December 2025

Can a Treating Doctor’s Medical Opinion on Causation Be Incorrect—and Potentially Hurt Your Case?

When a Treating Opinion Misses the Mark

We recently discussed a case that illustrates how a treating physician’s opinion on causation—though well-intentioned—can unintentionally weaken a legal claim.

A 49-year-old woman employed in a department store sustained bilateral leg injuries when several boxes fell from an overhead shelf. Although she remained ambulatory, she developed persistent aching in her left calf that gradually progressed to swelling. Within three weeks, she presented to the emergency department with severe pain and was diagnosed with a deep vein thrombosis (DVT) in the popliteal vein behind the knee.

The Treating Opinion

At the same time, the client was being evaluated by her gynecologist for large uterine fibroids. The gynecologist concluded that the clot was the result of venous compression from the fibroids. A hematologist, referencing that note, later echoed the same opinion: that the DVT was “likely related to massive uterine fibroids.”

The Timeline Told a Different Story

The client, however, recognized a clear sequence, leg trauma followed by persistent pain, swelling, and eventual clot formation and believed her DVT was work-related. She filed a Workers’ Compensation claim, asserting that the clot stemmed from her on-the-job injury.

What the Evidence Shows

Our discussion and literature review found that DVTs directly caused by uterine fibroids are extraordinarily rare—rare enough to appear in isolated case reports. When fibroid-related thrombosis does occur, the clot typically originates in pelvic, iliac, or femoral veins, where fibroids can compress major vessels.

In contrast, trauma-related DVT in the lower extremity is well documented. Direct leg trauma can injure the venous endothelium, creating a local environment conducive to clot formation. The timing of symptoms, the anatomic location of the clot, and the absence of hereditary or systemic risk factors all supported a traumatic, work-related mechanism.

Key Takeaway

Not all treating-physician opinions on causation are correct, and an inaccurate opinion can misdirect a case. A clear, evidence-based medical analysis helps attorneys distinguish coincidence from causation, protect case integrity, and ensure fair outcomes for clients.

November 2025

Can Trauma Precipitate Fibromyalgia?

Pacific Northwest MD Legal Consulting — Medical Perspective

We recently discussed a case involving a 39-year-old woman who was properly seat-belted when her vehicle was struck on the driver’s side by a drunk driver. The airbags did not deploy. She initially thought her injuries were minor but later presented to the emergency department with chest, shoulder, and neck pain. X-rays were negative, and she was discharged with a diagnosis of soft tissue strain.

Over the following weeks, she continued to experience persistent pain in her neck, chest, and left shoulder despite conservative management and physical therapy, which worsened her symptoms. MRI imaging of the cervical spine and shoulder was unremarkable. A bone scan revealed mild increased uptake in the clavicle, anterior shoulder, and upper chest—findings suggestive of localized inflammation but without structural damage.

As her symptoms persisted and began to generalize, she was referred to a rheumatologist, who diagnosed fibromyalgia, potentially related to the traumatic event. She also experienced ongoing fatigue, cognitive slowing (“fibro fog”), and increased work absenteeism. One-year post-collision, her pain and fatigue had become chronic, interfering significantly with daily activities and quality of life.

Medical Discussion

Fibromyalgia is a chronic pain disorder of unclear etiology characterized by abnormal central pain processing rather than structural or inflammatory tissue damage. Current understanding suggests dysfunction in the central nervous system’s modulation of pain, involving:

• Neurochemical imbalances:

• Elevated excitatory neurotransmitters

• Diminished serotonin and norepinephrine in descending anti-nociceptive pathways

• Dysregulation of dopamine and endogenous opioids

• Central sensitization: Heightened pain perception to normally non-painful stimuli (allodynia) and amplification of nociceptive signals

• Associated features: Sleep disturbance, fatigue, cognitive impairment (“fibro fog”), headaches, paresthesias with normal neurologic exam, and irritable bowel syndrome

While fibromyalgia is not a structural injury, it may be precipitated or unmasked by physical or emotional trauma. Following trauma, inflammatory and neurochemical events at the cellular level can trigger sensitization of pain pathways. This process, once established, can persist even after tissue healing has occurred, resulting in the chronic pain and fatigue characteristic of fibromyalgia.

In this case, although conventional imaging (MRI, CT) was negative, findings such as localized increased blood flow on bone scan and persistent allodynia were consistent with early central sensitization mechanisms.

Medical-Legal Relevance

In personal injury or disability cases, understanding fibromyalgia’s pathophysiology is essential.

• The absence of objective imaging findings does not exclude significant functional impairment.

• Temporal association between trauma and onset of widespread pain supports causal linkage, particularly when other explanations are excluded.

Fibromyalgia remains a complex and often misunderstood condition. However, from a medical-legal perspective, recognizing the neurophysiologic underpinnings and trauma-related triggers is critical in accurately assessing causation, prognosis, and damages.

October 2025

What Makes a Strong Medical Report — From an Adjuster’s Perspective

Pacific Northwest MD Legal Consulting

Medical reports play a pivotal role in helping attorneys, adjusters, and clients understand the full impact of an injury. A well-constructed report does more than summarize records — it explains the medical reasoning that connects findings, treatment, and functional outcomes.

Understanding the Audience

A report may be reviewed by many professionals — attorneys, adjusters, opposing counsel, judges, treating clinicians, and independent medical examiners. Each reader looks for clarity, accuracy, and sound reasoning. Writing with that diverse audience in mind ensures the report supports the case from both a medical and legal standpoint.

Causation and Mechanism of Injury

Many treating physicians focus on patient care rather than the why behind an injury. In a medicolegal setting, however, opinions on causation and mechanism of injury are essential. When appropriate, reports should explain how the medical evidence supports or refutes a causal connection between an event and the ongoing condition. This level of clarity can make a significant difference in how a case is interpreted and valued.

Commentary on Treatment and Medical Necessity

A comprehensive report also addresses whether the treatment provided was reasonable, medically necessary, and related to the incident in question. These insights help clarify which interventions are tied to the injury versus those reflecting pre-existing or unrelated conditions.

Precision and Individualization

Each case deserves an individualized assessment. Repetitive or “template-style” reports weaken credibility and may overlook important nuances. The most effective reports use precise language, accurate timelines, and correct diagnostic codes when applicable — presenting findings in a way that is both medically and legally reliable.

Language and Presentation Matter

Subtle word choices shape perception. For example, describing a “cervical spinal injury” provides a clearer and more accurate picture than “neck strain.” Similarly, using auto crash rather than auto accident emphasizes the event’s impact rather than implying randomness. Strong reports also describe the patient’s functional loss — explaining how injuries affect daily living and future capability.

Addressing Pre-existing Conditions and Multiple Incidents

Pre-existing conditions such as degenerative arthritis often complicate injury claims. Reports that clearly distinguish baseline disease from trauma-related changes help adjusters and attorneys understand what portion of impairment is new versus pre-existing. When multiple injuries or accidents are involved, clear apportionment of symptoms builds credibility and trust.

Collaborative Approach

Medical legal consulting can also bridge communication between treating physicians and attorneys. Guiding clinicians on how to document findings effectively benefits both the patient and the case, ensuring that the medical record accurately reflects causation, treatment rationale, and outcome.

Takeaway:

A strong medical report is clear, accurate, and objective — grounded in evidence-based reasoning and tailored to the needs of both medicine and law. By emphasizing causation, treatment rationale, and functional impact, physicians can provide reports that meaningfully inform the settlement process and support just outcomes for clients.