Every day medical mysteries are solved inside autopsy labs around the world due to the work of a highly skilled group of medical detectives known as forensic pathologists. These scientists are tasked with revealing the causes of unclear, unexpected, or otherwise suspicious deaths – uncovering crimes and revealing questionable claims in the process.
And yet all too often life claims adjudicators lack an adequate understanding of this complex discipline. Mastering the science of forensic pathology can help insurers better determine whether the mechanism, time, and manner of a death align with the terms and conditions of an insurance policy.
This journey starts with understanding the scope – and limits – of the pathologist’s role in investigating a suspicious or mysterious death. Forensic pathologists work closely with law enforcement agencies, medical examiners, and coroners to gather and examine evidence related to criminal investigations, using specialized training in toxicology, ballistics, analysis of “trace” evidence (usually not visible to the eye), or the analysis of biological evidence such as blood, saliva, or sweat.
During an autopsy forensic pathologists collect, examine, and preserve evidence to determine any factors that have contributed to a person’s death. They may also help identify the deceased through techniques such as examination of dental records, fingerprints, and DNA. Their analysis can help insurers and officials untangle the truth behind complex death cases.
Such forensic science is impressive but imperfect. Unlike popular Hollywood depictions in whodunnit movies and police dramas like “CSI: Crime Scene Investigation,” these medical detectives cannot always catch the criminal or even arrive at clear conclusions as to whether a crime occurred. Forensic pathologists must rely on physical evidence that may not always be available or may be inconclusive. Additionally, they must navigate complex technical, legal, and ethical considerations during their investigations that can sometimes prevent prompt or definitive outcomes.
Indeed, investigations into suspicious deaths can become protracted and this can, at times, frustrate insurers seeking timely assessment as to whether a claim is payable to a certain beneficiary. It is important to note that insurers also can rely on other evidence to assess complex death claims, including medical records, witness statements, police reports, and any other documentation relating to the circumstances of the death.
Given these limits, when should claims adjudicators look to forensic science for insight? Forensic pathologists play a role in distinguishing between natural, accidental, and intentional deaths in five main areas:
1. Suspicious DeathsIn cases where a death is deemed suspicious, a forensic pathologist will conduct a thorough autopsy to determine the cause and manner of death. In most regions, specific laws forbid the payment of an insurance benefit to a person who has brought about the insured event through criminal activity. When a policy beneficiary is identified as a potential suspect in a case of homicide, it is imperative that the insurer is aware to ensure the correct payment of any benefits. |
2. Accidental DeathsIn accidents where the circumstances are unclear or disputed, a forensic pathologist may be called to evaluate the injuries sustained by the deceased to determine if the accident caused the death or whether there were other potential causes, such as illness, disease, suicide or homicide. This can help insurance companies assess the validity of a claim on an accidental death policy, where a benefit only becomes payable if the cause of death is accidental (as defined in the policy) and is independent of any other cause. |
3. Deaths from Possible Pre-existing Medical ConditionsIf a death occurs due to an underlying medical condition, a forensic pathologist may help determine circumstances around that condition’s contribution to the death. From an insurance claims perspective, this can be an important consideration, particularly if the medical condition identified is proven to have existed, with the insured’s knowledge, prior to the commencement of the insurance coverage. |
4. Suspected SuicidesCertain insurance policies, such as accidental death policies, include a specific suicide exclusion, and other life policies may exclude suicide as a cause of death for the first one or two years of policy duration. It is not always clear whether a self-inflicted death was intentional or accidental and so a forensic pathologist’s findings regarding the precise cause of death can provide vital evidence for claim assessment. |
5. Drug and Alcohol-Related DeathsCertain insurance policies exclude payment of a benefit where the event that caused death was brought about due to the insured’s consumption of drugs or alcohol. Determining whether drugs or alcohol are present in the deceased’s body can normally be determined from the toxicology analysis report. What can be more difficult to determine, however, is the part that the drugs or alcohol played as contributing factors in the death. Would the death have occurred anyway, without the insured’s use of drugs or alcohol, or did they play a key contributing role? In this scenario, a forensic pathologist’s analysis can be an essential part of the death claim investigation process. |
Below a high-rise apartment building, a man was found dead on the pavement. The initial assumption was that it was a tragic accident. However, due to the nature of the injuries and inconsistencies in witness statements, a forensic pathologist was called in to conduct an autopsy. The pathologist discovered multiple fractures inconsistent with a straight-forward fall, as well as signs of struggle on the body. Through meticulous examination and expert analysis, the forensic pathologist concluded that the death was not accidental but instead a homicide.
A middle-aged man was found deceased in his home. Suicide was suspected as his family indicated that he had suffered from depression for many years and rarely left his home. During the autopsy, the forensic pathologist noted a peculiar pattern of bruising on the body and conducted a detailed analysis to determine the origin. Toxicology revealed no drugs, alcohol, or poisons in the body that would support suicide. The blood and tissue analysis revealed that he had advanced-stage Multiple Myeloma, which explained the bruising. Because of his reclusive lifestyle, he had not sought medical intervention for his symptoms.
A young woman was found dead in a lake after a day of water recreation activities. Drowning was initially presumed to be the cause of death, but due to conflicting witness accounts and unusual injuries, a forensic pathologist was called in to investigate and discovered marks on the deceased’s body consistent with a struggle. Combining this evidence with toxicology results, which revealed high levels of a sedative substance, the pathologist determined that the woman had been drugged before meeting with foul play, ruling out accidental drowning.
These case study stories illustrate the pivotal role forensic pathologists play in determining the nature of death and distinguishing between natural, accidental, and intentional deaths. Their expertise in examining the deceased and interpreting physical evidence from the body as well as evidence from the scene of death, is essential in untangling the truth behind complex death cases.
PODCAST: Forensic pathologists are members of a little-understood, and essential, specialty. To learn more about what it is like to work side-by-side with death, tune in to RGA’s Forensic Pathology Take10 Podcast with Professor Blumenthal.
TRAINING: Access specific training modules dealing with accidental death claims, homicide claims, and suicide claims, through the Pathfinder claims training program via the RGA Global Claims Manual/Guide.
A conversation about finding answers and what the dead can tell the living through the forensic pathology process. Listen to renowned forensic pathologist, Professor Ryan Blumenthal, discuss his work as a “Medical Detective’ in the world of forensic pathology.
