Causation Analysis — Case Review Template
This must be completed AFTER chronology and standard of care analysis and BEFORE final strategy or reporting.
Purpose
You are determining whether the identified failure or delay actually caused the injury, worsening, or outcome.

This is NOT the same as:
  • a bad result
  • a possible association
  • a suspicious timeline
This is the step where the team must decide whether the case is:
  • clinically linked
  • arguable
  • weak on causation
Step 1 — Identify the Alleged Causation Event
YOU MUST DEFINE:
  • What action or inaction is being blamed?
  • What exact outcome is alleged to have resulted?
  • What is the timeline between the event and the outcome?
If the alleged failure is vague, causation analysis cannot proceed.
Step 2 — AI Extraction of Causation Components
AI MUST extract:
  • Relevant timestamps
  • Clinical deterioration sequence
  • Symptoms before and after the event
  • Labs, imaging, and objective findings
  • Treatments delayed, missed, or performed
  • Alternative medical explanations
AI may organize:
  • temporal relationship
  • pathophysiological sequence
  • alternative etiologies
AI does NOT determine causation strength or final opinion.
Step 3 — Temporal Relationship Review
YOU MUST CONFIRM:
  • Did the alleged failure happen before the outcome?
  • Was there enough time for the failure to plausibly cause the harm?
  • Did the deterioration unfold in a medically logical sequence?
Ask:
  • Is the timing strong?
  • Is the timing questionable?
  • Could the outcome have occurred anyway in the same timeframe?
Step 4 — Pathophysiological Plausibility
YOU MUST DETERMINE:
  • Does the clinical mechanism make sense?
  • Can the alleged failure logically produce this outcome?
  • Is the progression medically believable?
If the mechanism is not medically plausible, causation is weak even if timing looks suspicious.
Step 5 — Alternative Etiology Review
AI may list:
  • underlying disease progression
  • comorbidities
  • independent risk factors
  • non-preventable outcome explanations
YOU MUST TEST:
  • What else could explain the outcome?
  • How strong is each alternative explanation?
  • Can these alternatives be ruled out, weakened, or left open?
Step 6 — Preventability Question
Ask the key question:
  • If the correct action had occurred, would the outcome more likely than not have been avoided, reduced, or delayed?
YOU MUST DETERMINE:
  • Was the harm preventable?
  • Was the injury inevitable?
  • Would earlier recognition or treatment have changed the clinical course?
Step 7 — Defense Challenge Test
Before finalizing, ask:
  • What will opposing counsel say caused this instead?
  • What part of this theory is most vulnerable?
  • Where is the weakest link: timing, mechanism, or preventability?
If the theory collapses under obvious alternative explanations, revise it before proceeding.
Step 8 — Final Causation Determination
YOU MUST CLASSIFY CAUSATION AS:
  • Strong — clear mechanism, timing, and weak alternatives
  • Moderate — plausible and supportable, but contestable
  • Weak — vulnerable to alternatives or poor mechanism/timing
Final determination must answer:
  • What caused the outcome?
  • How strong is the link?
  • What weakens the theory?
Final Output Requirements
A complete causation analysis must provide:
  • identified causation event
  • clear temporal relationship
  • medically plausible mechanism
  • alternative etiology testing
  • preventability assessment
  • final strength classification
If causation cannot be defended logically and clinically, stop. Do not elevate the case.
Define Event → Extract Timeline + Findings → Test Timing → Test Mechanism → Test Alternatives → Assess Preventability → Classify Strength