Medical Record Review Mistakes That Undermine Damages Claims

Medical record review helps attorneys determine whether the chart supports the connection between an event, injury, and resulting damages. The analysis should compare baseline condition with symptom timing, objective findings, treatment, intervening events, alternative causes, and current condition.

Meriem Seghier, VP of Medical Research at Expert Institute, sees these issues repeatedly during case review. “In most cases it can be traced back to the medical record,” she explains. Complete records reveal both support for damages and likely defense challenges.

Begin With a Complete Record Set

Causation analysis is only as reliable as the records reviewed. A missing facility can distort the baseline, conceal an intervening event, or create the appearance of a treatment gap.

Seghier identifies a common problem: “The attorney was unaware that the patient was seen at a different facility.” Those records may contain prior complaints, new imaging, improvement, a later injury, or a different account of symptom onset.

Counsel may need records from:

• Prior treating physicians
• Hospitals, urgent care centers, and EMS
• Imaging and diagnostic facilities
• Surgical and rehabilitation providers
• Pharmacies and prescribing providers
• Subsequent providers

Pre-event records establish baseline, while later records show whether the condition resolved, persisted, or changed after another event.

Test the Temporal Relationship

Timing does not prove causation, but it is often the first issue an opposing expert will test.

A focused chronology should establish:

• When symptoms first appeared
• Whether early complaints match the later diagnosis
• When objective findings emerged
• Whether the condition improved or worsened

A close temporal relationship may strengthen causation when the patient reports immediate symptoms, seeks prompt care, and gives a consistent history. It may weaken the claim when the symptom is absent from early records, appears after a delay, or follows an unrelated event.

Timing can also limit damages. In a delayed diagnosis matter, Seghier notes that “the delay was so small… that it’s very difficult to argue that that had an impact on the patient.”

Establish the Pre-Event Baseline

Preexisting conditions do not automatically defeat a claim. They establish the baseline against which post-event change must be measured.

Review the patient’s prior:

• Symptoms and diagnoses
• Imaging findings
• Injuries and surgeries
• Medications and treatment
• Work and functional restrictions

Then ask whether the event caused a new injury, aggravated an existing condition, accelerated decline, produced a temporary flare, or made no material difference.

Prior records may strengthen damages when they show stability, minimal treatment, and full function before the event. They may weaken damages when they document the same complaints, restrictions, medications, or proposed procedure beforehand.

Seghier cautions that non-medical reviewers may recognize a complex history without understanding “to what extent” it affects case outcome. A spine surgery after a collision must be evaluated differently when the patient had prior orthopedic surgery, a previous crash, or an autoimmune condition capable of producing similar symptoms.

Seghier also gives the example of a patient with cancer and a poor baseline prognosis. The issue is whether the event materially changed the expected course, function, treatment needs, or life expectancy.

Identify Intervening Events and Alternative Causes

A reliable review should account for later events or conditions that may explain deterioration, including:

• A subsequent collision or fall
• A new workplace injury
• A later surgery or procedure
• An unrelated illness
• Medication complications

An intervening event may create an apportionment question. The chronology should show whether symptoms changed afterward.

Alternative causes should be evaluated specifically. Could another condition plausibly account for the same complaints, findings, treatment, or prognosis?

For example, numbness after a collision may support a spinal injury claim. The analysis changes if prior records document longstanding diabetic neuropathy in the same distribution. A preexisting diagnosis may have limited value when the patient was asymptomatic and fully functional before the event.

Investigate Treatment Gaps

Treatment gaps often become defense themes. Before treating a gap as proof that symptoms resolved or later care was unrelated, determine whether:

• Symptoms improved
• Home treatment or medication continued
• Insurance or authorization delayed care
• Another condition took priority
• A later event prompted renewed treatment

A gap may weaken damages when the chart shows improvement, full activity, and no explanation for later care. It may be less significant when records document persistent symptoms, access barriers, or provider-directed conservative treatment.

Evaluate Apportionment Without False Precision

Apportionment asks what portion of the current condition is attributable to the event rather than baseline, another incident, or natural disease progression.

The evidence may support:

• A new injury
• Permanent aggravation
• Temporary exacerbation
• Accelerated treatment
• Multiple contributing causes
• An inability to separate causes reliably

Useful evidence includes imaging changes, new deficits, increased treatment, changed surgical recommendations, and loss of function. A qualified expert may need to explain whether apportionment is medically possible.

Findings That Strengthen or Weaken Damages

No single factor decides causation or damages. The question is whether the records present a medically coherent course across time and sources.

Use a Pre-Valuation Review Checklist

Before valuing damages or retaining a causation expert, confirm that the review addresses:

• Record completeness
• Pre-event baseline
• Temporal relationship
• Consistency across providers
• Intervening events and alternative causes
• Medical apportionment
• Support for past and future damages

Anticipate the Defense Review

Weak record review gives opposing counsel predictable arguments. Seghier describes that situation as “the dream for them.”

The defense may argue that preexisting disease caused the condition, treatment was not followed, the injury was temporary, the same procedure would have occurred anyway, or another event caused the deterioration.

Expert selection matters. Seghier notes that a physician may appear qualified by specialty but lack the fellowship training or procedural experience required for the issue. The defense may only need to show that the opinion is medically incomplete.

Review Future Damages as the Condition Develops

A sound review should address prognosis, permanency, complications, and anticipated care.

“Predicting future outcome and future treatment needed is a big part of the damages review,” Seghier explains. A review performed too early may miss persistent post-concussion symptoms, neurological complications, failed conservative treatment, or the need for surgery. A late review may leave too little time to investigate findings or retain the appropriate expert.

Medical record review is not the same as record organization or a medical chronology. A chronology places events in sequence. A causation and damages review evaluates their medical significance for the legal issues presented.

A focused medical record review can help counsel identify supporting evidence, anticipate alternative-causation arguments, and determine when clinical expert analysis is needed. Attorneys can also consult the medical record review guide for attorneys and the discussion of liability, causation, and damages.