FACTS TO KNOW ABOUT CORONER'S INQUEST

A coroner’s inquest is a formal judicial investigation conducted by a coroner to determine the cause and circumstances of a person's death, especially if the death was sudden, unexplained, violent, or occurred under suspicious circumstances.

Key Points About a Coroner’s Inquest:

Purpose:

To establish who the deceased was, when and where they died, and how the death occurred.

Not a trial:

It's a fact-finding exercise, not to assign blame or guilt, but to determine the facts surrounding the death.

May involve a jury:

In some jurisdictions, a jury may be called, especially for deaths in custody, public interest cases, or where required by law.

Evidence is presented:

Witnesses may be called to testify, and medical reports, police reports, and other relevant evidence may be reviewed.

Possible verdicts (now called findings or determinations):

Natural causes

Accident or misadventure

Suicide

Unlawful killing (e.g., murder or manslaughter)

Open verdict (when the cause cannot be determined)

When is a Coroner’s Inquest Held?

It is usually held when:

The cause of death is not clear.

The death occurred in police or prison custody.

The death was due to an industrial accident or medical procedure.

There’s public interest or suspicion surrounding the death.

CORONER’S INQUEST REPORT SAMPLE 

IN THE CORONER’S COURT OF LAGOS STATE

Holden at: Ikeja Magistrate Court

Coroner: Magistrate M. A. Adebayo

Date: 10th May, 2025

Case Reference Number: C/INQ/092/2025

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DECEASED DETAILS

Name: Mr. Samuel Abiodun

Age: 38 years

Sex: Male

Occupation: Commercial Driver

Address: 15, Olowu Street, Mushin, Lagos

Date of Death: 2nd March, 2025

Place of Death: Cell No. 4, Area C Police Command, Surulere, Lagos

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BACKGROUND

This inquest was initiated following a report made to the Coroner’s Office regarding the sudden and unexplained death of Mr. Samuel Abiodun while in police custody.

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EVIDENCE PRESENTED

1. Autopsy Report – Presented by Dr. Sola Owolabi (Pathologist, LASUTH):

Cause of death: Blunt force trauma to the head, consistent with repeated impact.

2. Police Statement – Officer Musa Ibrahim (Arresting Officer):

Claims the deceased was arrested for suspected robbery and had already sustained injuries prior to arrest.

3. Eyewitness Testimony – Mr. Bamidele Ajayi (cellmate):

Confirms deceased was beaten by officers in the cell before he became unconscious.

4. Family Testimony – Mrs. Ronke Abiodun (wife):

Claims her husband was healthy and without injuries prior to arrest.

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FINDINGS OF THE CORONER

After reviewing all submitted evidence, including medical findings and witness testimonies, the Coroner finds as follows:

The deceased, Mr. Samuel Abiodun, died from injuries sustained while in custody.

The injuries were not self-inflicted and occurred while he was under the care and control of the Nigeria Police Force.

There is prima facie evidence of unlawful killing.

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VERDICT

Death caused by unlawful killing while in police custody.

This matter is hereby referred to the Director of Public Prosecutions (DPP) for further criminal investigation and possible prosecution.

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SIGNED

Magistrate M. A. Adebayo

Coroner, Ikeja District

Date: 10/05/2025

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⚖️ Notes:

This sample is fictional but mirrors the style and content of actual coroner’s inquest reports in Lagos and other states.

In some states, coroners may be magistrates, and in others, dedicated coroners are appointed.

Verdicts like “unlawful killing” may trigger further police or judicial action.