Forensic implications of classification of accident-related deaths: A case report and review of the medical and legal literature

Abstract

One of the most important documents produced by physicians is a death certificate. It is not only used in the field of forensic science but is also utilized by statisticians, administrators, historians, researchers, and public health experts. Insurance companies refer to the cause and manner of death listed in the death certificate when deciding whether to distribute benefits. We report the case of a 40-year-old male who was declared dead after crashing his vehicle against a fixed object in a head-on collision. The collision occurred after he had worked a highly strenuous shift as a volunteer firefighter. The decedent’s daughter was a passenger in the car when the incident occurred, and witnessed him become unconscious and exhibit signs of a seizure while driving, before he lost control of the vehicle. The forensic pathologist who performed the autopsy received a police report which did not include details of the crash and which specifically omitted the daughter’s witnessed account. Based on the absence of traumatic injuries and the presence of facial petechiae and marks on his abdomen and chest from the seatbelt, the autopsy pathologist concluded that the cause of death was mechanical/positional asphyxia due to entrapment by the seatbelt. The decedent had significant cardiovascular disease, but this was not considered a cause or a contributory cause of death. Because the cause of death did not align with the terms of the decedent’s insurance coverage, which required that any qualified accident be directly due to on the job injury or occur due to a cardiovascular event within 24 h of job-related exertion, the family was denied Public Safety Officer accidental death benefits. The family approached a legal advocate with experience in appealing these types of claims, and the advocate reached out to a consulting pathologist to peer-review the case. The consultant authored a report incorporating the daughter’s witnessed statement and discovered evidence on microscopy that indicated that cardiac strain brought on by workplace exertion was the likely cause of the collision and terminal entrapment. Upon tertiary review by the Chief Medical Examiner, the death certificate was subsequently amended to acknowledge the decedent’s cardiovascular disease, allowing the family to successfully appeal the insurance agency’s decision and receive the benefits.