Crossings should not be placed near winning posts on racetracks, the coroner investigating the death of jockey Simone Montgomerie has found.
Montgomerie suffered fatal chest injuries when she fell from Riahgrand at the Darwin Cup meeting on August 5 last year.
Coroner Greg Cavanagh said he was satisfied Riahgrand had reacted to the change in texture and colour on the track due to the crossing.
He recommended the Australian Racing Board "articulates and implements a written Protocol for the assistance of Principal Racing Authorities (PRAs) in each State and Territory, advising against crossings being positioned in the final stages of a race".
Cavanagh said he was satisfied Montgomerie fell because Riahgrand "had an extreme and unusual reaction to the pedestrian crossing that was at that time positioned around 200-metres before the finishing line".
"The horse baulked or shied to the left and then appeared to try and stop before lurching forward again, and not even the most gifted of riders, as Ms Montgomerie was, could stay seated," the report said.
Montgomerie, who was the premier rider in Darwin, fell when Riahgrand veered sharply to the left when he was leading the field and in a winning position.
He then kept galloping and tried to jump the next crossing after the winning post.
Despite swift attention, efforts to resuscitate Montgomerie failed.
Cavanagh commended the Darwin Turf Club for taking action to move the crossings with the one where the fall happened now located 70 metres past the post.
"Although I cannot completely discount the possibility that another variable was responsible for the baulking and stopping action of the horse, ultimately I am comfortably satisfied on the balance of probabilities that it was the crossing," Cavanagh said.
Montgomerie was an experienced rider from a respected racing family and Cavanagh acknowledged the devastating effect her death had had on the community.
