Causation Reports
A cardiology causation opinion for clinical negligence claims — whether the alleged failing caused, or materially contributed to, the injury, assessed on the balance of probabilities with the counterfactual set out in full. CPR Part 35 compliant.
- CPR Part 35 compliant
- Material contribution
- Fixed fee available
Establish whether the injury
was caused by the care
A causation report sets out the factual counterfactual — what would have happened without the alleged failing — applies the balance of probabilities, and considers material contribution where the cardiac evidence supports it.
Each report is prepared under CPR Part 35 and Practice Direction 35, with the expert’s overriding duty owed to the court.
- Sequential instructions where breach has been established by a separate report, an admission or a court finding, and causation is now the live issue.
- Material contribution cases where the alleged failing is one of several factors and the contribution question needs specific analysis.
- Defendant work where breach may be conceded but causation is disputed — often the strongest defence position in clinical negligence litigation.
- Pre-action causation where the claimant team needs a clear view on the prospects of establishing causation before committing to full liability work.
What the report covers.
A causation report addresses the consequences of an alleged breach. It does not re-litigate whether the breach occurred — that is the role of the breach of duty report, or the breach section of a combined opinion.
What the report addresses
- Whether the alleged cardiac injury is linked to the care complained of under the “but for” test and material contribution principles. Bolitho.
- The factual counterfactual — what would have happened had the alleged failing not occurred — assessed on the balance of probabilities.
- Review of the relevant cardiac investigations — ECG, echocardiography, cardiac MRI, troponin and angiographic findings.
- Whether the records are sufficient for a definitive opinion, or what further disclosure is required.
- A signed CPR Part 35 statement of truth and declaration of duty to the court.
Not covered
- Whether the care was negligent — that is the role of a breach of duty opinion.
- Condition and prognosis, quantum or life expectancy — that requires a separate condition and prognosis report.
- Examination of the claimant — causation is determined on records and imaging.
Where we are regularly instructed
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Claimant · Delayed diagnosis
Timing of intervention in STEMI
Delayed diagnosis of ST-elevation myocardial infarction; primary PCI eight hours after symptom onset rather than within the recommended window. The report addresses whether earlier intervention would have reduced infarct size and the consequent loss of left ventricular function.
Often paired with: Breach of Duty Missed MI
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Claimant · AF stroke
Stroke risk reduction with anticoagulation
Documented atrial fibrillation, not anticoagulated, followed by embolic stroke. The report addresses the reduction in annual stroke risk timely anticoagulation would have conferred, and whether the stroke would, on the balance of probabilities, have occurred in the counterfactual.
Often paired with: Breach of Duty Atrial fibrillation
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Material contribution
Multiple cardiac risk factors
Pre-existing coronary disease, hypertension and diabetes, where the alleged failing is delayed escalation of antihypertensive therapy. The report addresses whether the failing materially contributed to the index cardiac event among competing risk factors.
Often paired with: Breach of Duty Hypertension complications
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Defendant · Causation defence
Pre-existing disease as alternative cause
Defence instruction where breach is conceded. The report addresses whether the claimant’s underlying cardiomyopathy would, on the balance of probabilities, have produced the same outcome regardless of the failing.
Often paired with: Critique & Rebuttal Cardiomyopathy
Report format, length and turnaround.
Most causation reports run to twelve to twenty pages; complex material contribution or cohort analysis runs longer. Standard instructions are returned within four to six weeks. Where a hearing date, limitation deadline or court direction requires it, an expedited timetable of two to four weeks is available subject to capacity.
Fixed fee where the records bundle is contained. Larger or complex matters are quoted on an indicative basis with a cap. LAA rates and deferred payment terms available — full fee schedule.
Need a causation report?
Submit case details today via email or our contact form and receive a same-working-day quotation. For urgent matters, call using the phone number below.
Same-working-day quotation Fixed fee where the bundle allows LAA rates available