What to Do When the Official Findings Don’t Match What You Know
Receiving autopsy results that contradict your understanding of the circumstances, conflict with what medical professionals told you, or simply do not make sense given what you know about your loved one can be profoundly frustrating. While forensic pathologists are highly trained medical professionals, they are not infallible. Errors in interpretation, incomplete testing, inadequate scene investigation information, and simple mistakes do occur. Families who disagree with autopsy findings have legitimate options for seeking a second opinion and, when warranted, challenging the official determination.
Common Reasons Families Disagree
Cause of Death Seems Wrong
Sometimes the listed cause of death does not align with the family’s understanding of events. For example, a death attributed to natural heart disease when the family knows the deceased was in a physical altercation shortly before death, or a death attributed to drug overdose when the family believes the person was not using drugs. In these cases, the family’s knowledge of context can be valuable information that the pathologist may not have had.
Manner of Death Disputed
The manner of death classification — particularly the distinction between accident, suicide, and undetermined — is one of the most frequently disputed aspects of autopsy findings. Families may strongly believe a death was accidental when it has been classified as suicide, or may believe foul play was involved when the death was classified as natural or accidental.
Incomplete Investigation
Some families receive autopsy results that feel incomplete. Perhaps toxicology testing was limited, certain organs were not examined in detail, the microscopic examination was cursory, or the pathologist did not have access to important medical history or scene investigation information. An incomplete investigation can lead to inaccurate conclusions.
Contradictory Medical Opinions
When the autopsy findings conflict with the opinions of the deceased’s treating physicians, specialists, or other medical professionals, the disagreement itself suggests that the matter is not straightforward and may benefit from additional expert review.
Your Options for Challenging Autopsy Results
Request a Meeting with the Pathologist
Before pursuing a formal second opinion, request a meeting with the pathologist who performed the autopsy. Share the information and concerns that led to your disagreement. In some cases, the pathologist may have additional context to share that addresses your concerns. In other cases, the additional information you provide may cause the pathologist to reconsider their findings. Many disagreements stem from miscommunication or incomplete information exchange rather than fundamental errors in the examination.
Obtain an Independent Case Review
An independent board-certified forensic pathologist can review the complete autopsy report, photographs, microscopic slides, toxicology results, medical records, and scene investigation reports. Based on this comprehensive review, the independent expert provides their own opinion on the cause and manner of death. If their opinion differs from the original pathologist’s, this creates a legitimate basis for challenging the official findings.
Request Additional Testing
If you believe the original autopsy did not include sufficient testing, you may be able to request additional analysis. Retained tissue samples, preserved blood or body fluids, and microscopic slides can often be subjected to additional testing months or even years after the autopsy. This might include expanded toxicology panels, molecular autopsy for genetic conditions, specialized staining for specific diseases, or consultation with subspecialty pathologists.
Request Amendment of the Death Certificate
If an independent expert provides a compelling alternative opinion on the cause or manner of death, you can petition the medical examiner or coroner to amend the death certificate. The process for requesting amendments varies by jurisdiction, and some offices are more receptive than others. If the office declines to amend, you may have the option to pursue a legal challenge through the courts.
Pursue Legal Action
In cases where the autopsy findings have significant legal or financial implications — such as insurance claim denials, criminal investigations, or civil litigation — your attorney can use independent forensic pathology opinions to challenge the official findings in court. Judges and juries regularly hear conflicting expert medical testimony and make their own determinations about which opinion is more credible.
How to Select an Independent Reviewer
For maximum credibility, the independent forensic pathologist should be board-certified in forensic pathology, have no affiliation with the office that performed the original autopsy, have extensive experience with the type of case in question, have experience providing expert testimony, and be willing to provide an honest opinion even if it agrees with the original findings. A reputable expert will not simply tell you what you want to hear. Their value lies in providing an independent, evidence-based assessment that you and your attorney can rely on.
What It Costs
An independent case review typically costs $2,000 to $5,000, depending on the complexity of the case and the extent of materials to be reviewed. If additional testing of retained specimens is needed, add $500 to $2,000 or more. If the expert needs to provide testimony, their time is typically billed at $300 to $750 per hour. While these costs are significant, they are often a small fraction of the financial stakes involved in insurance claims, legal cases, or other situations where the cause and manner of death have concrete consequences.
Disagreeing with autopsy results is not disrespectful to the pathologist who performed the examination. It is an exercise of your right to seek the most accurate determination possible about how your loved one died. The forensic pathology community recognizes that second opinions serve an important quality assurance function, and most pathologists welcome the professional accountability that independent review provides.