When civil attorneys hear the term forensic pathologist, most immediately picture the classic crime-lab stereotype: a doctor in a morgue performing an autopsy on a homicide victim. While autopsies are certainly a critical part of the job of a forensic pathologist, this limited view leaves out 80% of what forensic pathologists actually do – and more importantly what they can do for attorneys litigating cases involving injuries, contribution of injuries versus natural disease processes, how injuries may have come about, and address any conscious pain and suffering due to the injuries.
 
The truth is simple: forensic pathologists are the only medical professionals specifically trained to determine how and why an injury occurred. And that expertise can be critical in both criminal and civil litigation, even when no one is dead. This expertise can be the difference between a supported theory of liability and an argument that collapses under scrutiny.
 
Forensic pathology is a subspecialty of medicine dedicated to determining the cause of death and manner of death through scientific examination of the body. To serve in this capacity, forensic pathologists must complete medical school, a residency in pathology, and a fellowship in forensic pathology. The specialized training in forensic pathology focuses on identifying the entire spectrum of injuries and differentiating those injuries from natural diseases and normal human variation throughout the life spectrum. Integral to this is extensive training in interpreting patterns of trauma, differentiating unintentional harm from directed trauma, evaluating whether injuries match or contradict claimed mechanisms, and integrating medical information with scene information, witness statements, and other investigative data.
 
This specialized training in injury analysis and correlation with the entire scope of the investigative process is in sharp contrast to other medical specialties where the focus is on treating injuries with only minimal, preliminary investigative information. Even though emergency medicine physicians and trauma surgeons are assumed to be the most trauma-focused specialties, they do not have the resources, bandwidth, or mandate to explore how and why an injury occurred, nor are they trained to critically analyze minor injuries that might be the decisive clues to understanding the circumstances that brought the patient to their care.
 
In civil litigation, narratives matter, but only when the facts support them. Forensic pathologists are well-equipped to test those narratives and provide alternative explanations. In many cases, the injury itself seems straightforward: a crushing leg injury from a fall off a ladder, a splatter burn from hot oil, frostbitten fingers while unloading frozen food. The injury is taken at face value, especially if the narrative makes its way into the medical record, and the focus is then on the improper placement of the ladder or the inaccurate temperature readings on a thermometer or the defective cold weather gloves. But is the injury consistent with the stated mechanism? Is it plausible? Or is it scientifically impossible?  
 
Many litigants, including well-intentioned ones, misunderstand what happened to them. Trauma is confusing, frightening, and fast. Memory is imperfect. When physical findings contradict testimony, a forensic pathologist can clarify the circumstances without accusing the witness of bad faith. Alternatively, when the science supports the given narrative, the claim can move toward an efficient resolution.
 
Take for example a food service worker who has filed a workers compensation claim after sustaining burns to their feet after an extremely large pot of boiling water spilled while being carried from the stove to the counter. The worker sought medical care right after the incident and returned to work several days later, but eventually developed large, infected ulcers requiring skin grafts and eventually amputation of both feet. The medical record documents extensive burns to both feet (including photographs) and subsequent treatment of those burns. Does the evidence support the narrative? The answer is…maybe.
 
There is a lot of information missing from this hypothetical scenario such as: Does the worker have other conditions that might mimic burns or exacerbate burns (diabetes)? Do the injuries actually look like scald burns from water (they have a distinctive depth of penetration and distribution) or are they chemical burns? If the injuries are not scald burns from water, what are the other possible mechanisms for the lesions (ulcers from poor fitting shoes, peripheral vascular disease causing extremely poor circulation)? Exploring these sorts of questions are the forte of forensic pathologists.
 
An important point to remember is that medical records are not meant to be investigative documents. They are intentionally meant to be a mixture of the subjective (what the patient discloses) and the objective (what the clinical observes), interspersed with a collection of opinions and test results and diagnoses that are hopefully correct. If it turns out that the injuries in the above scenario are not from spilled boiling water, the medical record will continue to repeat in perpetuity the claim that the patient was injured in the workplace with boiling water. Who is going to change it? How does one even go about changing it? (Seriously, does anyone know?) Once entered into the medical record, the scald burn scenario will live forever, even if it turns out the worker walked through wet concrete prior to their shift but did not notice the chemical burns until the warm (not boiling) water was spilled. In the scenario below, the patient’s medical record will forever repeat the story of a person struck by a board.
 
Consider the following hypothetical. A group of individuals is unloading construction materials (lumber, plywood, and bags of concrete) from a box truck. During the process, a stack of 2x4s allegedly “topples” from the edge of the lift gate and strikes one participant on the head and face. The individual presents to the emergency department and reports this version of events. Clinical examination reveals only minor bruising to the head and face; however, the left eye is fixed in an upward position with no lateral movement. A CT scan confirms a classic orbital blowout fracture involving the maxillary sinus, and surgical intervention is required to repair the injured extraocular muscles.
 
The central question becomes: Is this injury consistent with a falling board? As with most mechanism-of-injury issues, the answer is...it depends.
 
Orbital blowout fractures typically occur when a small, rounded object (commonly a fist or sports ball) delivers a direct, concentrated impact to the eyeball, driving the eye posteriorly and inferiorly. This pressure gradient causes fracture of the orbital floor and can entrap or damage the ocular muscles. While it is not impossible for the narrow end of a 2x4 to strike the eye with sufficient precision to cause such an injury without significant damage to surrounding structures, this scenario is biomechanically less probable. In most accidental “topple” situations, the broad face of the board would more likely strike the forehead, cheek, or nasal area, producing a different injury pattern.
 
Alternative explanations should therefore be considered. The friends may have been tossing or sliding boards from the lift gate rather than carefully handing them down, prompting a face‑saving description of the incident. A minor physical altercation could have occurred in proximity to the falling boards, creating a mixed‑mechanism injury.
 
From a litigation standpoint, correlating or contradicting injuries such as abrasions, contusions, soft‑tissue patterns, are highly probative in assessing whether the reported mechanism is plausible. A thorough examination of the height of the lift gate, orientation and weight of the boards, relative positions of the participants, and documented injury patterns can either reinforce or undermine the claimant’s narrative. Such biomechanical and forensic analysis often provides a compelling foundation for establishing or challenging causation.
 
Ultimately, in situations where injury causation drives liability, forensic pathologists provide critical clarity. Their specialized training allows them to objectively test whether the physical evidence supports, contradicts, or refines the claimed narrative. By grounding legal arguments in scientific analysis rather than assumptions, forensic pathologists help attorneys build cases that are accurate, defensible, and capable of withstanding scrutiny.

Dr. Martha J. Burt is a board‑certified physician in Anatomic, Clinical, and Forensic Pathology, bringing more than two decades of experience in medical examiner leadership and forensic investigation across Washington and Florida. Before joining ESi as a Senior Consultant, Dr. Burt served as the Associate Medical Examiner and then as the Chief Medical Examiner for Clark County, Washington, where she built a respected career in death investigation, injury analysis, and forensic pathology. Her background includes extensive expert witness testimony, management of morgue operations, teaching in forensic and autopsy pathology, and fostering strong collaborative relationships with healthcare providers, attorneys, and law enforcement professionals. At ESi, Dr. Burt applies her highly specialized skills in medical record review and interpretation, death investigation, and injury pattern analysis to support clients with clear, science‑driven insights, backed by significant deposition and trial experience. ESi is a proud Annual Sponsor of WDTL.