As a claims examiner, when I was taking statements from injured workers, I used to believe that when they didn’t disclose previous accidents or surgeries, they were intentionally withholding information.

Bill Zachry

The ISO search would often reveal prior accidents, yet the worker claimed to have “no memory” of these events. I saw this as deception. I also saw many depositions where the injured worker had no information on underlying medical conditions, preexisting injuries, surgeries or prior industrial accidents. My attorneys were always playing the “gotcha” game with these claims. Our special investigation team was always pleased to say that the worker was not telling the truth.

What I did not understand was that forgetting pain is part of being human. We are biologically wired to suppress painful memories. Dr. Steve Feinberg once told me that if women truly remembered the intense pain of childbirth, the human species would not have survived. He called it "putting the pain in a box, and then putting the box aside."

I realized he was right when I reflected on my own experiences. I can't recall the exact dates or doctors of my two shoulder surgeries. This selective memory process became even clearer to me when I injured myself while diving to tackle a camera thief in Barcelona. As I now tell my friends, I earned style points for the dive, but I didn't stick the landing; I tore the muscle off the bone in my shoulder. By the way, I did get my camera back.

The pain was rather intense as soon as the adrenaline wore off. However, it was the intense anger at the thief that I could reproduce. Every time I thought of the event, I could feel the adrenaline and anger at the thief, but not the memory of the pain. This experience demonstrated exactly what Feinberg meant about putting pain in a box and setting it aside.

The insight from Feinberg altered my perspective on workers' compensation claims. What I once thought was dishonesty was, in fact, a biological phenomenon. Injured workers weren't lying to me. They simply could not remember.

Why pain memory fades

Medical science explains this. Pain memories are not stored the same way as other memories. The brain suppresses much of the sensory detail to protect us. MRI studies show that when we recall pain, the brain's pain-processing regions are far less active than when pain is actually experienced. The contralateral posterior insular cortex, which is crucial for experiencing pain intensity, is notably absent during the recall of pain. We can recall that something hurt, but we don't remember how much it hurt.

Daniel Kahneman's research on the "peak-end rule" adds insight: We remember the worst moment and how the pain ended, but not the whole duration of the experience. As a result, patients in his studies rated longer but less painful endings as more tolerable than shorter, sharper experiences. In workers' compensation, this means an injured worker may vividly recall the moment of injury or the relief from the treatment, but forget the weeks of lingering discomfort in between.

This forgetfulness has evolutionary value. If every painful detail stayed sharp, we would be too fearful to take risks, unable to recover and consumed by anxiety. Forgetting pain allows us to move forward.

Other factors that cloud memory

Beyond biology, several circumstances further impair recall:

• Trauma. The stress hormones released during an accident can disrupt memory formation, leaving gaps or fragmented recollections.
• Medication. Opioids and other drugs interfere with memory consolidation. Workers may genuinely forget conversations, prior treatments or even earlier injuries.
• Attention limits. In the case of acute pain, the brain allocates resources to coping rather than recording details. Information like dates, doctors and timelines often never makes it into memory.
• Head trauma. Head injuries often disrupt the hippocampus and frontal lobes, which are critical for forming and recalling memories. This can lead to fragmented or inaccurate recollections of the severity of pain felt at the time of injury.

These are not excuses; they are explanations of how and why injured workers forget.

What looks suspicious but isn't

Adjusters often interpret these scenarios as fraud indicators, but they're actually normal biology:

• A worker can't remember which hospital performed his back surgery two years ago.
• A worker fails to mention a previous workers' compensation claim when asked about prior injuries.
• A worker gives different descriptions of his pain level when interviewed at different times.
• A worker can't recall specific accident circumstances.
• A worker shows apparent fear of certain movements but can't explain the original pain severity.

None of these automatically indicate fraud. They're predictable results of pain-offset relief, the peak-end rule and protective fear mechanisms.

The technology solution

Human memory is a poor database. Instead of expecting workers to recall complex medical histories, we should lean on technology.

Modern AI systems can rapidly search across medical records, pharmacy data and treatment histories from multiple health care systems. They recognize patterns across years of data, build accurate timelines and highlight relevant preexisting conditions far better than human recall ever could. AI can provide comprehensive coverage that no individual could reasonably be expected to remember, cross-referencing dates and treatments more accurately than human memory.

This shift from interrogation to documentation removes bias, reduces conflict and allows investigations to be based on evidence rather than faulty memory.

A paradigm shift for claims professionals

This understanding requires a cultural change. Memory gaps should not automatically be treated as red flags for fraud. They are expected outcomes of human biology.

As adjusters and attorneys, our role is not to "catch" workers in memory inconsistencies, but to recognize the limits of memory and focus on objective evidence. Interviews should explore whether there are objective records of prior accidents and medical treatment. We should ask about current function, documented treatment and objective limitations, not rely on pain recall as a credibility test.

Training teams to understand pain memory and kinesophobia transforms the process. It reduces unnecessary conflict, improves fairness and saves time. Most importantly, it aligns workers' compensation practices with human reality.

Biology, not deception

Injured workers who forget prior injuries, doctors or dates are not always liars. They are human. The brain is designed to let pain fade so we can recover and move on. When they show fear-avoidant behaviors alongside poor recall, this demonstrates that normal biological processes are working exactly as designed.

By accepting this truth and embracing technology to fill the gaps, we can create a system that is both fairer and more effective. Claims investigations built on science, not suspicion, lead to better outcomes for workers and employers alike.

Memory lapses are not evidence of fraud. They are proof of biology working precisely as intended.

Bill Zachry is a board member of the California State Compensation Insurance Fund.