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The Boston Globe


Backlog of death certificates can tangle lives

Insurance claims, settling of estates slowed

Anne Marie Morrison, 55, died alone at home in March. The State medical examiner has yet to determine the cause of her death.

Aram Boghosian/Boston Globe

Anne Marie Morrison, 55, died alone at home in March. The State medical examiner has yet to determine the cause of her death.

John Morrison was still recovering from his wife’s death in March when he found himself in an unexpected limbo: He would have to wait up to six months for the state to issue the official certificate listing the cause of Anne Marie’s death.

That meant a delay in closure, and in his ability to collect benefits on her life insurance.

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“We’re stuck in the grieving process and this is one more thing in the process,” Morrison said.

Such delays have become increasingly common for families in Massachusetts, who must rely on the state medical examiner’s office, with its massive backlog of incomplete death certificates, to issue the crucial document needed to settle estates or process life insurance claims.

The number of unfinished death certificates soared to 947 last year from 58 in 2011, according to the Massachusetts Executive Office of Public Safety, which oversees the medical examiner’s office. Some families who lost loved ones in 2011 are still awaiting final death certificates.

“We understand that causes a severe hardship with estates and insurances,” said Curtis Wood, the Massachusetts undersecretary for forensic science for public safety. “It’s a process challenge and a volume challenge. They’re unacceptable to us, but they are what they are.”

Under state law, the medical examiner must conduct autopsies and determine the cause of death in cases of unattended deaths, as well as homicides, suicides, deaths in custody, and deaths of infants.

John Morrison, 58, of Haverhill, said he had to tap retirement funds to pay his wife’s funeral expenses

Aram Boghosian/Boston Globe

John Morrison, 58, of Haverhill, said he had to tap retirement funds to pay his wife’s funeral expenses

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Morrison’s 55-year-old wife, Anne Marie, died alone at their Haverhill home. A few weeks later, when he filed a claim on the $50,000 life insurance policy the couple had paid into since 1988, he learned the medical examiner had not determined a cause of death and probably wouldn’t for several months.

The insurer, meanwhile, would not pay the claim based on the death certificate that listed the cause as “pending.” Morrison had to cash in stock, set aside for retirement, to pay the funeral costs.

“This is a contract we had [that] would help with my family,” said Morrison, 58.

The backlog in processing death certificates appears to have multiple causes, starting with a shortage of pathologists. The medical examiner’s office has just 10 doctors to handle nearly 2,500 autopsy cases annually even though a 2007 study recommended at least 17 doctors.

In addition, a move by the medical examiner’s office to save $600,000 a year on toxicology testing by switching laboratories delayed some results for a long as four months.

Aside from conducting initial autopsies, the examiners also must gather medical and police reports on the cases, testify in criminal cases, and attend regular training sessions. The workload is so heavy that completing the paperwork for an autopsy report and death certificate gets delayed, Wood said.

The national medical examiners’ association recommends autopsy reports be completed within 90 days; in Massachusetts it often takes twice as long.

Such delays have left some families unable to pay funeral expenses, said David Walkinshaw, a spokesman for Massachusetts Funeral Directors Association. Funeral homes have agreed to wait for payment until the death certificate is finalized and insurance claims fulfilled, Walkinshaw said.

“It’s excruciating for those families,” he said.

Catherine Price, a physician at Emerson Hospital in Concord, said she used to tell families that it would take only a few weeks to get autopsy results and death certificates. But after her 52-year-old brother’s unexpected death in a group home in 2012, Price said she and her mother had to wait nearly five months for the death certificate. Fortunately, she was able to pay the $7,000 in funeral expenses, she said.

Now, she warns families, “it often times takes months and you won’t get insurance money until you have that death certificate,” Price said. “It was pretty eye-opening.”

John Morrison has not been able to collect the $50,000 life insurance policy he and his wife had paid into since 1988.

Aram Boghosian/Boston Globe

John Morrison has not been able to collect the $50,000 life insurance policy he and his wife had paid into since 1988.

In some cases, the medical examiner will offer a letter stating “no foul play” while the final death certificate is pending. But insurers are hesitant to pay claims without an official determination of the cause of death because of concerns about fraud,said Rick Fingerman, a Newton financial planner.

For example, if the deceased committed suicide within two years of purchasing a policy, the company will usually deny the claim. Insurers also want to make sure the death wasn’t suspicious and the beneficiary wasn’t responsible, he said.

“If something gets tied up in the medical examiner’s office, it throws a wrench into everything,” Fingerman said.

Some of the state’s largest life insurance companies, including MassMutual and John Hancock, said they haven’t seen an increase of pending death certificates from Massachusetts customers. The insurers said they work with families on a case-by-case basis to determine whether something other than a death certificate is acceptable.

The state’s Division of Insurance, which regulates the industry, may contact a company on a consumer’s behalf, a spokeswoman said, but a policy is a contract under which a completed death certificate is usually required.

Attorney General Martha Coakley’s office said it has received a handful of complaints in recent years about delayed death certificates. In a statement, Coakley said the medical examiner’s office needs more money, staff, and oversight.

“Families who are already suffering from the loss of a loved one should not be forced to endure long delays,” Coakley said.

Governor Deval Patrick proposed adding $2 million to the medical examiner’s $10 million budget for next year, and both the House and Senate have included similar amounts in their budget plans. That would help by adding more doctors, support staff who can tackle the paperwork backlog, and family liaisons to help relatives through the process and call insurance companies when necessary, state officials said.

State officials also are telling funeral homes to inform families that they should contact the medical examiner’s office immediately if they need the final death certificate for settle insurance claims and other financial issues.

“Families are taken back when it could be six months,” said Wood. “Unfortunately, that’s the way it is.”

Deirdre Fernandes
can be reached at Follow her on Twitter @fernandesglobe.

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