Inquests and service inquiries | Cruse Bereavement Care

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Not all deaths require an inquest or a service inquiry (formerly a Board of Inquiry) and each case may be different.

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An inquest is to ascertain the cause of death – not to apportion blame. Coroners are independent, and come under the Ministry of Justice. An inquest is a civil matter, over which the MOD has no control. However the MOD has set up the Defence Inquest Unit (DIU) which is there to liaise with HM Coroners and with the Service Police. The Ministry of Justice together with the Ministry of Defence have also produced a guide to Coroners' Inquests and Service Inquiries.

The army has produced a DVD which is sent to families once the inquest date has been set to let them know what to expect. For deaths resulting from anything other than natural causes, the Coroner is required to hold an Inquest and may request a post mortem examination irrespective of whether such an examination was carried out overseas. Where there is a possibility that the death may have been the result of a criminal act two post mortems may be required.

MOD will send British Pathologists to Germany and other overseas bases to conduct post mortems; all operational deaths have post mortems at the John Radcliffe Hospital in Oxford. It is not advisable to finalise the funeral arrangements until the Coroner has released the body to the undertaker. Normally a coroner will open an inquest and then adjourn it while information is gathered; this is an administrative function and does not involve a court hearing.

Once the Coroner has received the police report and is satisfied that he has all the evidence he requires he will set the date for the inquest. The Coroner will deal direct with the family and should consult them before fixing the date and the family should understand that they have direct access to HM Coroner through his staff and do not have to approach him through the MOD. Inquests into operational deaths for an incident where there have been multiple fatalities will be held before the Oxford Coroner (from Sep 11 2011) but where there is only one death it may be passed to the Coroner in whose jurisdiction the funeral has taken place as this generally makes it easier for the surviving family. (For families in Scotland and N Ireland differences in legislation prevent the inquest from being delegated.)

If the death has been due to Service, the costs for three family members to travel to inquest will be met. The Visiting Officer will normally accompany the family and this is generally the final duty the VO carries out. The Royal British Legion offers legal advice to families prior to inquest but does not provide legal representation. In Scotland the equivalent to an inquest is a Fatal Accident Inquiry but the threshold for these is very different from inquests and currently (August 2011) the Procurator Fiscals do not have jurisdiction for deaths which occur outside Scotland.


Service inquiries

A Service Inquiry will be held into any incident resulting in death or serious injury in order to understand the circumstances, learn lessons, and change procedures/equipment to prevent recurrence. Increasingly these are taking place after the inquest to reduce delay. NOK will be invited to attend the proceedings as observers.


Service prosecuting authority/civil prosecutions

Where the evidence shows that the death may have been the result of a criminal act (not including operational deaths) the case will be referred to the Crown Prosecution Service (Procurator Fiscal in Scotland) or to the Service Prosecuting Authority if the accused is subject to Military Law. All investigations stop until criminal proceedings have been completed. It is not usual to have an inquest as well as a criminal case as all evidence will have been heard in court. In these circumstances the Coroner will conclude the inquest in chambers and a final death certificate will be produced.


Complex cases

In complex cases there may be a number of other agencies involved such as Health and Safety Executive or foreign nationals and agencies. This can greatly complicate the investigation and may result in lengthy delays which are distressing and frustrating for everyone involved and can impede the grieving and healing process