Medical examiners, coroners and post-mortems

After a death, the cause has to be checked before it can be registered. Depending on the circumstances and where in the UK the person died, a medical examiner, coroner or procurator fiscal may be involved. This guide explains what each one does, when a post-mortem or inquest happens, and how it can affect the funeral.

Key points

• England and Wales: since 9 September 2024, every death is either reviewed by a medical examiner or investigated by a coroner.
• Scotland has no coroners or medical examiners. Some certificates are randomly reviewed, and the procurator fiscal investigates sudden, suspicious or unexplained deaths.
• Northern Ireland has coroners but no statutory medical examiner system yet. A prototype service reviews some hospital deaths.
• You cannot object to a legally required post-mortem, but you can raise religious or cultural concerns.
• If a faith needs a quick burial, tell the doctor, medical examiner’s office or coroner’s officer straight away.

Who checks the cause of death

Medical examiners (England and Wales)

A medical examiner is a senior doctor who was not involved in the person’s care. They are trained in the legal side of death certification. Their office, usually staffed by medical examiner officers, will:

• look at the medical records and the cause of death proposed by the doctor
• contact you, usually by phone, to explain the cause of death and answer your questions
• hear any concerns you have about the care the person received
• send the medical certificate of cause of death to the registrar and tell you that you can register

Talking to them is voluntary. If you do have concerns, this is a good moment to raise them. Before you can register, the doctor must first confirm the death and contact the medical examiner, which can take a few days. The 5-day registration period starts when the medical examiner’s office confirms you can register. The ONS found that the median time from death to registration rose from 6 to 8 days after the system became statutory.

Wales had a non-statutory medical examiner service from 2019, before the statutory system started across both nations.

When a death is referred to a coroner (England and Wales)

Doctors must report a death to the coroner in certain situations. These include when:

• the cause of death is unknown
• the death may have been violent, unnatural or caused by an accident, injury or self-harm
• it may be linked to poisoning, drugs, neglect, a medical procedure or the person’s work
• the person died in prison, in police custody or in other state detention
• there is no doctor who can certify the death

The coroner’s officer will contact you. Then one of three things happens:

1. The coroner doesn’t investigate. The medical examiner will contact you to confirm that you can register the death.
2. The coroner finds the cause, without an inquest. This may follow a post-mortem. The coroner sends a form (CN2) to the registrar, and a Cremation 6 certificate if the person is to be cremated. The registrar then contacts you to register.
3. The coroner holds an inquest. An inquest must be held if the cause of death is still unknown, the death may have been violent or unnatural, or it happened in prison or police custody.

Post-mortems

A post-mortem (also called an autopsy) is a medical examination of the body to find out how someone died. It takes place in a hospital or mortuary.

• Coroner’s or procurator fiscal’s post-mortem: consent is not needed, and families cannot object. In England and Wales, if you’ve asked, the coroner must tell you (and the person’s GP) when and where it will take place. In Northern Ireland, the next of kin can be represented at the examination by a doctor of their choice.
• Scans instead of an invasive examination: some areas may use a scan instead, for example for families with religious objections. Ask the coroner’s officer whether it is possible in your case.
• Tissue samples: small samples are sometimes kept for tests. You will be told if tissue or organs are retained, and asked what you would like to happen to them afterwards.
• Hospital post-mortem: sometimes doctors ask to do one to learn more about an illness. This can only happen with consent, and you can say no.

Once no more examinations are needed, the coroner releases the body so the funeral can go ahead.

Inquests

An inquest is a public hearing, held by a coroner, to find out who died, when, where and how. It is not a trial. The coroner usually opens the inquest and then adjourns it while enquiries continue. The full hearing may be months later.

• The coroner can release the body for the funeral before the inquest finishes.
• You can ask the coroner for an interim death certificate, which you can use for probate and Tell Us Once.
• The death is registered after the inquest, and the registrar can then issue the final death certificate.
• Families can ask questions at the hearing, with or without a lawyer.

The Coroners’ Courts Support Service offers free, independent support to families at inquests in England and Wales. Its helpline is 0300 111 2141 (Monday to Friday 9am to 7pm, Saturday 9am to 2pm).

Scotland: certificate reviews and the procurator fiscal

Death Certification Review Service (DCRS). Some medical certificates are chosen at random for review by Healthcare Improvement Scotland. The registrar tells you if yours has been chosen. Reviews should delay registration by no more than 1 to 3 working days. If the funeral must take place quickly, ask the registration office for advance registration. If you have concerns about what a certificate says, you can apply for an interested person review.

Procurator fiscal. Sudden, suspicious or unexplained deaths are reported to the procurator fiscal by a doctor, the registrar or the police. The procurator fiscal:

• investigates the circumstances and may order a post-mortem without the family’s consent. Tell them as soon as possible if you have religious or cultural objections. They will respect your wishes where the law allows.
• in most cases finds that the death was from natural causes, after which a certificate is issued and you can register
• in some cases, may bring criminal proceedings or hold a Fatal Accident Inquiry

The Victim Information and Advice service can pass questions to the procurator fiscal for you and go with you to meetings.

Northern Ireland: coroners

A death is reported to the coroner if, for example:

• no doctor treated the person in their last illness, or saw them for that condition in the 28 days before death
• the death was sudden, violent or unnatural, or the cause was unclear or suspicious
• it was caused by an industrial lung disease

If the coroner is satisfied that the death was natural, they may accept the doctor’s cause of death and issue a notification so that the death can be registered. Otherwise they may order a post-mortem. Coroner’s liaison officers keep families informed. Funeral arrangements should wait for the coroner’s consent, and the coroner can allow the burial or cremation before the death is registered.

In hospitals, an independent medical examiner prototype service reviews certificates for deaths certified during weekday working hours.

Faith burials and urgent release

For Muslim and Jewish families, and some others, burial is expected as soon as possible after death. To help:

• tell the ward, the GP or the medical examiner’s office as early as possible that the funeral is urgent
• in England and Wales, national medical examiner good-practice guidance covers urgent release of a body, and many register offices offer out-of-hours registration for religious reasons. Arrangements vary locally.
• in Scotland, ask the registration office about advance registration
• if a coroner or procurator fiscal is involved, explain the religious need to the coroner’s officer. They will try to help but cannot always avoid delay.

A funeral director experienced in your faith will know the local arrangements. Find Muslim or Jewish funeral directors, or read our Muslim and Jewish faith guides.

Where to get help

• How to register a death
• How long after a death is a funeral?
• Death certificates, including interim certificates
• Bereavement support and coping with grief
• What to do when someone dies