The omission may have been accidental, caused by poor instructions, an incomplete bundle or a chronology prepared by somebody else. Its effect is the same: the opinion appears stronger than the evidence permits.
An expert does not need to reproduce every consultation. They do need to identify records that could materially support, weaken or qualify the opinion. Leaving out relevant evidence can make an otherwise well-written report misleading.
Selection is necessary.
A medical bundle may contain hundreds or thousands of pages. Much of it will have no bearing on the injury under consideration. Routine screening, repeat prescriptions and unrelated consultations need not be summarised merely to prove that the records were reviewed.
The expert’s role is to select and interpret material. Practice Direction 35 requires experts to consider all material facts, including those that may detract from their opinions. It does not require a transcript of the entire bundle.
Selection becomes omission when excluded material could reasonably alter diagnosis, causation, prognosis, treatment recommendations or function. Examples include previous symptoms affecting the same body region, earlier mental-health episodes, subsequent accidents, relevant imaging and records showing a different onset from the history given at examination.
The question is not, “Have I mentioned every entry?” It is, “Would a reader assess my opinion differently if this information were known?”
Adverse records deserve direct treatment.
Experts sometimes include favourable records in detail and refer to contrary material only vaguely. A report may describe the first post-accident consultation while failing to mention similar symptoms shortly beforehand.
The GMC requires medical experts to make reports accurate and not misleading, take reasonable steps to check information and include all relevant evidence. The expert should state what the adverse record shows and explain its clinical significance.
Clinical notes can be brief, contain errors or record only the issue addressed during a consultation. An expert may conclude that an inconsistency has a reasonable explanation. The record must still be exposed before its weight is assessed.
A report should distinguish between the claimant’s account and documentary evidence. “The claimant reports no previous symptoms” is different from “there were no previous symptoms.” Where the records contradict the account, both should be stated.
An incomplete bundle is different.
An expert cannot include documents they have never received, but they remain responsible for noticing obvious gaps.
The bundle may begin shortly before the accident despite references to earlier treatment. A hospital letter may mention imaging that has not been supplied. A medication history may suggest an earlier psychiatric condition without the related consultations being available.
The expert should identify the missing material promptly and explain why it matters. If the gap prevents a safe conclusion, the report should be paused or the affected opinion made provisional. Practice Direction 35 requires experts to make clear when insufficient information prevents a definite opinion.
Saying “I have reviewed the available records” is not enough where a material period is known to be absent. The report should identify what is missing and which questions cannot yet be answered reliably.
Do not rely blindly on summaries.
Record summaries and chronologies can save time. They can also reproduce another person’s selection errors.
An expert who receives a solicitor’s chronology, an administrative summary or an AI-generated extraction should not assume that all relevant entries have been captured. The underlying records remain the source material.
A chronology may omit entries that weaken the claim, merge consultations or present a reported history as a confirmed diagnosis. AI can produce the same errors in fluent language. Material points should be verified against the original documents.
The signed opinion remains the expert’s responsibility. It is no answer to say that the omitted entry was missing from somebody else’s chronology. CPR Part 35 requires an expert’s report to state the substance of the material instructions on which it was written and to contain confirmation that the expert understands and has complied with their duties.
Materiality depends on the question.
The same record may matter in one instruction and little in another. A remote episode of depression may have limited relevance to a fracture but be central to a claim involving accident-related depression. Earlier back pain may affect causation in a lumbar injury claim while adding little to an opinion about a hand injury.
The expert should connect each significant record to the issue it affects. Listing previous conditions without analysis can obscure the baseline just as effectively as omitting them. Records that were peripheral initially may also become important when the claimant fails to recover as expected.
Materiality is not determined merely by the age of the record. A remote condition may remain relevant if it shows recurrence, continuing vulnerability or an alternative explanation for the present symptoms. A recent entry may have little significance if it concerns an unrelated condition.
Omission can distort prognosis and treatment.
Leaving out records does more than affect causation.
A prognosis may be too optimistic if the report omits treatment failures, substantial psychological symptoms or continuing neurological complaints. It may be too pessimistic if the expert overlooks improvement, return to work or resumed activity.
Treatment recommendations can also become misleading. The report may recommend therapy already completed without benefit, repeat imaging already performed or rehabilitation the claimant could not tolerate.
A complete analysis does not mean agreeing with every entry. It means accounting for information that could change the recommendation.
The expert should also avoid presenting an earlier clinician’s provisional view as a final diagnosis. A referral, suspected condition or claimant-reported history must be described accurately. The existence of words in a medical record does not automatically establish their truth or clinical significance.
When an omission is discovered.
If relevant records arrive after the report has been prepared, the expert should review them promptly and decide whether they affect any material opinion.
Where they do not, a short confirmation may be sufficient. Where they qualify or change diagnosis, causation, prognosis or treatment, the expert should issue a clear amendment or supplementary report. The new material should be identified, its significance explained and the revised opinion stated.
The GMC requires experts to communicate a material change of opinion without delay. Defending the original wording after its factual basis has changed is more damaging than acknowledging the correction.
The amendment should not quietly replace the earlier version without an audit trail. Readers need to understand what changed and why. The earlier report, the new evidence and the resulting alteration should remain identifiable.
A report can be concise and still complete.
The answer to omission is not a forty-page medical chronology.
A good report selects the entries that matter, explains why they matter and provides enough context for the opinion to be tested. It includes evidence that supports the conclusion and evidence that weakens it. Where the records are incomplete or ambiguous, it says so.
Relevant records should not disappear because they complicate the narrative. Complication is often the reason expert analysis is required.
The expert who includes only the material that fits the opinion has not simplified the case. They have changed it.
