brand logo

The need for inquest and medico-legal autopsy in life insurance claims

26 Jul 2022

  • Forensic medicine academics propose amending Code of Criminal Procedure for an inquest into deaths of those with life insurance policies 
BY Ruwan Laknath Jayakody The conduct of an inquest and medico-legal autopsy and giving a medical opinion is important in cases of life insurance claims, and is beneficial to both the parties including the claimant and the insurance company. Therefore, academics in forensic medicine have suggested that an inquest should be requested in cases of the death of a person having a life insurance policy while amendments to Code of Criminal Procedure should be considered in this regard. These observations and recommendations were made in a research article on “Life insurance policy: Is it an indication for an inquest?”, which was authored by A.N. Vadysinghe, A.M.G. Abeysekara, M.D.P. Gunasena, and R.M.U.C. Ratnayake (all four attached to the Peradeniya University’s Medical Faculty’s Forensic Medicine Department at the time) and published in the Sri Lanka Journal of Forensic Medicine, Science and Law’s 3(1) in November 2012. According to the Code of Criminal Procedure Act, No. 15 of 1979, an inquest is done to ascertain the cause and circumstances of a death in cases of suicide, deaths caused by an animal, machinery or an accident, a sudden death or when the cause is not known, and deaths in custody, etc. In some instances, a medico-legal autopsy is needed in order for the further confirmation of the cause of death. However, Vadysinghe et al. noted that the medico-legal investigation with ancillary investigations is an essential part in certain instances such as claiming insurance which is not an indication in death related investigation in the current practice, per the aforementioned Act.  This case report by Vadysinghe et al. highlights the importance of an inquest and medico-legal autopsy in order to fulfil the needs of the relatives of the deceased in claiming the life insurance and that it would also be a great benefit for both parties, namely, the client and the insurance company. Case report An apparently healthy young male of 22 years who was a second-year student in a technical college suddenly developed shortness of breath following his lunch and then lost consciousness. He was immediately taken to a hospital. Resuscitation was unsuccessful.  According to the electrocardiogram (test that can be used to check the heart's rhythm and electrical activity where sensors are attached to the skin and are used to detect the electrical signals produced by the heart each time it beats) findings by the attending medical officer at the out-patient department, the probable cause of death was given as ischemic heart disease (heart problems caused by narrowed heart arteries [blood vessels], where when the arteries are narrowed, less blood and oxygen reaches the heart muscle). An inquest was requested.  The inquirer into sudden death (ISD) requested for a medico-legal autopsy for the further confirmation of the cause of death.  The deceased did not have any history of asthma (affects the airways in the lungs where the airways are inflamed and narrowed at times which makes it harder for the air to flow out of the airways when one breathes out), cardiac (heart) diseases or any allergies (when the immune system reacts to a foreign substance) in his past medical history. He did not have a family history of unexplained deaths. However, he was a smoker, where he smoked 10-20 cigarettes daily for about two to three years, and consumed alcohol occasionally. In the general examination, the deceased was found to be moderately obese (overweight with body fat and having a body mass index of 30-35) and the height was 160 centimetres. Even after subcutaneous (under the skin) and muscular-skeletal dissections, no injuries were detected.  Upon internal examination, the heart was 225 grams and showed that the proximal one-third of the right coronary (arteries which surround and supply the heart) artery was 75% narrowed eccentrically with atherosclerosis (a sticky substance called plaque which builds up inside the arteries), while mild to moderate atherosclerosis was seen in the left coronary artery. The myocardium (the muscular layer of the heart), the endocardium (the innermost layer of the heart and lines the chambers and extends over the projecting structures) and the valves were normal. In the stomach, partially digested food was present and there was no smell of alcohol or poison.  Other system examinations were macroscopically (observable by the naked eye) normal. The histological (the study of tissues and cells under a microscope) examination was normal including the myocardium and only mild pulmonary oedema (too much fluid in the lungs where the fluid collects in the many air sacs in the lungs, thus making it difficult to breathe) was seen. Toxicology, including alcohol and microbiological investigations, was normal.  Finally, the cause of death was pronounced as coronary artery disease. The verdict was given by the ISD as natural circumstances. As known later, the deceased had a life insurance policy which was only three months in duration but the insurance company had refused to release the full payment as issues were raised by them as to whether the relatives knew in prior that the deceased was having heart disease. Then, the next of kin went to the relevant district court in order to get the payment, and there, issues were raised as to whether the circumstances of the death were natural or known previously. Also, the insurance company needed to know as to whether violence and poisons were excluded as other possible causes of death. As the medico-legal autopsy with histology and laboratory investigations had been performed in order to confirm the cause of death and to exclude other possible causes, the medico-legal evidence was strong enough to confirm that a previously healthy young man can have an unexpected death due to the 75% narrowing of the coronary vessels, and therefore, the parents of the deceased were able to claim the insurance. Generally, an inquest is performed for all sudden deaths. If suspicions are not raised during the inquest regarding the probable cause of death, the ISD may not request for an autopsy. As noted in T. Kircher, J. Nelson, and H. Burdo’s “The autopsy as a measure of accuracy of the death certificate” and H. Randy, and H. Gib Parrish’s “The failure of death certificates to record the performance of autopsies”, when the relatives of the deceased attempt to make a claim for the life insurance, controversial issues regarding the cause of death may be raised, and there, the clinical diagnosis may be challenged if it is not confirmed by a medico-legal autopsy.  Even if the post-mortem examination confirms the cause of death, as was the case in the above case, issues may still be raised regarding intoxication where the laboratory investigations will help the final decision regarding the cause of death. Even though in the present Code of Criminal Procedure, insurance issues are not a prerequisite for performing an inquest with a subsequent autopsy, it is important however to conduct an autopsy with ancillary investigations including histological and toxicological investigations which are helpful in giving a complete cause of death and in solving the issues raised by the insurance companies.  It also plays a vital role, per W.D. Johnson, J.P. Srong, M.C. Oalmann, W.P. Newman the Third, R.E. Tracy, and W.A. Rock Junior’s “Sudden death from coronary heart disease in young men”, M. Luqman, A. Sattar, S. Abbasi, and T.M. Satti’s “Pattern of sudden deaths in armed forces personnel – Post-mortem study”, R.H. de Gouveia, A.C. van der Wal, C.M. van der Loos, and A.E. Becker’s “Sudden unexpected death in young adults. Discrepancies between the initiation of acute plaque complications and the onset of acute coronary death”, V.J.M. Di Maio and S.E. Dana's “Handbook of forensic pathology” and J.K. Mason's “Forensic medicine for lawyers”, in excluding other causes of death in a case like the one above, where the death due to coronary artery disease is rare, but was the identified cause of death in a young male of 22 years.  However, it is disclosed by W.B. Kannel, L.A. Cupples, and R.B. D'Agostino’s “Sudden death risk in overt coronary heart disease”, R. Virmani, A.P. Burke and A. Farb’s “Sudden cardiac death”, T. Crawford, D. Dexter, and R.D. Teare’s “Coronary artery pathology in sudden death from myocardial ischaemia (when the blood flow to the heart muscle is obstructed by a partial or complete blockage of a coronary artery by the build up of plaque)”, and Mason, that a person with 75% occluded coronary vessels, specially eccentric narrowing, may remain asymptomatic, and that at the same time, it can lead to a sudden death.  In a sudden death of an individual with a life insurance policy, it is therefore worthwhile to conduct an inquest and a medico-legal autopsy as it is impossible for the insurance company to challenge the cause of death against such scientific evidence while on the other hand, it will prevent insurance companies from paying unnecessary claims.  

