Background <p>For the second postmortem examination reporting obligations arise from the postmortem examination laws of the federal states, particularly in cases where there are doubts about the natural manner of death or suspicion that the death was caused by violence or a&#xa0;criminal act.</p> Aim of the study <p>The consequences of reporting to the criminal investigation department after the second postmortem examination were investigated.</p> Material and methods <p>All cases reported to the police in the catchment area of the Institute of Legal Medicine in Frankfurt am Main between 2021 and 2023 following a&#xa0;second postmortem examination were investigated. If a&#xa0;judicial autopsy was performed, the autopsy report and the results of subsequent investigations were also evaluated.</p> Results <p>A&#xa0;total of 972 cases were reported to the criminal investigation department, 75% of which were due to external abnormalities on the body and 25% to abnormalities in the content of the death certificate. In 15% of the reported cases a&#xa0;judicial autopsy was performed. After the autopsy the manner of death changed in 48% of cases which were specified as natural on the death certificate.</p> Discussion <p>In everyday clinical practice, the transfer of clinical findings to the cause of death, in particular the differentiation between natural and unnatural causes of death, appears to be inadequate, especially in cases involving a&#xa0;previous accident. The quality of the postmortem examination should be improved and dialogue between forensic medicine and the investigating authorities would also be desirable, as an autopsy was performed to clarify the cause and manner of death in only a&#xa0;minority of cases.</p>