Fall-Related and Slip-and-Fall Injury Claims: What a Rigorous Independent Medical Examination Examines
November is Fall Prevention Month, and there's a reason why it warrants a month of its own. According to the Public Health Agency of Canada, falls are the leading cause of injury-related hospitalization in the country, affecting people across age groups and settings.
A great many of those falls are minor; some are serious; and a portion of them eventually become claims. When they do, one question tends to sit at the centre of the file - and it is a genuinely difficult one to answer well.
The question at the centre of every fall claim
That question is causation. How does the injury relate to the person’s health before the fall, and what does each contribute to the current picture? It is rarely a clean split. A fall can cause a real and significant injury in someone who also has years of pre-existing change, and both things can be true at once. The task of a thorough Independent Medical Examination (IME) is not to force the picture into 'all new' or 'all old', but to describe, as precisely as the evidence allows, what the fall actually contributed.
Mechanism matters
Careful assessment begins with the mechanism of injury: how the fall occurred, the forces likely involved, how the person landed, and whether the injuries described are consistent with that account. A slip that produces a wrist fracture, a trip that results in a knee injury, a fall involving a strike to the head - each carries a plausible pattern, and part of the assessment is considering whether the clinical findings align with the mechanism, or whether something in the picture does not quite fit. This is not about suspicion; it is about clinical coherence. The aim is to understand whether the mechanism, symptoms and clinical findings form a consistent picture of the injury and its presentation.
The pre-existing question, and the limits of imaging
The hardest part is usually the pre-existing question, and it is here that diagnostic imaging is both essential and easily over-read. Degenerative changes - in the spine, the shoulders, the knees - are extremely common with age, and are frequently present in people who had no symptoms at all before their fall. A finding on an X-ray or magnetic resonance imaging (MRI) scan is not, by itself, proof that a condition pre-dates an injury, nor proof that it is the source of current symptoms. What matters is the correlation between what the imaging shows and what the clinical examination and history actually support. An assessment that reads the scan in isolation, in either direction, risks drawing a conclusion that the evidence cannot support.
The right specialty for the injury
Fall injuries are not confined to one part of the body, and the right assessment depends on matching the clinical question to the appropriate discipline. A complex fracture or joint injury may call for orthopaedic assessment; questions of chronic pain, function, and rehabilitation potential may be better addressed through physiatry; a head strike with cognitive consequences may require neurological or neuropsychological input. Sending a file to the wrong specialty does not simply slow things down - it risks answering a different question from the one at the heart of the claim.
From injury to impact
Beyond causation, a rigorous assessment addresses what the injury means going forward: the current functional limitations, the expected trajectory of recovery, and the extent to which the person's presentation is consistent with the objective findings. The goal throughout is neither to minimise a genuine injury nor to inflate one, but to give an accurate account of what the fall caused and what that means for the person going forward.
Separating the fall from what came before
Fall claims are among the most common an assessor sees, and among the easiest to get wrong when the pre-existing question is handled carelessly. This Fall Prevention Month, that is the standard worth holding to. Medylex matches each file to the appropriate physician specialist, and to an assessment built to clarify how the fall and the person’s prior health interact. That understanding is often central to how a fall claim is resolved.