Unum Denied Your Accidental Death Claim? Here’s What the Appeal Has to Prove.
Dorian Law represents families challenging Unum, First Unum, and Colonial Life accidental death denials nationwide. We start with the exact policy language Unum relied on and build the appeal around the evidence a federal judge would need to see.
Unum denied the claim: what to do next
Find the appeal deadline in the denial letter, request the complete claim file and the policy, and identify every provision Unum cited. For employer-provided coverage governed by ERISA, you have at least 60 days to file the administrative appeal, and the policy usually sets a separate deadline to sue. Unum often relies on more than one ground, such as an exclusion and the policy’s definition of an accident, and the appeal has to answer each one.
You may be reading the letter while grieving. You don’t need every record before calling. Send us the denial letter and the date it arrived, and we will tell you what the appeal needs.
What reason did Unum give?
Each denial ground turns on different policy words and different evidence. Pick the one in your letter to see the language Unum has used, what courts have done with it, and what the appeal should contain.
Select a reason to see the analysis.
The crime exclusion
Language Unum has usedExcludes accidental losses “caused by, contributed to by, or resulting from . . . an attempt to commit or commission of a crime.” The Fulkerson policy did not define “crime,” and both courts looked to dictionary meaning and state law to decide what the word covers.
What courts have doneCourts have upheld Unum where the driving was extreme: about 80 mph in a 35 mph zone while passing on a double yellow line (Boyer, 8th Cir. 2021), and 80 to 100 mph in a 60 mph zone (Fulkerson, 6th Cir. 2022). Boyer distinguished “a de minimis non-criminal ‘infraction,’” and Fulkerson expressly did not decide whether speeding alone is a crime. In Lohse (E.D. Tex. 2023), Unum failed to prove reckless driving and the family recovered.
What the appeal should containThe reconstruction and witness evidence on speed and conduct, how state law classifies the specific offense, and Unum’s own claims-manual guidance. In Boyer, the manual said the exclusion “was not intended to apply to activities which would generally be classified as traffic violations.”
The intoxication exclusion
Language Unum has usedLosses “caused by, contributed to by, or result[ed] from . . . being intoxicated,” as Unum’s denial letter quoted it in Williams. The exclusion’s definition of intoxication, and any threshold it sets, matters.
What courts have doneIn Williams v. Unum (8th Cir. 2021), the insured fell down stairs with a blood-alcohol level of 0.337. The court upheld the denial under deferential review, reading “contributed to” to mean “help[ing] [to] bring about,” so intoxication did not have to be the only cause.
What the appeal should containThe testing method and timing, whether the sample reflects the level at the time of the event, the exclusion’s exact threshold, and medical or reconstruction evidence on whether the substance actually played a role in the loss.
The illness or disease defense
Language Unum has used“Accidental bodily injury” as “bodily harm caused solely by accidental means and not contributed to by any other cause” (Boyer), and, in other policies, “a bodily injury that is the direct result of an accident and not related to any other cause,” with an exclusion for losses “caused by, contributed to by, or resulting from . . . disease of the body” (Lohse).
What courts have doneIn Lohse v. Unum (E.D. Tex. 2023), the insured had narcolepsy and died of head trauma in a crash. The court held the disease exclusion reaches only proximate causes: narcolepsy “may have been the cause of the crash” but “was not the cause of Mr. Lohse’s death.” It was “merely a cause of a cause.” The family was awarded the benefit.
What the appeal should containThe autopsy, a medical chronology, and a causation opinion that addresses what actually caused the death, not just what was present in the medical history.
Medication, medical treatment, and later complications
The issueUnum may argue that a prescription drug, a surgery, or a complication such as a pulmonary embolism after a fall broke the chain between the accident and the death. Many policies exclude medical or surgical treatment but carve out drugs taken as prescribed or treatment of the accidental injury itself.
What to look forRead the treatment exclusion and any exceptions together. A complication caused by treating the accidental injury is a different question from an unrelated illness.
What the appeal should containThe full chronology from injury through treatment to death, the prescribing records and dosage, and a qualified medical opinion tying the complication to the original injury. Brent Dorian Brehm has handled AD&D claims involving pulmonary embolisms after a fall or injury.
