Unum Accident Insurance Coverage: Benefits, Exclusions, and Claims

Unum accident insurance coverage pays you a lump sum of cash when a covered accident causes a specific injury or requires certain medical treatment. The money is paid directly to you, not to a hospital or doctor, and you can spend it on anything: the deductible on your health plan, groceries, rent, or the co-pays stacking up on the kitchen counter. It is a supplemental policy, sold through employers, and it is not a replacement for major medical insurance.¹

Because each employer picks the plan design and the optional benefits, the exact dollar amounts and add-ons in your certificate will differ from someone else’s at a different company.² The structure, though, is consistent, and the categories below hold across plans.

Injuries That Trigger a Payment

Unum accident plans pay set amounts for a defined list of injuries. Each has to be diagnosed by a physician within a specific window after the accident, usually somewhere between 90 and 365 days depending on the injury.³ The covered injuries typically include:

Fractures anywhere in the body. Chip fractures pay 25% of the full benefit, and stress fractures are not covered.⁴
Dislocations of joints such as the shoulder, hip, knee, ankle, elbow, and fingers. Incomplete dislocations typically pay 25% of the listed amount.⁴
Second- and third-degree burns, with amounts that scale to the percentage of body surface involved.³
Lacerations, with higher payments for longer cuts that require repair.⁴
Concussions diagnosed by a physician.³
Torn, ruptured, or severed tendons, ligaments, rotator cuffs, or muscles.³
Knee cartilage tears, with separate benefit levels for surgical repair and exploratory procedures.⁵
Internal injuries including collapsed or punctured lungs, ruptured spleen, kidney, or liver, and ruptured eardrums.³
Ruptured or herniated discs, with higher payments when surgery is required.³
Eye injuries that require removal of a foreign object.³
Permanent, total loss of a finger, thumb, or toe.³

Treatments and Services That Pay on Top

The injury payment is only part of what you can collect. Unum pays separate amounts for the treatments and services the injury requires, and those stack. A single accident can trigger multiple payouts.

Emergency Room, Ambulance, and Hospital Stays

Emergency department visits, ground and air ambulance transport, hospital admission, daily hospital stays, and ICU confinement each carry their own benefit. In one real employer plan, those amounts are $300 for an ER visit, $500 for a ground ambulance ride, $1,500 for air ambulance, $2,000 for hospital admission, and $400 per day in the hospital or ICU.⁴ Hospital daily stays can run up to 365 days per accident; ICU stays are generally capped at 15 days.³

Surgery and Anesthesia

Surgical benefits cover general abdominal, thoracic, and cranial procedures, hernia repair, exploratory surgery, and specific repairs for fractures, dislocations, connective tissue, knee cartilage, and ruptured discs. Anesthesia is paid separately, with different amounts for general anesthesia and for epidural or regional anesthesia.⁴

Imaging, Follow-Ups, and Therapy

Diagnostic imaging is tiered. X-rays and ultrasounds pay a lower amount; CT scans and MRIs pay a higher one.⁴ Physician follow-ups are usually covered for up to two visits per accident.³ Many plans include occupational, physical, and speech therapy with session limits that vary by employer. One plan allows up to ten therapy sessions per accident and up to three chiropractic visits per calendar year.⁵

Other Treatment-Related Payments

Prescription drugs related to a covered injury.³
Durable medical equipment such as crutches, slings, neck braces, walkers, wheelchairs, and hospital beds, organized by tier.³
Injections, including tetanus boosters, rabies shots, antivenom, and immune globulin, plus pain-management injections like cortisone or epidural steroids.³
Emergency dental repair, including crowns, extractions, and fillings for teeth broken in the accident.⁴
Skin grafts for burns or accidental traumatic skin loss.³
Blood and plasma transfusions.³
Behavioral health therapy following a covered accident.⁴

Death, Dismemberment, and Catastrophic Loss

Most Unum accident plans include accidental death and dismemberment coverage. In one employer plan, the accidental death benefit is $100,000 for the employee, $50,000 for a spouse, and $25,000 for a child. Those amounts double if the death happens while riding as a fare-paying passenger on a common carrier such as a commercial airline.⁴

The same plan pays dismemberment and loss-of-use benefits for hands, feet, fingers, sight, hearing, and speech, with amounts between $25,000 and $100,000 depending on severity. Paralysis benefits run from $25,000 for loss of use of one limb up to $100,000 for quadriplegia. A $20,000 coma benefit and allowances for home and vehicle modifications fill out the catastrophic coverage.⁴

Recovery, Travel, and Newer Lifestyle Benefits

Recovery care covers at-home nursing and inpatient rehabilitation for a limited number of days per accident. If treatment or surgery requires traveling more than 50 miles from home, the plan can reimburse transportation and lodging for up to 30 days per accident.³

For policies effective January 2023 and later, Unum added several newer benefits that an employer can choose to include.⁶ They are not automatic:

Family care pays $50 per day, up to three days per accident, when a child must attend a childcare center during a parent’s hospitalization or surgery.⁷
Pet boarding pays $30 per day, up to three days per accident, when a pet needs overnight boarding during hospitalization or surgery.⁷
Organized sports adds 25% on top of applicable injury and treatment benefits when the accident happens during an organized sport.⁴
Personal safety pays $50 per year per covered family member for completing a program like CPR certification, first-aid training, swim lessons, self-defense, or defensive driving.⁸

The Annual Wellness Benefit You Can Claim Without an Accident

Most Unum accident plans also include a wellness benefit that has nothing to do with an accident. Each covered person can collect $50 once per calendar year for completing a qualifying health screening or preventive test. Eligible screenings include routine annual physicals, dental exams, cancer screenings, cholesterol and diabetes tests, cardiovascular screenings, chest X-rays, and immunizations like flu shots.⁹

You can file the wellness claim online at unum.com, through the MyUnum for Members mobile app, or by calling 1-800-635-5597. A quick note on names: in New Hampshire this is called the Health Screening benefit, and in Kansas immunizations are excluded from the accident and critical illness versions.⁹

What Is Not Covered

Unum accident insurance pays only for injuries caused by accidents. The policies explicitly exclude illness, infection, disease, and any physical condition that was not caused by an injury. Allergic reactions fall under that sickness exclusion.⁵ Standard exclusions beyond sickness include:

Self-inflicted injuries or suicide attempts
Injuries sustained while committing or attempting a felony, or while engaged in an illegal occupation
War and acts of terrorism
Racing, stunt shows, or speed tests in a motor vehicle
Operating, crewing, or parachuting from an aircraft or hot air balloon (riding as a fare-paying passenger is fine)
High-risk recreation such as hang-gliding, bungee jumping, parasailing, and parakiting
Semi-professional or professional athletic competition for pay
Work-related injuries, if your plan is designed for off-the-job accidents only

Some plans also exclude catastrophic benefits when the insured was intoxicated or using a non-prescribed narcotic at the time of the accident.⁵

On pre-existing conditions: most Unum accident plans do not impose a traditional pre-existing condition limitation, and base coverage is typically guaranteed without health questions.¹⁰¹¹ At least one certificate does carry a pre-existing condition exclusion that applies during the first 12 months of coverage, so check your own plan documents.¹²

Sample Dollar Amounts From a Real Plan

Dollar amounts depend on your employer’s plan design. Here is the schedule from one large employer’s 2026 plan year to give you a sense of scale:

Hip fracture: $6,000
Leg fracture: $4,500
Ankle fracture: $4,000
Depressed skull fracture: $8,000
Hip dislocation: $6,000
Shoulder dislocation: $2,000
Third-degree burns over 20% or more of body: $20,000
Emergency department visit: $300
Hospital admission: $2,000
Hospital daily stay: $400
Air ambulance: $1,500
Ground ambulance: $500
Advanced imaging (MRI/CT): $400
General surgery, abdominal, thoracic, or cranial: $1,500

These are from one plan. Your schedule may be higher or lower.⁴

On-the-Job Versus Off-the-Job

Your employer picks whether the plan covers injuries that happen at work, away from work, or both, and your certificate will say which.² When a plan covers accidents “at any time, including while an Insured is working,” there’s no distinction between on-duty and off-duty injuries.⁴ Off-the-job-only plans exclude work-related accidents, which would typically go through workers’ compensation instead. If your plan is the off-the-job version, don’t assume a workplace injury will be paid.

How to File a Claim

Unum pays accident benefits as a lump sum directly to you, with no restrictions on how you spend it.¹ The amount is set by the type of injury and the treatments you received, matched against the schedule of benefits in your certificate.

You can file online through Unum’s secure portal at services.unum.com, through the Unum mobile app, or by submitting paper forms by fax or mail. Claim forms are available at unum.com/claims or from your HR department. The dedicated phone line for accident, critical illness, and hospital claims is 1-800-635-5597.¹³ Direct deposit is available for faster payment of approved claims.

There is no lifetime or annual maximum on the accident plan, so each new covered accident starts fresh. You will not hit a cap.¹

1
Unum. Accident Insurance for Employees
2
Unum. Accident Insurance for Employers
3
Kalamazoo College HR. Unum Accident Insurance Booklet
4
Truist Benefits. Unum Accident Product Flyer
5
FFBenefits. Unum Accident Highlights and Rates
6
Unum Investors. Unum Refreshed Accident Policy Covers Pet Boarding, Organized Sports, and Family Care
7
Truist Benefits. Unum Group Accident Summary Plan Description
8
JCCAL. Unum Accident Insurance
9
Truist Benefits. Unum Product Wellness
10
NMSU Benefits. NMSU Accident M2O Flyer
11
Ivinson Memorial Hospital. Unum Life Insurance Options
12
SHC Content Hub. Unum Group Accident Insurance Certificate
13
Unum. Contact Us