A Causation Checklist for Medication and Vaccine-Related Injuries
- Gary Moller
- 1 day ago
- 7 min read
Updated: 5 hours ago
Introduction
For more than fifty years, I’ve been working with people dealing with injury, illness, and the consequences of medical treatments. Over the last decade, one of the most difficult areas I’ve encountered has been helping people who believe they’ve suffered harm from a prescribed medication, a medical procedure, or more recently, a vaccination.
These people often find themselves trapped in a maze of medical bureaucracy and legal red tape. Their lived experience tells them something is wrong, but official systems can make them feel silenced, dismissed, or even blamed for their suffering.
It became clear to me that we needed a practical tool—a way to systematically consider whether a medical procedure or treatment is likely to have caused harm. That is how the Causation Checklist & Scorecard was born.
Why a Checklist Was Needed
When dealing with New Zealand’s ACC (Accident Compensation Corporation) and similar bodies overseas, causation is the key battleground. To gain recognition and support, the injured person must demonstrate—on the balance of probabilities—that their harm was caused by treatment.
This is easier said than done. Most people don’t have the medical knowledge, the legal training, or the time to fight these battles. At the same time, ACC and insurers often employ highly paid experts to slice cases apart, breaking complex syndromes into fragments that are then denied one by one. Meanwhile, few injured people can afford legal representation and my impression is that lawyers are exiting this field, rather than entering it.
I realised that if we were to level the playing field, we needed a framework based on both medical science and international commercial insurance law—a framework that was rigorous, transparent, and simple enough for ordinary people to follow.
Where the Ideas Came From
ACC treatment injury law:
In New Zealand, cover depends on proving that the injury was caused by treatment and not simply the ordinary consequence of that treatment or a pre-existing condition. This provided a starting point.
International insurance law:
Insurers worldwide have long dealt with thorny questions of causation—“but-for” tests, proximate cause, material contribution, and concurrent causation. I borrowed these concepts to make the checklist more robust.
Clinical practice:
Decades of real-world experience told me what questions matter most when sitting across from someone who has been harmed. Timelines, pre-existing conditions, known mechanisms, and—most crucially—whether they ever gave informed consent to the risks they were exposed to.
Epidemiology and plausibility:
Data matters, but so does biological plausibility. Just because an adverse event is “rare” doesn’t mean it didn’t happen to you.
What the Checklist Does
The checklist provides a structured way to gather and weigh evidence. It asks questions such as:
Did symptoms appear soon after the medical intervention, in a biologically plausible timeframe?
Is there a known mechanism by which the drug or vaccine could have caused this?
Were other causes ruled out, or is there a strong competing explanation?
Did the intervention materially increase the risk of harm, even if it wasn’t the sole cause?
Was the patient fully informed of risks, especially with pre-existing conditions that made complications more likely?
Each section can be scored, building towards a clear picture of whether causation is likely, possible but uncertain, or unlikely. This doesn’t guarantee ACC or insurers will play fair—but it gives the injured person a structured, evidence-based argument to present.
What Each Criterion Means – In Plain English
1. Temporal proximity
Did the symptoms show up soon after the procedure or medication? If the timing matches what we’d expect from that kind of injury, it strengthens the case. If the timing is off—too early or far too late—it weakens it.
But bear in mind that, in human terms and not that of lab rats, a delay between cause and effect may be many days, if not months and even years. Take, for example, recent evidence of COVID mRNA excess deaths peaking an estimated 90-120 days post the procedure (and we can assume that the clock resets each time there is a booster):
Some researchers and commentators have suggested that adverse outcomes may not appear immediately after vaccination but instead peak in the 90 to 120 days that follow. This observation is based on analyses of Japanese mortality data, although it has not been universally accepted or confirmed in peer-reviewed literature. The claim is that repeated mRNA exposure may set in motion immune or vascular processes that only fully express several months later. While this remains speculative, it highlights the importance of looking beyond the first few days or weeks post-injection when assessing potential vaccine-related harm. Long-lag signals—if real—would strengthen the argument for careful long-term monitoring rather than assuming safety once short-term reactions have passed.
2. Mechanistic plausibility
Is there a believable way the drug, vaccine, or procedure could cause the harm? For example, an immune reaction leading to inflammation, or a medication damaging the liver. If there’s no known mechanism, causation is harder to prove.