“Self-inflicted” or “not an accident”
Language Unum has usedUnum “will not pay if the loss is caused by . . . intentionally self-inflicted injuries.”
What courts have doneIn Critchlow v. First UNUM Life Insurance Co. of America, 378 F.3d 246 (2d Cir. 2004), the insured died of autoerotic asphyxiation. Reviewing de novo because the policy gave Unum no discretion, the Second Circuit held the death was accidental, found the self-inflicted-injury exclusion ambiguous as applied, construed it against Unum, and directed judgment for the beneficiary.
What the appeal should containEvidence of what the insured expected to happen, the circumstances and investigation, and a close reading of whether the exclusion’s words actually reach the conduct.
The quoted language comes from Unum policies described in the cited opinions. Your policy may use different words, so compare it line by line.
How we build the appeal: a crime-exclusion example
Our Litigation Back Approach starts with what a federal judge would need to see to rule for the family, then builds the administrative appeal to contain it. Courts usually decide ERISA cases on the record the insurer had, so evidence that isn’t in the appeal may never be considered. For a crime-exclusion denial, that means:
Pin down the conduct Unum actually relied on
Speeding, reckless driving, and an attempted felony are different allegations. We compare the denial letter with the police report, witness statements, and any reconstruction.
Classify it under the state’s law
Boyer turned partly on Missouri treating speeding and improper passing as jailable misdemeanors. Another state’s law, or a lesser offense, may not support the same result.
Get Unum’s own guidance into the record
We request the claims-manual provisions on the crime exclusion. In Boyer, that manual said the exclusion was not intended to cover ordinary traffic violations, and in Caldwell a dissenting judge relied on the same point.
Prove or contest the causal link
The exclusion requires that the loss be caused by, contributed to by, or result from the crime. Road conditions, mechanical failure, or another driver may matter.
Settle the standard of review early
Whether Unum has discretion, and whether a state law bars that discretion, decides how much deference a court gives Unum’s reading. We address it before the appeal closes, not after.
For denials where the death certificate says “accident” but the insurer still says no, see The Death Certificate Says “Accident.” Why Was the AD&D Claim Denied?
Appeal and lawsuit deadlines
Appeal: for an ERISA-governed plan, at least 60 days after you receive the denial, under 29 C.F.R. § 2560.503-1(h)(2)(i). The same regulation entitles you to the documents relevant to your claim, free of charge, on request. Check the letter; the plan may allow longer.
Lawsuit: the policy usually sets its own deadline, and it may start running before the appeal is decided. The Supreme Court enforced that kind of provision in Heimeshoff v. Hartford Life & Accident Insurance Co., 571 U.S. 99 (2013). Calculate both dates as soon as the denial arrives.
Will a court defer to Unum?
Only if the plan validly gives Unum discretion. Without it, the court decides the claim de novo, as the Second Circuit did in Critchlow. Some states restrict discretionary clauses, but not every restriction reaches AD&D coverage: in Williams, the Eighth Circuit held Maine’s ban on discretionary clauses in “health plans” did not apply to a Unum AD&D policy that paid cash benefits. Even under deferential review, Unum’s role as both insurer and decision-maker is a factor the court weighs (Metropolitan Life Insurance Co. v. Glenn, 554 U.S. 105 (2008)).
Is it an ERISA plan at all?
Coverage through a private employer is usually governed by ERISA. Voluntary worksite policies, common with Colonial Life, may fall outside ERISA under the Department of Labor’s safe harbor, which requires no employer contributions, completely voluntary participation, limited employer involvement without endorsement, and no employer compensation beyond administrative costs (29 C.F.R. § 2510.3-1(j)). If ERISA does not apply, state insurance law, including bad-faith remedies, may.
Unum accidental death decisions, with outcomes
Unum wins some of these cases and loses others. The outcomes usually track the exact policy words, the evidence in the record, and the standard of review. Dorian Law was not counsel in these cases.
Boyer v. Schneider Electric Holdings, Inc., 993 F.3d 578 (8th Cir. 2021)Unum prevailed
Crime exclusion applied to a crash at about 80 mph in a 35 mph zone while passing in a no-passing zone. Deferential review. The district court had ruled for the beneficiary; the Eighth Circuit reversed.
