Those discrepancies matter. They do not automatically prove dishonesty or defeat a claim, but they cannot be ignored. The expert must decide whether the reported symptoms are consistent with the clinical history, examination findings, records, treatment pattern and expected recovery.
Inconsistency is not the same as fraud.
An inconsistency between a claimant’s account and the records is not, by itself, proof of fraud. Medical records are imperfect. Entries may be brief, clinicians may focus on the principal complaint, and claimants do not always describe every symptom at the first consultation. Symptoms can also change. Pain may develop, psychological symptoms may emerge later, and memory may become less precise. The expert should therefore analyse a discrepancy rather than label it.
The important question is what weight it carries. Does it materially affect causation, prognosis, disability or treatment needs? The expert is not a lie detector, but neither should they disregard evidence that does not fit the account.
The records are imperfect, but important.
Medical records are written for treatment, not litigation. They may omit detail or contain errors, but they are usually created close to the events in question. They may identify pre-existing symptoms, medication, referrals, work absence and treatment changes. They may support deterioration after an accident or record improvement earlier than later evidence suggests. A claimant’s later account is evidence, but the records are evidence too. Where they align, the opinion is strengthened. Where they diverge, the difference must be addressed.
Timing often determines significance.
Chronology is central to causation. A claimant who reports neck pain shortly after a collision and develops shoulder pain during the following week may present no real inconsistency. Symptoms can evolve, different issues arise when severe symptoms are said to have existed from the first day, but there is no medical attendance for months and no explanation for the gap. Delay does not automatically defeat a claim. A claimant may self-manage, expect recovery, struggle to access treatment or feel reluctant to disclose psychological symptoms. The expert should consider whether the delay is clinically plausible, whether other evidence supports the account and whether the later symptoms fit the expected injury pattern. If the gap remains unexplained, the opinion may need qualification.
Severity should fit the treatment pattern.
A claimant may describe severe pain, poor sleep and major restriction, yet the records show little treatment, no medication change and no repeated attendance. That does not prove exaggeration. People respond differently to pain and access to treatment may be limited. However, prolonged and severe symptoms should usually produce a treatment history that makes clinical sense. Where they do not, the report should identify the gap and consider the explanation.
The reverse is also true. Repeated consultations, increased medication, physiotherapy, referral and work absence may support the seriousness of symptoms even where objective findings are limited. Treatment is not decisive, but it is important evidence.
Function often reveals the real discrepancy.
Function may be more informative than diagnosis. A claimant may report that they cannot drive, work, lift, walk far or socialise, while other evidence suggests a return to ordinary activity. The expert should ask what the claimant could do before the accident, what changed afterwards and whether restrictions remained consistent. Employment records, rehabilitation notes and witness evidence may assist.
A person can experience pain and still function. Equally, activity does not prove the absence of pain. The issue is whether the documented level of function is consistent with the disability alleged.
Psychological symptoms require careful chronology.
Psychological symptoms are not always reported immediately. A claimant may initially focus on physical injury, feel embarrassed or expect distress to resolve. A late report may be genuine, but it still requires analysis. The expert should consider when symptoms were first recorded, how they developed and whether they fit the wider presentation. The correct approach is neither to dismiss symptoms because they were recorded late nor to accept them without testing the timeline.
Pre-existing conditions may appear inconsistent.
A claimant may report that back pain began after an accident, while earlier records refer to back pain. Earlier symptoms may have been mild, intermittent or resolved. Alternatively, they may have represented an active condition already affecting function.
The report should establish the pre-accident baseline. Was treatment ongoing? Was medication being taken? Was work affected? Had the claimant recovered before the index event? What changed afterwards? The question is whether the accident caused a new injury, aggravated an existing condition, accelerated deterioration or made no material difference. Without that analysis, the inconsistency may be overstated or understated.
The report must explain what changes.
It is not enough to list discrepancies. The expert must explain their effect. A delay in reporting may weaken causation. Records showing earlier improvement may shorten the supported recovery period. Evidence of greater function than reported may require qualification of the disability opinion. Failure to pursue treatment may affect prognosis.
Some inconsistencies will not materially alter the opinion. That should also be stated. A discrepancy without analysis is merely criticism; a discrepancy with reasoned explanation becomes useful evidence.
Measured language matters.
Experts should avoid language suggesting dishonesty unless there is a proper basis. It is generally more accurate to say that an account is inconsistent with, unsupported by or difficult to reconcile with the available evidence. Credibility and dishonesty are matters for the court, the expert’s role is to explain whether the medical evidence supports the reported symptoms and restrictions. Where an account is medically implausible, the expert should say so and give reasons. Where it is possible but poorly documented, that limitation should be identified.
The real question.
Inconsistencies are common in medico-legal cases. The issue is not simply whether they exist, but whether they matter. Do they weaken causation? Do they suggest earlier recovery, a pre-existing condition or a higher level of function than alleged? Do they require further records or a more guarded prognosis?
A credible report confronts the awkward evidence. It does not turn every discrepancy into fraud or excuse every gap as poor record-keeping. It weighs the claimant’s account against the records, explains the significance of any difference and adjusts the opinion where necessary. That is what the court needs: a clear and balanced account of whether the reported symptoms fit the evidence, and what follows if they do not.