3. Pre-existing conditions or alternative causes
Could the problem be explained by something else—like a health condition you already had, or a separate illness or injury? If yes, that makes causation harder to prove. If not, the treatment stands out as the likely cause.
4. But-for causation
A simple test: “But for this treatment, would the injury have happened?” If the answer is no, that’s strong evidence. If the injury would have happened anyway, the case is weaker.
5. Material contribution / risk increase
Even if the treatment wasn’t the only cause, did it significantly increase the risk or tip the balance towards injury? For example, if a vaccine raised the risk of an immune flare-up that wouldn’t otherwise have happened.
6. Concurrent or cumulative causation
Sometimes there’s more than one cause acting together—say, a vaccine plus an infection, or a drug plus an underlying weakness. This asks whether the treatment was one of the key contributors.
7. Exclusionary factors (ACC or legal)
ACC won’t cover injuries if they are considered an “ordinary consequence” of treatment (like mild nausea after antibiotics), or if they’re mostly due to a pre-existing condition. This part checks whether those exclusions might apply.
8. Epidemiological evidence
Do population studies or case reports show a link between the treatment and this type of injury? For example, has it been reported often enough in other people to suggest a pattern?
9. Clinical consistency
Does your case look like other known cases of treatment-related injury? If the symptoms and progression fit what’s already documented, it adds weight.
10. Differential diagnosis
Have other possible explanations been properly checked and ruled out? The more alternatives that are excluded, the stronger the case that the treatment was responsible.
11. Informed consent & risk disclosure
Were you warned of the risks, especially if you already had pre-existing conditions that made complications more likely? If consent was not fully informed, in writing, explained to you, and signed off by you, then that’s an important factor in your favour.
A Guide for Medical Specialists
The checklist is also designed as a guide for medical specialists who are asked to assess and report in support of a claim. Too often, specialists are left without a clear structure and fall back on vague or fragmented opinions that ACC can easily dismiss.
By working through the checklist, a specialist can systematically consider each criterion. The more criteria they can reliably tick off in the claimant’s favour, the stronger the case becomes. This not only supports the injured person but also protects the integrity of the specialist’s report by showing it rests on a transparent, methodical framework.
Why Informed Consent Matters
One of the most important additions to the checklist is the question of informed consent. Too many people with known risk factors—heart conditions, autoimmune tendencies, clotting disorders, and so on —have been assured “it’s safe” without disclosure of the risks unique to them.
When informed consent is absent, the patient has been exposed to risks they could not reasonably anticipate. That strengthens the case for causation and for compensation.
How to Use the Checklist
Print it out or use the PDF version. Work through each section carefully, writing down details and attaching supporting evidence (medical notes, lab tests, personal logs).
Use it as a guide in consultations. Take it with you when meeting doctors, lawyers, or ACC case managers.
Apply it as a family tool. If a loved one has suffered, sit down together and go through it—this often uncovers overlooked details that strengthen the case.
Timelines: Event timelines are powerful - so make one with significant events recorded such as the dates a medical procedure happened, prescriptions given, visits to the Dr and when adverse signs and symptoms were first noted, and then worsened - those sorts of events.
Bring it all to your advocate or specialist, along with associated medical tests and reports. Encourage your doctor or chosen medical expert to use the checklist in preparing their report. The clearer their answers, the more compelling your case with the ACC.
A Tool for Justice and Healing
The checklist is not perfect. Medicine is complex, biology is messy, and causation is rarely black-and-white. But this tool helps cut through the fog. It restores some power to the injured person and their family, giving them a structured voice in a process often stacked against them. It also gives honest specialists a backbone framework to rely on when writing reports.
I’ve seen too many people suffer in silence. This checklist is part of my commitment to ensure that doesn’t continue.
Download the Checklist
You can download the Causation Assessment Checklist & Scorecard (PDF) here and use it freely:
[Download PDF]
Here is a draft cover letter for medical experts for you to edit and use:
Use these wisely, share them with others who need , and above all—don’t let anyone dismiss your story without giving it the respect it deserves.
Disclaimer:
This checklist is an educational and advocacy tool. It does not replace medical or legal advice. For any injury claim, consult with a qualified health practitioner and legal professional.
Comments