed to by a specific injurious event or by the conditions of the claimant’s employment.  Often these questions are directed at doctors whose daily practice involves primarily diagnosis and treatment, and not determining a medical causal relationship between medical conditions and events.  As a result, when faced with these issues, some doctors resort to assessing causation on a purely subjective basis: i.e. the patient’s self report.  Fortunately, the American Medical Association’s Guides to the Evaluation of Disease and Injury Causation provide evaluators with a protocol for making scientifically credible findings on causation.

The Protocol provided by the Guides is a six-step process.  Failure to complete any of the steps in a manner that supports a causal relationship eliminates credibility for claims of injury-relatedness or work-relatedness.  The six steps are:

  1. Definitively establish a diagnosis: Is there any objective and credible evidence of a diagnosis that might explain the examinee’s clinical presentation (complaints, symptoms, signs, etc)?
  2. Apply relevant findings from epidemiologic science to the individual case: Has the claimed cause (in this individual case) been scientifically identified as a significant risk factor for the diagnosis?  What are the most well-established risk factors?
  3. Obtain and Assess the Evidence of Exposure: Is there evidence, primarily objective, of exposure to the claimed cause of the clinical presentation and what is the relationship in time between the exposure and presentation?
  4. Consider other relevant factors: Are there other risk factors that contribute to the development of this clinical presentation?  Are any relevant here?
  5. Scrutinize the Validity of the Evidence: Is there conflicting information? Have other examiners provided opinions lacking in scientific credibility?
  6. Evaluate the Results from All of the Above Steps, Generate Conclusions

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