The Biology of Pain Memory — Injured Workers Aren’t Always Lying

Key Message:

Memory gaps about painful experiences are not evidence of fraud — they are evidence of normal human biology functioning exactly as designed.

A Claims Examiner’s Revelation

When I first began taking statements from injured workers, I believed that when someone failed to disclose previous accidents or surgeries, they were intentionally withholding information. The ISO search would reveal prior accidents, yet the worker would claim to have “no memory” of them.

I viewed this as deception. During depositions, many injured workers seemed to have no recollection of underlying medical conditions, pre- existing injuries, surgeries, or prior industrial accidents. My attorneys often treated these moments like “gotcha” opportunities, and our Special Investigation Unit was always pleased to report that the worker was not being truthful.

What I did not understand was this: 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 cannot recall the exact dates or physicians from my two shoulder surgeries. And when I injured myself diving to tackle a camera thief in Barcelona, yes, I got my camera back and I vividly remember the adrenaline and anger. But I cannot clearly recall the pain, even though I tore a muscle completely off the bone.

Every time I think about that event, I can feel the rush of adrenaline and the anger but not the pain. That is pain memory biology in action.

This realization changed how I saw workers’ compensation claims. What I had once assumed was dishonesty was often a biological phenomenon. Most injured workers weren’t lying, they truly couldn’t remember.

Why Pain Memory Fades

Medical science confirms this. Pain memories are not stored like other memories. The brain suppresses much of the sensory detail to protect us.

Neuroimaging studies show that when we recall pain, the brain’s pain- processing centers especially the contralateral posterior insular cortex are far less active than when pain is actually experienced. We remember that something hurt, but not how much it hurt.

Behavioral economist Daniel Kahneman’s “peak-end rule” adds more context:

We remember the worst moment and how the pain ended, not the full duration.

This means an injured worker may vividly recall the moment of injury or relief after treatment yet forget weeks of lingering pain in between.

This forgetfulness has evolutionary purpose. If every painful detail stayed sharp, we would become fearful, avoid activity, and struggle to recover. Forgetting pain allows us to move forward.

Other Factors That Cloud Memory

In addition to biology, several factors can impair recall:

• • Trauma & stress hormones: Can disrupt memory formation.
  • Medication: Opioids and other drugs interfere with memory consolidation.
  • Attention limits: During acute pain, the brain prioritizes survival, not record-keeping.
  • Head trauma: Can damage brain regions crucial for memory, leading to fragmented or inaccurate recall.
  • Kinesiophobia: Fear of movement due to anticipated pain can persist even when the pain memory fades.

These are not excuses, they are explanations grounded in neuroscience.

What Looks Suspicious — But Isn’t

Adjusters often see the following as red flags, but they are common and predictable responses to injury:

• Forgetting which hospital or doctor performed a past surgery
• Failing to mention a prior workers’ compensation claim
• Inconsistent descriptions of pain levels over time
• Incomplete or changing accident recollections
• Demonstrating fear of movement without recalling pain severity

These are not necessarily signs of fraud. They are signs of being human.

The Technology Solution

Human memory is a poor database. Instead of relying on recall, we should rely on data.

Modern AI can:

• Search across medical records and pharmacy networks
• Identify prior treatments and surgeries
• Build accurate timelines
• Recognize patterns far better than human memory

This shifts the process from interrogation to documentation. It reduces bias, minimizes conflict, and supports fact-based investigations.

A Paradigm Shift for Claims Professionals

To better serve injured workers and employers, we need to update our mindset:

• Memory gaps are not immediate fraud indicators
• Human biology not dishonesty explains many inconsistencies
• Interviews should focus on objective records, not perfect recall
• Training teams in pain memory science improves fairness and efficiency

When we understand pain memory and the psychological responses to injury, we improve accuracy and compassion in the claims process.

Biology, Not Deception

Injured workers who forget prior medical history or details of their injury are not necessarily lying. The brain is designed to let pain fade so we can survive, recover, and move on.

Memory lapses are not evidence of fraud.

They are evidence of biology working as intended.

By accepting this and using technology to fill the gaps, we create a workers’ compensation system that is both fair and effective. One built on science, not suspicion.