When someone dies unexpectedly (primarily outside of the hospital or hospice), the police notify the medical examiner. The medical examiner has certain guidelines they have to go by in terms of deciding if that person is going to be released via a release number that is given to the funeral home, or if they are going to be transported to the ME’s office for autopsy. Sometimes the ME is required to actually attend the scene to make that call. Where I live, there are certain guidelines that help the ME make these determinations. For instance, let’s say a 70 year old man dies at home. If he had not been under the care of a doctor within the past year, he is automatically going in for autopsy regardless of any other circumstances. The ME here has a database which allows them to see all prescriptions that are prescribed to the decedent and all relevant doctor information. If the ME decides to release directly to the funeral home via a release number, the police notify the NOK of the passing and they decide what funeral home their loved one is to go to. In the instance that the NOK isn’t readily identified or able to be located/contacted, where I live the decedent is automatically transported to the ME for holding until the NOK is contacted to determine which funeral home the decedent is to be released to. In some locations, the police have a list of funeral homes they have contracts with and essentially go down the list and reach out to whatever funeral home is next up and they take custody until the NOK is located/contacted and decides if they’re staying with them or going to another funeral home. Most states have some type of kinship laws in place that determine who is considered NOK. For instance, where I live it goes spouse, adult children, parents, siblings, extended family, etc etc and ends with “most responsible party” if no one else is deemed to be actual NOK. What a lot of people don’t know is that even if a will and testament is done giving “rights” to a specific person outside of the kinship law lineage, unless it has specific after death verbiage, it’s not valid for that purpose. It very well mag be suitable for whatever is contained in the will in terms of property, etc, but I’ve oftentimes had to tell these people “sorry, we can’t use this”. In fact, it appears not many attorneys that handle wills are versed in the after death verbiage portion required. In some states, people are able to sign what is called a “self cremation authorization”. While this is sufficient, the NOK still has to sign the contract, make payment (even if prearrangements have been made, the preneed has to be converted to an at need contract and must be signed), handle death certificate information, and ultimately still sign off on the at need cremation authorization and other related paperwork. Cremation requires much more paperwork than a burial because a burial can be “reversed” while cremation is a permanent, non reversible form of disposition. So, regardless of if someone leaves a note saying they don’t want whoever to be contacted, if that person is legal NOK, they will be contacted even if the decedent has a will and a self cremation authorization. If the NOK doesn’t want to proceed with paperwork for the decedent, they can choose to abandon that person at which point it becomes a “90 day case” or whatever length of time that state requires. After that period passes, the funeral home can apply for a permit and proceed with disposition without authorizing signatures. If a person is considered indigent, most of the time the medical examiner for that area will have a program where they contract with a local funeral home to do a free cremation and mass placement.

Source: I am a funeral director and embalmer and I deal with this exact scenario more often than I would like to.