Fulkerson v. Unum Life Insurance Co. of America, 36 F.4th 678 (6th Cir. 2022)Unum prevailed
Reckless driving at 80 to 100 mph is a “crime” under the plain meaning of the exclusion. De novo review, by the parties’ agreement. The court did not decide whether speeding alone would be enough. $100,000 AD&D benefit at issue.
Caldwell v. Unum Life Insurance Co. of America (10th Cir. 2019) (unpublished)Unum prevailed
Crime exclusion applied to driving 74 mph on an unpaved Wyoming road; the posted limit was disputed, and the driver was speeding under either. A dissent relied on Unum’s internal manual, which did not treat traffic violations other than DUI as crimes; the majority called reliance on a manual never shown to insureds problematic.
Williams v. Unum Life Insurance Co. of America, 11 F.4th 641 (8th Cir. 2021)Unum prevailed
Intoxication exclusion applied to a fatal fall with a 0.337 blood-alcohol level. Maine’s discretionary-clause ban did not reach the AD&D policy, so deferential review applied.
Critchlow v. First UNUM Life Insurance Co. of America, 378 F.3d 246 (2d Cir. 2004)Beneficiary prevailed
De novo review. The death was accidental, and the self-inflicted-injury exclusion was ambiguous as applied and construed against Unum. Judgment directed for the beneficiary.
Lohse v. Unum Life Insurance Co. of America, No. 5:21-cv-00143-RWS-JBB (E.D. Tex. Sept. 25, 2023)Beneficiary prevailed
De novo review, by agreement. Narcolepsy that may have caused the crash was “too remote” to trigger the disease exclusion because head trauma caused the death, and Unum did not prove reckless driving. AD&D benefits awarded.
Which Unum company denied the claim?
Use the exact company name on the policy and the denial letter. It identifies who decides the appeal and, for some policies, which state’s rules apply.
Unum Life Insurance Company of America
Portland, Maine. The insurer on most employer-provided Unum group AD&D coverage, and the defendant in most of the decisions above.
First Unum Life Insurance Company
New York, New York. Unum’s New York company; the insurer in Critchlow (captioned there as First Unum Life Insurance Company of America).
Colonial Life & Accident Insurance Company
A Unum Group subsidiary since the 1990s that sells voluntary coverage at the workplace. A separate company from Unum Life, with its own policies.
Sources: Unum’s list of insuring subsidiaries (Unum Life and First Unum); Colonial Life company history.
What the market data shows
A loss ratio is incurred claims plus the change in contract reserves, divided by earned premiums. Lower means a smaller share of premium went to claims. It is not a denial rate and does not explain any individual decision. Source: NAIC, 2024 Accident and Health Policy Experience Report, Individual and Group Market Share by Line of Business, accident only or AD&D.
Why families bring Unum AD&D denials to Dorian Law
- This is the whole practice. Life, disability, and accidental death insurance denials and ERISA benefit disputes are all Dorian Law does. Brent Dorian Brehm has represented claimants since 2006 and has resolved more than 500 benefit disputes.
- The denial grounds Unum uses are the ones we handle. Brent’s accidental death work includes injury-versus-illness disputes, intoxication and drug exclusions, pulmonary embolisms after a fall or injury, felony exclusions, dangerous activities, and drownings.
- A consistent AD&D record. Every accidental death matter Brent has resolved has produced a recovery, through a successful appeal or a settlement. Those matters involved several insurers. Past results don’t guarantee a recovery in another case.
- We take cases to federal court. In Cobb v. Chevron (N.D. Cal. 2025), a disability case, we won de novo review by showing the plan never properly delegated discretion to its claims administrator.
An intoxication exclusion argued in the Ninth Circuit
Brent argued an AD&D appeal in the U.S. Court of Appeals for the Ninth Circuit over an exclusion for “acute alcoholic intoxication.” The case settled after oral argument. That experience shapes how we read an exclusion and build the medical record from the first appeal.
“Dorian Law represented me in a professional manner and resolved my case with a favorable outcome in a very reasonable time period. Brent Dorian took and won my case after several other attorneys had declined to take me on as a client. Thanks Brent!”
This review concerns an AD&D claim Dorian Law got paid without a lawsuit. The insurer was not Unum. A testimonial is not a guarantee or prediction of the outcome of another matter. See the firm’s Google profile.