Kapruka

Discover Kapruka, the leading online shopping platform in Sri Lanka, where you can conveniently send Gifts and Flowers to your loved ones for any event. Explore a wide range of popular Shopping Categories on Kapruka, including Toys, Groceries, Electronics, Birthday Cakes, Fruits, Chocolates, Automobile, Mother and Baby Products, Clothing, and Fashion. Additionally, Kapruka offers unique online services like Money Remittance, Astrology, Medicine Delivery, and access to over 700 Top Brands. Also If you’re interested in selling with Kapruka, Partner Central by Kapruka is the best solution to start with. Moreover, through Kapruka Global Shop, you can also enjoy the convenience of purchasing products from renowned platforms like Amazon and eBay and have them delivered to Sri Lanka.Send love straight to their heart this Valentine's with our thoughtful gifts!

Discover Kapruka, the leading online shopping platform in Sri Lanka, where you can conveniently send Gifts and Flowers to your loved ones for any event. Explore a wide range of popular Shopping Categories on Kapruka, including Toys, Groceries, Electronics, Birthday Cakes, Fruits, Chocolates, Automobile, Mother and Baby Products, Clothing, and Fashion. Additionally, Kapruka offers unique online services like Money Remittance, Astrology, Medicine Delivery, and access to over 700 Top Brands. Also If you’re interested in selling with Kapruka, Partner Central by Kapruka is the best solution to start with. Moreover, through Kapruka Global Shop, you can also enjoy the convenience of purchasing products from renowned platforms like Amazon and eBay and have them delivered to Sri Lanka.Send love straight to their heart this Valentine's with our thoughtful gifts!


More News..