Reliability in distinguishing murder from accidental event with current forensic criteria in traumatic head injury

•A 60-year-old man was found in his apartment with numerous head injuries, surrounded by blood and vomit.•The death was caused by post-traumatic intracranial and external hemorrhages.•The HBL Rule and other published criteria were applied to evaluate the manner of death.•It was impossible to distinguish between an accident and a homicide basing solely on those criteria.•A multidisciplinary approach allowed to identify the manner of death as most probably accidental. Discovering a body displaying signs of multiple head trauma requires a thorough examination by the forensic pathologist, and a multidisciplinary approach is recommended. However, determining the manner of death is not always possible. We present a case in which the body of a 60-year-old man was discovered lying face down on the floor of his apartment, partially unclothed, surrounded by blood and vomit, and presenting numerous head injuries. The autopsy concluded that the cause of death was a result of post-traumatic brain injury. Nevertheless, applying current criteria made it challenging to ascertain whether the trauma stemmed from an accidental event or an assault.