On 17 April 2026, Coroner Ingrid Giles published a costs ruling following the inquest into the death of Simon Christopher Gaskill. The Coroner made a costs order against the Chief Commissioner of Police and ordered that they pay the legal costs for Amanda Gaskill (the sister of the deceased) for participating in the inquest.
This ruling is significant and unusual in in the coronial jurisdiction but confirms that costs can and will be awarded against public authorities. More significantly the ruling (though not binding) broadens what amounts to “unreasonable conduct” and emphasises systemic accountability for investigative failures.
Although this ruling concerns the conduct of Victoria Police, it has broader implications for any public authority involved in a reportable death investigation and/or inquest, including Corrections Victoria. Whist the status quo in this jurisdiction has been that parties bear their own costs; this ruling shows the Coroners’ Court is willing to impose cost consequences for what it perceives to be systemic investigative failures. Whilst this is only the decision of one coroner, this will likely have consequences in other inquests and will likely lead to more applications by family members for costs orders in light of the success in Gaskill.
Background
On 15 April 2022, Mr Gaskill’s body was found on the foreshore sand dunes at Ocean Grove Beach. He was 50 years old at the time of his death and had suffered a mental and physical health decline in the years before his death, including issues with alcohol and drugs, and was sleeping rough.
The Coroner exercised her discretion and determined to hold an inquest into Mr Gaskill’s death. The scope of the inquest was to examine: the adequacy of the police investigation, cause and circumstances of Mr Gaskill’s death, and medical care and systemic issues (including alcohol dependence and access to services).
The inquest arose against a background of purported deficiencies in the initial police investigation, including failures to: seize and analyse key evidence (e.g. laptop, records), establish a timeline of events, to identify police as among the last to see the deceased alive, recognise and preserve the deceased’s mobile phone (which was later destroyed), and delayed notification to the family.
Costs
Mr Gaskill’s sister sought an order under section 74(2) of the Coroners Act 2008 (Vic) that the Chief Commissioner of Police pay her legal costs for participating in the inquest. The application was contested by the Chief Commissioner.
The ground relied upon for seeking an order for costs, was that the conduct of the Chief Commissioner during the investigation into Mr Gaskill’s death was such as to justify an award of costs because ‘the inquest has only been necessary because of the ‘complete failure’ of Victoria Police to adequately and properly investigate the death for the first two years after the discovery of his body.
The Chief Commissioner, in opposing the application for costs, submitted that: ‘the default position under s 74(1) – that each party bears their own costs – is not a position to departed from whenever unreasonableness can be identified at some point in the history of an investigation. It requires the Court to be satisfied that the statutory conditions are met and that, in the exercise of its discretion, a costs order is warranted’. Further, the Chief Commissioner also submitted that coronial investigators are Victoria Police members conducting investigations at the behest of the Coroners Court and therefore ‘it would be incongruous in that context, in this case, to treat the Chief Commissioner as a kind of party akin to an adversarial party against whom costs should be ordered’.
There are two limbs to the test to determine whether a costs order could be made:
- unreasonable conduct; and
- causal link to costs.
The Coroner was satisfied that both limbs of section 74(2) were made out.
In relation to the first limb, the Coroner determined that whilst there was no unreasonable conduct during the inquest itself, there had been significant and systemic investigative failures over a prolonged period amounted to unreasonable conduct by the police. The failures were serious, pervasive, and inconsistent with established police procedures.
Importantly, the Coroner rejected the argument that police act merely as neutral assistants to the Coroner; the Chief Commissioner can be held responsible for failures of police investigators in coronial investigations. This undermines the role of the coronial investigator, which is at law, to assist the Court and to act at the direction of the Coroner.
The Coroner accepted that systemic and cumulative investigative failures (rather than bad faith) can amount to “unreasonable conduct”. In accepting that submission, the Coroner considered the relevant factors included the police failing to secure or preserve evidence, to identify key facts and the delay and inaction over a prolonged period. This appears to have expanded the concept of “unreasonable conduct” determining that it was not limited to acting in bad faith or misleading conduct but could include systemic failures, omissions over time and department from internal procedures.
For future matters for CV this could include: inadequate incident reporting or record‑keeping; failure to preserve CCTV; delays in internal reviews (eg JARO) or referrals to the coroner; or non-compliance with Corrections Victoria operating procedures and policies.
In relation to the second limb, Ms Gaskill identified deficiencies in the police investigation, provided key evidence that police should have gathered, and effectively prompted the reinvestigation into her brother’s death. The Coroner determined that it was reasonable for her to retain counsel given she was a witness and the inquest directly examined issues she had raised.
The Coroner found that, “But for” the investigative failures, her legal involvement would not have been required. Examples of the causal link included Ms Gaskill filling investigative gaps, advocating for a proper investigation and participating extensively at inquest. These are not unusual motivators for senior next of kin, as the family often are the ones advocating for action in this jurisdiction especially where there is a direction for the coroner to proceed to inquest.
Implications for future inquests
The ruling confirms that section 74(2) costs orders will be applied in practice where a public authority acts “unreasonably”, and that conduct causes a party (typically the family) to incur costs. The Court emphasised that a departure from the default “each party bears their own costs” rule can be justified where failures are serious and causative. This confirms that public authorities (especially Victoria Police) can face actual cost liability where investigations are materially deficient though there needs to be something ‘highly unusual’ to necessitate departure from the default.
This ruling raises legal, reputational and financial risks for public authorities. The most significant risk is the financial risk given the duration of mandatory inquests. This ruling is likely to be relied on in other coronial costs disputes.
For further information
Please get in contact with Sarah Manly or Emma Fitzgibbon
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