Expert Testimony to Prove Medical Causation is Rare But It Can Happen

A recent truck accident case in Georgia involved a 2018 tractor-trailer accident where an injured driver sued the truck driver and trucking company.

The plaintiff was returning from a doctor’s appointment concerning his back and leg pain when the collision happened. He was transported by ambulance to the hospital, where he complained of back pain. He returned to the emergency room about four months later with complaints of more back pain. The plaintiff eventually had surgery to address his symptoms, but he continued to experience back pain and numbness, tingling, and pain in both of his legs.

The plaintiff’s daughter testified that he complained of back and leg pain for at least two to three years before the accident. In addition to the medical appointment on the day of the accident, the plaintiff sought medical care for back pain on several other occasions, and for numbness, tingling and pain in both legs four different times.

The defendants asked the judge to grant summary judgment on the plaintiff’s claims because they contended that he couldn’t carry his burden to show causation. Specifically, they argued that the plaintiff’s failure to designate an expert on causation was fatal to the claims because the alleged injuries and the plaintiff’s preexisting conditions presented specialized medical questions concerning causation.

Based on their argument that the plaintiff couldn’t prove causation, the defendants further asserted that the plaintiff’s vicarious liability claim against the trucking company only should also fail. The defendants also argued that summary judgment was appropriate on the claim against each defendant for punitive damages and against the trucking company only for negligent hiring and supervision because there was no evidence to support such claims.

The plaintiff said that expert testimony is not necessary to prove causation in a negligence case. In the plaintiff’s view, the facts of the accident and alleged injury are simple, and causation would be within the common knowledge and experience of a juror.

The plaintiff didn’t reply to the defendants’ opposition to the punitive damages, vicarious liability, and negligent hiring and supervision claims.

A Plaintiff Must Show Proximate Cause

U.S. District Judge J. P. Boulee wrote that under Georgia law that it’s well established that to recover for injuries caused by another’s negligence, a plaintiff must show four elements:

  • A duty;
  • A breach of that duty;
  • Causation; and
  • Damages

To establish proximate cause, “a plaintiff must show a legally attributable causal connection between the defendant’s conduct and the alleged injury” and must “introduce evidence which affords a reasonable basis for the conclusion that it is more likely than not that the conduct of the defendant was a cause in fact of the result,” the judge wrote, quoting earlier Georgia Court of Appeals decisions. Further, proximate cause is properly reserved for the jury and can only be appropriately addressed on summary judgment in ‘plain and indisputable cases. Still, a court may grant summary judgment where there’s only a “mere possibility” of causation or “the probabilities are at best evenly balanced.”

Is Expert Testimony Necessary to Prove Causation?

Judge J. P. Boulee explained that expert evidence typically isn’t required to prove causation in a simple negligence case. That’s because a lay jury can conclude from common knowledge that a causal connection exists between an accident and an injury where there’s a short lapse between the accident and the onset of the plaintiff’s symptoms.

However, the judge noted that expert testimony is necessary where the issue of causation presents “specialized medical questions,”— where the link between a defendant’s actions and the plaintiff’s injury is beyond common knowledge and experience’ and presents medical questions that can be answered accurately only by witnesses with specialized expert knowledge. One such instance, the judge noted, is the diagnosis and potential continuance of a disease or other medical condition.

Here, the plaintiff’s preexisting conditions of back pain and leg numbness and tingling added complexity to the question of whether a jury could infer causation of new or aggravating back and leg injury from the accident without expert testimony to “connect the dots.”

On one hand, there was lay testimony regarding the facts of the accident and the plaintiff’s subsequent symptoms and medical treatment. A jury could conclude that a causal connection existed between the plaintiff’s accident and his injuries based on temporal proximity. But, on the other hand, there was significant evidence of preexisting conditions that bore directly on the plaintiff’s claim of injury.

Here, Judge J. P. Boulee held that the jury may well need the assistance of experts to determine whether the accident caused new or aggravating injuries.

Nonetheless, Georgia law views this issue as a question of disputed fact and tasks the jury, not the judge, with weighing the facts and deciding whether the plaintiff has carried the burden on causation. The court may not circumvent this process and decide the issue at summary judgment.

As a result, the defendants’ motion for summary judgment was denied to the extent it was based on the argument that the plaintiff couldn’t carry his burden on causation. Adams v. Warner Heinrichs & BWG Transp. Ltd., 2022 U.S. Dist. LEXIS 168943 *; 2022 WL 4332059 (N.D. Ga. September 19, 2022).

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