The task is narrower. The expert must assess whether the history, clinical findings and documentary evidence support the alleged injuries. Any inconsistency should be identified plainly, without turning the report into an accusation that goes beyond medical expertise.
Two different allegations.
An accident may have been deliberately arranged while a participant still sustains a genuine injury. A real collision may also occur accidentally, followed by an exaggerated account of symptoms or disability. These possibilities should not be treated as though they prove one another.
The circumstances of the collision are primarily factual matters. A medical expert can consider whether the reported mechanism is capable of producing the diagnosed injury, but should not attempt to reconstruct the event without the necessary evidence and expertise.
Official guidance recognises deliberately caused collisions, often described as “crash for cash”, as a form of insurance fraud. That wider concern does not allow an expert to presume that an unusual history is fraudulent. Each claimant still requires an individual medical assessment.
Begin with the claimant’s account.
The examination should explore the accident, onset of symptoms, treatment and functional effect without leading the claimant towards a preferred answer.
The expert should establish where the claimant was seated, what movement or impact they recall, when each symptom began and what happened afterwards. The history should then be compared with the instructions, accident notification, Accident and Emergency notes, GP records and other available evidence.
A rehearsed or formulaic account may raise concern, particularly where several claimants use identical language. It is not proof that the history is false. People involved in the same event may discuss their symptoms, receive similar advice or complete forms with assistance.
The report should describe material similarities or inconsistencies without speculating about how they arose. Where another account of the accident has been supplied, MedCo expects the expert to consider whether that version affects the diagnosis or prognosis.
Read the early records carefully.
Early records may support or weaken the account. A note of immediate pain, restricted movement or medication provides useful evidence. A substantial delay before the first complaint may require explanation, especially where severe symptoms are later alleged.
Silence is not the same as contradiction. An emergency note may focus on serious injury and omit minor stiffness. A positive entry saying that the claimant denied neck pain or gave a later onset carries different weight. The expert should also consider whether the records are complete. Missing GP periods, absent imaging or treatment mentioned but not supplied may prevent a firm opinion. The gap should be identified rather than filled with assumption.
Practice Direction 35 requires experts to consider all material facts, including those that may detract from their opinions. It also requires them to state when a definite opinion cannot be reached because the available information is insufficient.
Describe inconsistent findings without moral judgement.
Movement may appear more restricted during formal testing than during ordinary activity. Reported tenderness may vary, or neurological symptoms may not follow an anatomical pattern. These observations should be recorded accurately. They should not automatically be labelled as malingering.
Pain, fear, misunderstanding, functional symptoms and variable effort can all produce inconsistency. Genuine injury and symptom exaggeration may also coexist. The expert should explain whether the findings support the diagnosis, reduce confidence in the claimed severity or require assessment by another specialist.
The GMC requires medical experts to provide objective, impartial and non-misleading evidence, remain within their professional competence and explain limitations affecting their opinions. A medical examination is not a lie-detection exercise.
Separate symptoms from disability.
A claimant may have sustained a minor injury while overstating its effect upon work, travel or domestic activity.
Diagnosis, causation, duration and function should therefore be addressed separately. Returning to work may weaken an assertion of complete incapacity without disproving pain. Exercise may contradict a claim that a particular movement is impossible without showing that the claimant is symptom-free.
Surveillance, photographs and social-media material require context. They show what occurred during a particular period, not the claimant’s condition at all other times. The expert should identify the specific claimed restriction affected and avoid broader conclusions than the material supports.
A claimant who reports being unable to drive but is shown making a short familiar journey may have overstated the restriction. That evidence does not necessarily disprove travel anxiety. The clinical significance depends upon what was claimed, what the material shows and whether a reasonable explanation exists.
Do not find fraud in every discrepancy.
Minor differences are common in genuine claims. Dates are forgotten, symptoms change and medical notes use different terminology. Treating every imperfect recollection as deception overstates the evidence. Concern becomes stronger where several material features converge, such as an implausible chronology, repeated contradictions, unsupported severity, inconsistent function and findings lacking a satisfactory clinical explanation.
Even then, the report should state what is medically supported rather than pronounce upon guilt. The opinion may be that the evidence supports a short-lived soft-tissue injury but not the alleged duration or disability. In another case, the inconsistencies may prevent a reliable diagnosis or causation conclusion.
The expert may comment upon clinical plausibility and the reliability of the information on which the opinion depends. A final determination that an accident was staged or that a claimant acted dishonestly generally requires evidence extending beyond the medical assessment.
Raise concerns through the proper route.
The expert should not confront the claimant with an accusation of fraud during the examination. Material discrepancies may be put neutrally, giving the claimant an opportunity to explain them. Concerns should be included in the report or communicated to the instructing party where they materially affect the opinion. Appointment notes, records reviewed, correspondence and amendments should be preserved. The report should not be altered silently if later evidence changes the view.
MedCo has warned that inaccurate medical reports can themselves create unwarranted credibility disputes. It has identified examples of experts failing to check templated or software-generated content before signing reports and has emphasised that responsibility for accuracy remains with the expert.
This point is particularly important in a suspected fraud case. A copied error, incorrect seating position or impossible injury mechanism may appear to support suspicion when the mistake was introduced by the report-writing process rather than the claimant.
The expert should also resist pressure from either side. A concern should not be softened because it is inconvenient or strengthened because fraud is alleged elsewhere in the claim. The medical opinion must remain the expert’s independent assessment.
What a defensible opinion looks like.
A useful report identifies the injury that is medically supported, the parts of the history that are inconsistent, the possible explanations considered and the effect of those difficulties upon prognosis and function.
It may conclude that a genuine minor injury occurred but that symptoms were overstated. It may find that no accident-related injury can be supported. It may also conclude that inconsistencies are present but insufficient to undermine the diagnosis.
The expert does not need to decide whether the collision was staged in order to provide valuable evidence. Their contribution lies in establishing what can be supported medically and refusing to make the records, examination or claimant’s account say more than they do.
Suspicion should lead to closer analysis, not a more dramatic report.
