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Determining causation is essential in assessing liability and compensation, yet it’s often complex. Many cases involve multiple contributing factors, making it crucial to use the right analytical approach.

A recent review by Meilia et al. (2020) examined key methods of causal analysis, including:

• The AMA’s 2013 guide on disease and injury causation
• The Forcier-Lacerte medicolegal model
• Siegerink et al.’s epidemiology-based approach
• Freeman’s 3-step medicolegal causation method
• The INFERENCE approach (Meilia et al., 2020)

Notably, the 10th Circuit U.S. Court of Appeals (2016) endorsed Freeman’s 3-step methodology as the standard for injury causation, citing its application in spinal disc injury cases.

 What are the criteria for the 3-step medicolegal causal methodology when assessing causation? 

• There must be a biologically plausible or possible link between the exposure and the outcome.
• There must be a temporal relationship between the exposure and the outcome.
• There must not be a more likely or probable alternative explanation for the symptoms.   

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