While at work I was hit in the head with a 10-pound object that fell about 8 feet and struck me on the right side of my head just above my temple. I had a huge bump and was nauseated and dizzy about an hour after being struck but did not seek medical attention. I did, however, file a report at work. For the next 13 days I had headaches, issues concentrating, and just did not feel right.
By the second week, I was really messed up. I felt confused, unable to think and comprehend. I told my girlfriend that I was not feeling right and needed to go down to the basement to rest and take my mind off of things. When I got to the bottom of the stairs I yelled to her “I need help.” The next thing I knew paramedics were standing over me and I was in and out of consciousness for the next two days. I spent six days in the ICU. Results from the MRI showed bleeding in three locations of my brain. One of the locations was noted as the right temporal lobe, where I had gotten hit near my temple 13 days prior at work.
How likely is it that the hit on the head at work caused me to lose consciousness two weeks later?
Is there a way to prove my hospitalization and medical problems two weeks later were caused from the original hit in the head? I ask because I had a workers compensation hearing that said the two injuries were unrelated.
Whether an event caused a medical condition that develops days, weeks, or even months later requires an explanation of the concept of “legal causation.” In order to successfully establish the link between an event and an injury, an attorney must consult with and obtain the expert opinion of a qualified medical provider, usually a board certified physician in the specialty of medicine that is being discussed. It is impossible to legally establish the link without the benefit of expert evaluation. After a medical expert has evaluated the event and the injury and is able to establish that the first caused the latter, he or she must be willing to testify to that fact in court.
The question that the expert witness must address in his testimony is: “Do you have an opinion with a reasonable degree of medical certainty if event X was the competent producing cause of condition Y? If yes, please give the basis for your opinion. At which point, the expert witness will explain to either the court or to a jury why he believes the medical condition was caused by the traumatic event. Without this, the “legal causation” cannot be proven.
The explanation usually explores the medical condition itself, the medical literature in support of the opinion, the biomechanics of the traumatic event and how that caused this particular condition to develop. The expert will need to establish that the individual did not suffer from this condition prior to the event and he must then rule out other reasonable causes for the development of the condition.
In cases of traumatic brain injury, an attorney needs to demonstrate in the courtroom that this type of trauma is known to be the cause of a particular condition and provide the medical evidence in the particular case to establish how the individual’s signs and symptoms evolved. It is well known in the medical literature that not all signs and symptoms of a traumatic brain injury develop at the time of the initial trauma. Signs and symptoms may take hours, days, or even weeks to manifest themselves. The initial onset of nausea and vomiting soon after the impact from the object falling on the individual’s head are the classic presenting signs of a concussion. The confusion and other symptoms that developed over the next two weeks can also be attributed to the original injury. A qualified expert relying on those facts and his expertise can form an opinion that the event competently produced the signs and symptoms of this individual’s concussion.
In the legal arena, the opinions of experts are tested by attorneys representing the other side through the process of cross-examination and by the introduction of other experts’ testimony intended to contradict the injured individual’s expert witnesses. The burden of proof is upon the injured individual. The finder of fact, either the judge or a jury, must determine if the injured person’s proof met the legal burden of proof and must determine if “the case proved by a fair preponderance of the credible evidence.”
Shana De Caro, Esq. is partner at De Caro & Kaplen, LLP. Ms. De Caro serves on the board of directors for both the Brain Injury Association of America and the New York Academy of Trial Lawyers. She is first vice president of the American Academy of Brain Injury Attorneys and serves as secretary of the Civil Justice Foundation.