How to Contest the Reason for Death on a Certificate

A death certificate serves as legal proof that a person has died. Various entities, including governments, banks and insurance providers, use this document to issue or stop benefits and update family members of the decedent, or deceased person. While some errors on a death certificate are easy to fix, others, such as changing the cause of death, are a bit more complex.

In most states, only a medical professional, such as a physician, medical examiner or coroner, can change the cause of death and only if they have evidence contrary to their original pronouncement. In the wake of COVID-19, the Biden administration has loosened the requirements for amending the underlying causes of death so that families who lost a loved one at the beginning of the pandemic can be reimbursed for funeral expenses through the Federal Emergency Management Agency's (FEMA) $2 billion funeral services program.

Death certification wasn't a common practice in the United States until the early 1900s and it has evolved since then. In creating a death certificate, each state must comply with the requirements of the Centers for Disease Control and Prevention (CDC) U.S. Standard Death Certificate form. The form must include the following information about the decedent:

• Age, gender, ethnicity, Social Security number, place and date of birth, marital status, parents' names and level of education.
• Location and time of death.
• Method of disposition including funeral director contact information and burial or cremation verification.
• Cause of death certification: A medical certifier, such as a first responder, doctor or medical examiner who legally pronounces a person as dead, completes this portion of the certificate.

Those who lose a loved one will use a death certificate as proof of death required by various private and government entities. Anyone over 18 can get a certified copy of a death certificate, which is a public vital statistics record. Certificates will not always include the cause of death, as it is sometimes considered private information. In some states, however, the cause of death is public record for those who were over 50 when they died. Requirements to access a person's cause of death are different from state to state, but usually involve certain people, as long they can provide proof of who they are:

• Spouse.
• Parent.
• Sibling.
• Child or grandchild.
• Executor of a will or estate.
• Person acting on behalf of any of the above.

When filling out a death certificate, the certifier lists the decedent's immediate and underlying cause of death as well as the manner of death. The immediate cause of death is the condition that caused the person to die when and where they did and is the first condition listed. The underlying cause of death describes the circumstances or events leading up to someone's death and it is the last condition listed. These are sometimes the same; if there is more than one cause, the certifier lists them in reverse chronological order of the sequence of events.

The manner of death defines a person's proximate cause of death. There are several classifications, and only a medical examiner can use all of them. They are:

• Natural: Caused by disease or other natural processes, like old age, cardiac arrest or heart disease. If injury occurs as the result of a natural process, such as if someone who has cancer falls and hits their head, the medical examiner does not consider the death to be due to natural causes.

• Accidental: An unnatural death resulting from an unintended chance happening. Some examples of this can be traffic-related fatalities, overdoses in the absence of facts supporting the death as a homicide or suicide, or deaths that occur during or due to complications of medical, diagnostic, surgical or therapeutic procedures.

• Suicide: Defined by self-inflicted injury with proof of intent to die. This can include an explicit expression of death, like previous attempts to take one's own life, a suicide note or a verbal threat.

• Homicide: Defined by someone who directly causes the death of another person. This can be intentional, but does not need to be.

• Undetermined: This occurs when little information is available to the medical examiner regarding the circumstances of a person's demise or when the available information supports or conflicts with more than one manner of death.

• Pending: This is not a manner of death, but a medical examiner will use this temporary classification to describe someone's death when it is necessary to collect further information. When that information becomes available, the classification is changed.

The cause of death can vary among individual attending physicians, as they all have different medical opinions. By signing a death certificate, the certifier verifies in their medical opinion that the person died from one or more causes of death listed in the cause-of-death section of the death certificate. They base this belief on their training, experience and knowledge of medicine, as well as the decedent's medical history, symptoms, diagnostic tests and autopsy results.

Even with all this information available, determining the cause of death can pose a challenge to the certifier, who may indicate this on the certificate. There may be a challenge to the cause of the death at some point by the decedent's family, and who in the medical community can amend the cause of death will vary from state to state. Most states will allow changes only by the doctor or medical examiner who originally signed the death certificate.