What happens in a consultation
Send the denial letter, the date you received it, and the policy or certificate if you have it. We discuss the reason Unum gave, the documents available, and the deadlines, and tell you whether we can help. Consultations are free. Accepted AD&D matters are handled on a contingency fee under a written agreement.
Unum accidental death denial questions
Dorian Law P.C., a California-based firm, represents beneficiaries in denied Unum, First Unum, and Colonial Life accidental death claims nationwide, in ERISA appeals and federal lawsuits. Founding shareholder Brent Dorian Brehm has represented claimants since 2006, has argued an AD&D intoxication-exclusion appeal in the Ninth Circuit, and builds appeals using the firm’s Litigation Back Approach. Free consultations: dorianlaw.com/contact or (747) 297-7409.
Find the appeal deadline in the denial letter, request the complete claim file and the policy, and list every provision Unum cited. For ERISA plans the appeal period is at least 60 days from receipt of the denial under 29 C.F.R. § 2560.503-1(h)(2)(i), and the policy usually sets a separate deadline to sue.
Unum has applied its crime exclusion to extreme driving, and courts upheld it in Boyer v. Schneider Electric (8th Cir. 2021) at about 80 mph in a 35 mph zone and in Fulkerson v. Unum (6th Cir. 2022) for reckless driving at 80 to 100 mph. Boyer distinguished de minimis speeding, and Fulkerson did not decide whether speeding alone is a crime. In Boyer, Unum’s own claims manual said the exclusion was not intended for ordinary traffic violations.
Not under exclusions worded “caused by, contributed to by, or resulting from.” In Williams v. Unum (8th Cir. 2021), the court read “contributed to” to mean helping to bring about the loss and upheld the denial of a fall with a 0.337 blood-alcohol level. The exact exclusion wording, the testing, and evidence of what actually caused the loss still decide each case.
Not necessarily. In Lohse v. Unum (E.D. Tex. 2023), the insured’s narcolepsy may have caused the crash, but head trauma caused the death, and the court held the disease exclusion reaches only proximate causes. The narcolepsy was “merely a cause of a cause,” and the family was awarded AD&D benefits. A causation opinion grounded in the autopsy and medical chronology is usually the key evidence.
A death certificate’s “accident” designation does not decide coverage. Unum can still rely on a policy exclusion, such as crime, intoxication, or disease, or on its definition of accidental bodily injury. The Williams v. Unum death certificate listed the manner of death as accident, and the court still upheld the intoxication exclusion. The appeal has to answer the specific provision Unum cited.
For an ERISA-governed plan, at least 60 days after you receive the denial to file the administrative appeal; check the letter, since the plan may allow longer. The policy usually sets a separate deadline to sue, which may start before the appeal is decided. The Supreme Court enforced such a provision in Heimeshoff v. Hartford (2013).
They are separate insurance companies within Unum Group. First Unum Life Insurance Company is Unum’s New York company. Colonial Life & Accident Insurance Company, a Unum Group subsidiary, sells voluntary workplace coverage, which may or may not be governed by ERISA. Follow the appeal instructions for the company named on your letter.
Only if the plan validly gives Unum discretion. Without it, the court decides de novo, as the Second Circuit did in Critchlow v. First UNUM (2004), ruling for the beneficiary. Some state bans on discretionary clauses do not reach AD&D coverage: in Williams v. Unum (8th Cir. 2021), Maine’s ban on discretion in health plans did not apply to a Unum AD&D policy.
The denial letter, the date you received it, and the policy or certificate if you have it. We identify the provision Unum relied on, the evidence that addresses it, and the appeal and lawsuit deadlines, and tell you whether we can help. Accepted AD&D matters are handled on a contingency fee under a written agreement.
Related: Accidental death insurance overview · Unum long-term disability denials
Send us the denial letter before you write the appeal
We will identify the provision Unum relied on, what evidence answers it, and both deadlines. Contingency fee representation under a written agreement.
This page is general information, not legal advice, and reading it does not create an attorney-client relationship. Outcomes depend on the policy language, the evidence, the standard of review, and the governing law. Case descriptions reflect the linked opinions as of October 2026 and do not report later history. Statements about past results do not guarantee a similar outcome.