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In law, "causation" is a complex concept that often overlaps with general doctrines of analytic philosophy. In medicine, "causation" is also complex. Modern medicine is science-based. In science, there is a method for determining causality, with the gold standard being to prove cause and effect in a way that others can reproduce.

"In the context of disability evaluation, where a particular condition might be linked to the workplace, medical definition of causation requires valid scientific proof; legal definition requires either a probability of > 50% or that the event was more likely than not to be causative." (McGraw-Hill Concise Dictionary of Modern Medicine. © 2002)

In the fifth edition of the AMA Guides,

"causation means an identifiable factor (e.g., accident or exposure to hazards of a disease) that results in a medically identifiable condition.

Medical or scientifically based causation requires a detailed analysis of whether the factor could have caused the condition, based upon scientific evidence and, specifically, experienced judgment as to whether the alleged factor in the existing environment did cause the permanent impairment. Determining medical causation requires a synthesis of medical judgment with scientific analysis." (p. 11)

While there needs to be a causal connection between employment and an injury (see AOE-COE), "such connection need not be the sole cause; it is sufficient if it is a contributing cause." [See SCIF v. IAC (Wallin) (1959) 176 Cal.App.2d 10, quoting Justice Carter.]

"Proximate cause and legal cause do not mean exclusive cause....Causation is a question of fact unless the issue is so clear that reasonable minds could not differ." Smith v. WCAB (1981) 123 Cal.App.3d 763
For death cases, it is sufficient that there be substantial evidence that the employment was a contributing factor. See. e.g., Lamb v. WCAB (1974) 11 Cal. 3d 274

Label Item Links Comments
Labor Code The term "causation" appears twice in the Labor Code: once in reference to psychiatric injury; then in reference to apportionment. LC §3208.3

LC §4663

Escobedo: Leading case on causation of permanent disability

Peter Kiewit Sons v. Industrial Acci. Com.: "Where an issue is exclusively a matter of scientific medical knowledge, expert evidence is essential...."

Death under mysterious or unexplained circumstances: "In resolving that conflict in order to determine whether there is any causal connection between the employment and the death, the board is bound, as are the courts, "by the fundamental principle that to effectuate the purposes of the compensation statute, all reasonable doubts as to whether an injury is compensable are to be resolved in favor of the employee." Clemmens v. WCAB (1968) 261 Cal. App. 2d 1

The California Supreme Court in South Coast Framing Inc. v. WCAB (Jovelyn Clark) clarified the standard of causation in a workers’ comp death case: "In the workers’ compensation system, the industrial injury need only be a contributing cause to the disability." Death cases do not have a higher standard: "we may not break from long-standing precedent to apply a higher proximate cause standard to death cases when the Legislature has not seen fit to do so."

Escobedo en banc

Peter Kiewit Sons v. Industrial Acci. Com

Clemmens v. WCAB






South Coast Framing

Websites To access the free "Reference Manual on Scientific Evidence, Third Edition, click here.    
Practice Tips Never make assumptions about causation, whether to establish AOE-COE or  apportionment. Do some medical research, then examine the doctor's statements for medical and scientific bases and logical fallacies (see "Attacking Causation and Apportionment")    
Articles Causation and Effect: Workers’ Comp Experts Discuss Impact of Rising Costs on Causation Standards Causation Standards  
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