Skip to content
Sponsored Content

The Law and You: What is a Coroner's Inquest?

Adam Little, Partner at Oatley Vigmond Personal Injury Law Firm, explains what a Coroner’s Inquest is, as well as why and when they are held in Ontario

You may have heard media reports from time to time about Coroner’s Inquests.  Recently, a Coroner’s Inquest into the death of Sammy Yatim during an interaction with police concluded with 63 recommendations calling for changes in areas such as officer training and monitoring, as well as mental health supports.   

But what is a Coroner’s Inquest, and why are they held? 

A Coroner’s Inquest is an open hearing conducted by a Coroner to inform the public about the circumstances of a person’s death.  The hearing is conducted before a 5-member jury selected from the local community.  The jury is tasked with reaching a decision related to the deceased person’s cause of death, and may make recommendations to prevent future deaths, but they are not required to do so.  Any recommendations made by the jury are non-binding. 

A Coroner’s Inquest is not an adversarial process, nor is it a trial to determine fault or liability for a person’s death.  In fact, Coroner’s Inquest juries are prohibited from making any finding of legal responsibility in any circumstances. 


At present, Coroner’s Inquests are mandatory where the death occurs: 

  • On the job at a construction site or mine/quarry; 

  • While a person is in custody or being detained; 

  • When the use of force of a police officer is at issue; 

  • To a child as the result of a criminal act of a person with custody of the child; or 

  • While a person is physically restrained and detained in a psychiatric facility, hospital, or secure treatment program. 

An inquest can also be held in other circumstances, at the discretion of the Coroner, or on request of a family member. 

It is often said that a Coroner “speaks for the dead to protect the living.”  Ultimately, this is the purpose of a Coroner’s Inquest – to help protect the public from future avoidable fatalities. 

Oatley Vigmond is Ontario’s Personal Injury Law Firm.  If you or someone you know has suffered a fatal injury as a result of potential negligence, we may be able to help.