AO22OCFL 3 We will pay a percentage of the Closed Reduction Benefit Amount as shown in the Schedule of Benefits if the Dislocation is repaired by a Physician with local anesthesia or no anesthesia. We will pay no more than one Dislocation benefit per joint per Covered Person while this policy is in force. The Fracture benefit pays an indemnity amount for a Covered Person who receives a Fracture and requires Open or Closed Reduction. If the Fracture cannot be repaired by Open or Closed Reduction, the Closed Reduction Benefit Amount will be paid. The amount payable for this benefit will be based on the bone Fractured. We will pay a percentage of the Closed Reduction Benefit Amount as shown in the Schedule of Benefits for the bone involved if the Fracture is a Chip Fracture. The Severe Burns benefit pays an indemnity amount if a Covered Person suffers a 2nd degree or 3rd degree burn. The amount payable will be based on the degree of burn and amount of the body surface burned. Treatment for the burn must occur within 3 days of the Covered Accident. The Skin Graft benefit pays an indemnity amount for a Covered Person who receives a skin graft for a burn for which benefits were paid under the Severe Burn Benefit. The Laceration benefit pays an indemnity amount for a Covered Person who suffers a laceration that must be repaired or treated by a Physician. The amount payable will be based on the method of repair and the total length of all lacerations. The Ambulance benefit pays an indemnity amount for a Covered Person who requires ambulance transportation en route to or between a Hospital, emergency center, or medical facility due to Injuries sustained. The Emergency Dental Work benefit pays an indemnity amount if a Covered Person requires repair by crown or extraction of a broken natural tooth, free of decay, by a Physician or dentist and that is the result of Injuries sustained. The dental repair must occur within 3 days of the Covered Accident. The Physical, Occupational, or Speech Therapy benefit pays an indemnity amount for each day a Covered Person receives Physical, Occupational, or Speech Therapy from a Physical, Occupational, or Speech Therapist. This benefit is payable up to 8 days per Covered Person per Covered Accident for all therapies combined. The Blood, Plasma, and Platelets benefit pays an indemnity amount for blood, plasma, and platelets needed. The X-ray benefit pays an indemnity amount for each day a Covered Person undergoes an x-ray for the purpose of diagnosing an Injury. This benefit is payable once per day up to 2 days per Covered Person per Covered Accident. The Medical Imaging benefit pays an indemnity amount if a Covered Person undergoes a Computerized Tomography (CT or CAT), Magnetic Resonance Imaging (MRI), Single-Photon Emission Computed Tomography (SPECT), Positron Emission Tomography (PET) scan, or an ultrasound, for the purpose of diagnosing an Injury. The Gunshot Wound benefit pays an indemnity amount if a Covered Person receives a gunshot wound and the gunshot wound does not cause the Covered Person to die; is caused by a shot from a Conventional Firearm; requires treatment by a Physician within 24 hours of the Covered Accident; and requires a Confinement. The Epidural Pain Management benefit pays an indemnity amount if a Covered Person receives an epidural injection into the epidural space for management of pain due to an Injury.
Accident Insurance Overview Level 4 Page 6 Page 8