Steven Babitsky, Esq.

Physicians of many specialties perform Independent Medical Examinations (IMEs). One of the key issues that these physicians are frequently asked to opine on is causation (e.g. are the claimant’s medical complaints related to an incident/accident at work or from an auto or other kind of accident). The issue of causation can be a difficult one due to pre-existing or comorbid medical problems and the mechanism of injury. It is not uncommon for the IME physician to have only a vague or general description of the mechanism of injury. The physician who opines on causation without a full understanding of the mechanism of injury opens themselves to effective cross-examination at deposition and risks having her opinion discounted or rejected by the fact finder. Let’s look at a few examples.

Example: Lifting

The physician here is given a history of lifting a box at work and opines that it is/is not the cause of the claimant’s back problems. This is an inadequate history of the mechanism of injury. Here, the physician should determine (from her interview with the claimant) at a minimum, the following:

  1. How heavy was the box?
  2. How did the lifting take place from the floor to the table?
  3. What was the posture of the claimant when the lifting took place (e.g. was he bent over an obstacle and in an awkward posture)?

Example: Car Accident

Here, the physician has a history of the claimant being in a car accident and asked to opine on whether his ruptured disc is casually related to the accident. This is also an inadequate history on which to opine of causation. Here, the physician should determine:

  1. The types of vehicles involved in the accident (e.g. smart car and tractor-trailer).
  2. How fast were the vehicles going?
  3. Did the airbags deploy?
  4. Was the driver wearing her seatbelt?
  5. What was the damage to the vehicles?
  6. What was the force involved in the accident?

Case Example

When I was litigating workers’ compensation cases I was given a case where the claimant alleged he injured his back while shoveling in a ditch at work. The case was tried years earlier by my partner and was appealed several times until it reached the Massachusetts Supreme Court. Of course, when it came time to write the brief and argue the case, the senior partner was on vacation and unavailable. I briefed the case and appeared before the Supreme Court. The one question I was asked during the argument by the court was whether the claimant was using a long-handled shovel or a short-handled shovel when the accident occurred. Fortunately, I remembered it was a short-handled shovel and we were successful at the Supreme court.


IME physicians who get a detailed history of the mechanism of injury are in the best position to opine on the issue of causation.

Steven Babitsky Esq. is one of the trainers for the SEAK course IME Skills for Physicians: The Master’s Program. This course in now available as a streaming video for your review. See here: