Coroner vs. Medical Examiner: What's the Difference?

When a death is sudden or unexplained, families often hear that “the coroner” or “the medical examiner” is involved and aren’t sure what that means or who to call. The two jobs overlap a great deal. This guide explains how they differ, why you may deal with one and not the other, and what to expect.

What do they do?

Both offices investigate deaths and decide the cause (the injury or disease that led to death) and the manner (natural, accident, suicide, homicide, or undetermined). The Bureau of Justice Statistics describes their work as conducting death scene investigations, performing autopsies, and determining cause and manner when a person died from violence, under unexpected or suspicious circumstances, without a physician in attendance, or for other reasons.

Most deaths never reach them. In 2018, offices across the country received more than 1.3 million referrals and accepted about 605,000 (46%) for further investigation. A death in hospice or under ongoing medical care, where the doctor can certify the cause, typically doesn’t involve either. See what to do when someone dies at home unexpectedly and what happens if someone dies alone.

What is the real difference?

It’s about who holds the job and how they’re trained, not what the job is:

• Selection. Coroners are generally elected officials, and medical examiners are generally appointed, according to the Bureau of Justice Statistics
• Training. Medical examiners are in most cases trained physicians, while coroners often don’t need any medical or forensic science training, according to the same agency’s census materials. California’s law as summarized by the CDC requires a medical examiner to be a licensed physician specializing in pathology, and lists no qualification for coroners
• Who performs autopsies. In 2018, about 890 autopsy pathologists (physicians specially trained to examine sudden, unexpected, or violent deaths) worked in these offices, and about three-quarters of them worked in medical examiner offices. About 97% of the roughly 2,210 non-physician coroners worked in coroner offices. Coroner offices were more likely to send autopsies elsewhere: about 70% reported using outside organizations for complete autopsies, versus about 41% of city, county, district, or regional medical examiner offices
• Accreditation. About 17% of offices were accredited in 2018: about 14% of coroner offices, 29% of city, county, district, or regional medical examiner offices, and 52% of state medical examiner offices

None of this means a coroner’s determination is wrong or a medical examiner’s is always right. Plenty of coroner offices hire forensic pathologists, and some coroners are physicians. It does mean the title alone doesn’t tell you who is doing the examination. If an autopsy is planned, you can ask who will perform it and whether it will be a forensic pathologist.

Which one do I have?

It depends on the state and often the county:

• Nationwide (2018). There were about 2,036 offices: 1,630 coroner offices, 384 city, county, district, or regional medical examiner offices, and 22 state medical examiner offices. Coroner offices were the most numerous but covered about 34% of the U.S. population, because many serve small counties. Medical examiner offices covered about 66%
• State by state. In 2018, 16 states and the District of Columbia had only a centralized medical examiner system. The other 34 states had local systems: 13 with coroners, 7 with medical examiners, and 14 with both. Seven of those also had a statewide medical examiner office
• Hybrids. Texas is county-based. In many counties an elected justice of the peace conducts inquests, while some counties have appointed medical examiners (a county of more than one million without a medical school must establish the office). The BJS census doesn’t count Texas justices of the peace as coroners. California is also county-based: coroners are elected unless a county votes to make the office appointive, and a county board can abolish the coroner’s office and create an appointed medical examiner. Many California counties combine sheriff and coroner

To find yours, ask the funeral home, the hospital, or the police or sheriff who responded, or search for the county’s medical examiner or coroner. The D.C. system, for example, is a single centralized office; see who can authorize cremation in D.C..

Which deaths do they investigate?

Each state sets its own standards. Two examples from the CDC’s summaries:

• Texas. A justice of the peace must conduct an inquest when a person dies in prison or jail, dies an unnatural death, dies in circumstances that suggest unlawful means or suicide, dies without having been attended by a physician, or dies while attended by a physician who can’t certify the cause and asks for an inquest. A child under six is included when state child-welfare law requires an inquest. In counties with a medical examiner, a similar list applies to that office
• California. The coroner must inquire into violent, sudden, or unusual deaths; unattended deaths; deaths where the person wasn’t attended by a physician or a hospice nurse in the 20 days before death; known or suspected homicide, suicide, or accidental poisoning; deaths from accident or injury; deaths in prison or under sentence; deaths from suspected contagious disease that is a public hazard; and others. The coroner has discretion over how far to investigate a death that appears natural

Being investigated is not a suggestion of wrongdoing. It is the routine process for deaths that can’t simply be certified by a doctor.

Will there be an autopsy?

Not always. In 2018, offices performed about one full autopsy for every three cases they accepted (about one for every five in coroner offices). Laws differ on when one is required: in California, for example, the coroner must perform one when an infant dies suddenly and unexpectedly, and otherwise decides. In Texas, a justice of the peace decides case by case whether to direct an autopsy or certify that none is necessary, and must order one if it’s needed to determine the cause, if a child under six’s death was unexpected or from abuse or neglect, or if the district attorney directs it. Neither state requires that a pathologist perform it.

Some offices say they don’t need the family’s permission for an autopsy within their jurisdiction. Georgia’s office adds that it makes efforts to respect the religious and cultural beliefs of the next of kin. If this matters to your family, say so immediately, because the timing is short.

What should a family expect?

Practices vary by office, and these are examples from offices that publish them:

• Release of the body. Offices commonly release the body within a day or two of examination. Orange County, Florida, says most bodies can be released within 24 to 48 hours even when the cause is still pending, and San Diego County says generally 48 to 72 hours. The legal next of kin picks a funeral home and signs a release. In Texas, Travis County says only the legal next of kin may sign it
• Viewing. Several offices say families can’t view the person at the office (Waukesha County, Georgia). Viewing is usually done at the funeral home
• Death certificate. The office does not issue copies of the death certificate (San Diego, Orange County, Travis County, Connecticut). It certifies the cause and manner, the funeral home files the certificate, and you order copies from vital records. See how to get death certificates
• “Pending.” If the cause isn’t known yet, the certificate is filed with “pending” so arrangements aren’t delayed, and it’s amended later. San Diego and Waukesha say a pending certificate can be used as proof of death. Texas’s health department says a “pending investigation” certificate can be amended later at no charge. See how to correct a death certificate
• Personal belongings. Typically released to the funeral home with the body, or held for the next of kin on request (Travis County)
• Cremation. Many offices also handle cremation approvals. About 7 in 10 offices reported handling cremation waivers or authorization themselves in 2018. D.C., for instance, requires Medical Examiner authorization before any cremation

What does it cost?

• The autopsy. Offices say there is no charge to the family for an autopsy done within their legal responsibility (San Diego, Connecticut, New York City, Waukesha County, Georgia). If the office doesn’t require one and the next of kin wants one, that is generally at the family’s expense; San Diego cites a California statute that allows it
• Possible pass-through fees. Waukesha County says it charges the funeral home a fee whenever it signs a death certificate, and the funeral home may pass it on. Ask for itemized costs
• Reports. Several offices provide the first copy of the report to the next of kin free (San Diego) or free generally (New York City)

When will we have answers?

It varies widely. San Diego County says reports are released only when all the reports (autopsy, investigative, toxicology) and the death certificate are finished, which can be as long as 4 to 6 months but is usually sooner. Georgia’s office says the final decision can take several months in complicated cases. The Connecticut office says the autopsy report is not public and by law is obtained only from that office.

King County’s office defines “pending” as a temporary designation for cause or manner when more investigation, information, or test results are needed. Its definitions also note that intent to cause death is a common element of a homicide classification but isn’t required for one, so ask the office what a particular manner ruling means rather than assuming.

What if we disagree with the finding?

Start by asking the office what it relied on, and provide any new information in writing. How a determination can be changed depends on the state. In Texas, for example, a justice of the peace may reopen an inquest if credible information suggests a different cause or circumstances, and a 2009 Texas Attorney General opinion declined to say that a justice of the peace can never be required to amend a cause of death, so the courts’ role here depends on the facts. An attorney can advise on your state’s options. For a related situation, see what families face after a suicide.

What should I ask?

• Which office has my loved one, and who is my contact?
• Is an autopsy planned, who will perform it, and is that person a forensic pathologist?
• When can the body be released, and what do I sign?
• Is cremation approval needed, and how is it done?
• Will the death certificate say “pending,” and when will it be finalized?
• Are there any fees, and who bills them?
• How and when can the next of kin get the reports?

For court- and coroner-ordered exhumations, see Can a body be exhumed? How disinterment works; for hospital records, see How to get a deceased person’s medical records.

For hospital and private autopsies, which families can request, see Autopsy explained: when it’s done, who pays, and how long results take; for a death far from home, see What if someone dies out of state or abroad? A practical guide.

Systems and practices differ by state and county, and the national figures are from 2018. This is general information, not legal or medical advice; the office handling your case, a funeral director, or an attorney can confirm what applies to your situation.