If the healthcare professional who stated the original cause of death on the certificate has proof that the designation was incorrect, they can agree to change it, but only with sufficient medical evidence that contradicts the original decision. Those who change the cause of death must submit the necessary paperwork to their health department.

Most agencies require medical proof as well as the notarized signature of the medical professional who initially signed the death certificate. Each state has a different way of how the information on a death certificate can be changed. Most will waive their medical amendment fee if the change occurs within a year of the person's death, however, there is usually a small fee for copies.

When amending a cause of death in Florida, the certifying physician or medical examiner must fill out, sign, notarize and file a DH434A Affidavit of Amendment to Medical Certification of Death. This form includes the reasons for amending the cause of death. Afterward, the certifier will mail the certificate to the Florida Department of Health. Medical amendments in Florida do not have an amendment fee attached, but there is a $5 charge for certifying the amended record and $4 for each copy.

California has its own form VS 24 B, which it uses to change information on a death certificate, including the cause of death. To amend the certificate, a coroner or certifying physician must sign it. The state registrar then sends a copy to the local registrar and county recorder, who keeps a copy of the original record on file. There is no fee for the first year after the cause of death, but there is a fee for a certified copy of $21; after the one-year mark, the cost goes up to $23.

The applicant can get a certified copy of the amended record by supplying a sworn and notarized statement that they have the authorization to receive it. Applicants who are not authorized will receive a certified copy that states: "INFORMATIONAL, NOT A VALID DOCUMENT TO ESTABLISH IDENTITY."

Washington State allows changes to the cause of the death on a certificate from a medical certifier, who can be a physician, a physician's assistant (PAC), an osteopath, a health officer, an advanced registered nurse practitioner (ARNP), a medical examiner, a coroner, a prosecuting attorney or a chiropractor. The certifier in question must be the person who signed off on the original certificate. If they have not been available to do so in over a month, another medical certifier can certify the changes if they are from the same office as the original signer.

In rare instances, a medical examiner or coroner can also change the cause of death in the county where it occurred. However, this happens only in the case of an investigation by either one. Those who disagree with the cause of death listed on the certificate can contact the medical certifier or their office.

The COVID-19 pandemic has emphasized the importance of amending the cause of the death and how complex the process can be. Recently, over 200,000 people have sought help from FEMA, which announced its $2 billion funeral assistance program, with up to $9,000 reimbursement per family for pandemic-related funeral expenses. However, eligibility was limited to families with certificates stating that their loved one's death "may have been caused by" or "was likely a result of" COVID-19 or its symptoms. As a result, this excluded thousands who died earlier in the pandemic, as there was limited testing at that time, and doctors were unsure how to diagnose the coronavirus.

FEMA responded by telling families that they must have the decedent's death certificate amended to reflect a COVID-19 diagnosis to get the payout. As physicians and medical examiners demanded conclusive proof before they will change the cause of death, there was pushback. As a result of that hesitancy, families of those who died from COVID-19, but couldn't prove it, could not get financial help from FEMA.

On July 6, 2021, the Biden administration announced it was loosening the rules regarding cause of death statement changes so that families could qualify for funeral aid. FEMA subsequently changed its policy regarding deaths that occurred in the early months of the pandemic. It now offers funeral cost reimbursement to families whose loved ones died between January 20, 2020 and May 16, 2020 as long as they submit a statement or letter from the certifier linking the chain of events of that person's death to COVID-19. This change allows families to attribute their loved one's death to COVID-19 without directly amending the cause of death on the death certificate.

This decision covers the dates before the Centers for Disease Control and Prevention published its guidance on death certificates. Deaths after May 16, 2020, however, must still show a direct link to the COVID-19 virus. Families participating in the program can expect reimbursements for funeral costs, which can include a burial plot with a marker or headstone, a casket, cremation, an urn, and transportation for family members when identifying the deceased.