When a doctor or hospital makes a mistake, that alone is not enough to obtain compensation.
You must be able to prove that your loss is actually the result of that mistake. In legal terms, this is called the causal link.

In this blog, we explain what the causal link exactly entails, how judges assess this, which evidentiary problems often occur in cases of medical errors, and what you can do to preserve your rights.

What does causal link mean?

Causal link literally means: causal relationship.
It is the legal link between the doctor’s error and the harm you have suffered.

Only if those two can be linked to each other is there a right to compensation.

For example:

• A doctor forgets to remove a medical instrument during surgery and you get an infection as a result. → There is a clear causal link.

• A diagnosis is made too late, causing treatment to start later and recovery to become more difficult. → There may be a causal link, but it is less straightforward to establish.

In medical liability cases, that proof is often the biggest challenge.

Who must prove the link?

In principle, the burden of proof lies with the patient.
That means that you must demonstrate that your damage is the result of a medical error.

However, that is not always black and white.
The judge takes into account the special position of the patient: they do not have access to all medical records and usually do not have the same knowledge as a doctor.

Therefore, in medical liability law there is sometimes a lighter burden of proof for patients.
If it is plausible that the damage likely was caused by the error, the judge may still accept the causal link.

How does the judge assess causation?

The judge examines whether it is plausible that the error caused the damage.
This does not always need to be proven with absolute certainty.

Among other things, the following are considered:

• the nature of the error (for example, a wrong action, wrong diagnosis, or missed follow-up);

• the medical consequences that are typically associated with that error;

• the time between the error and the occurrence of the damage;

• any other possible causes.

The stronger the connection between the error and the injury, the greater the likelihood that the causal relationship will be assumed.

Reduced chance of recovery: also damage

Sometimes it cannot be established with certainty that the error caused the damage, but it can be established that the error reduced the chance of recovery.
Even in those cases there may be a right to compensation.

For example:

• Due to a missed diagnosis, treatment is started only months later. As a result, the chance of full recovery has decreased.

• A patient receives the wrong medication, causing the original illness to worsen.

In such situations, people often speak of a loss of a chance to recovery or a more favorable course.
The compensation is then determined in proportion to the lost chance.

Evidence for causation: medical substantiation is crucial

In medical liability, the evidence almost always revolves around medical records.
Therefore, it is important to:

1. The complete medical record to request from the hospital or the treating physician.

2. Carefully document all symptoms, examinations, and treatments.

3. A medical advisor to engage someone who can assess whether the error likely led to the damage.

You can read more about this on our blog Medical record: access, copy and correction.

Expert report: the key to evidence

In many medical liability cases, an independent expert assessment is carried out.
Such an expert (usually a medical specialist) assesses whether the doctor’s actions were careful and whether there is a link between the error and the injury.

The judge attaches great importance to this expert report.
When it states that the harm was likely caused by the medical error, that is often decisive for the outcome of the case.

What if the cause remains unclear?

In some cases, it cannot be determined with certainty whether the error caused the harm.
The judge can still decide to rule in favor of the patient if it is highly likely that the error played a relevant role.

A common example:

• A patient develops a complication after surgery that could also have occurred without any error.
  However, if the doctor has violated a medical standard (for example, by providing insufficient aftercare), the judge may rule that the error at least contributed to the harm.

In that case, the causal link is partially accepted, which leads to a partial compensation for damages.

Practical tips for proving a causal link

1. Request your medical records right away – you are entitled to it.

2. Record all symptoms and limitations from the beginning that you experience.

3. Keep medical correspondence (emails, appointments, examination reports).

4. Consult a medical advisor about the medical cause and connection.

5. Consult a specialized lawyer before you file a claim – so you don’t miss evidence or deadlines.

Why legal assistance is essential

Proving causation requires both legal and medical knowledge.
A specialized lawyer knows how the judge assesses this and works with medical experts to substantiate your position.

At Arslan Advocaten we combine legal expertise with medical experience.
We ensure that your case is fully substantiated, that the evidence is collected on time, and that you receive the maximum compensation to which you are entitled.

Our assistance is free of charge for victims, because the costs are recovered from the liable party.

Why choose Arslan Advocaten?

• Specialized in medical liability and personal injury

• Experience with complex evidence and causation issues

• Close collaboration with medical advisors and specialists

• Free legal assistance for victims

We ensure that your story is heard and that the medical error does not go unpunished.