RL-ACC3-CERT2-23-IN 20 D12967 (11/25) If you receive a Fracture and a Dislocation in the same Covered Accident, a benefit is payable for both. However, the benefit will be no more than two times the amount for the bone or joint involved which pays the highest benefit amount. Laceration: A laceration is a cut. The laceration must be treated by a Doctor within 3 days after a Covered Accident. The benefit amount will be based on the total length of all lacerations requiring repair that are received in any one Covered Accident as shown on the SCHEDULE OF BENEFITS. If the laceration is severe enough to require sutures but the Doctor chooses to repair it another way, the benefit will be determined as if the laceration was sutured. This benefit is payable once per Covered Accident. If your Injury qualifies as both a laceration and puncture wound, only one benefit in the higher amount will be payable. Paralysis: Spinal cord Injuries sustained in a Covered Accident that result in the loss of use of one or more arms and legs. Hemiplegia = the complete and irreversible paralysis of both limbs on either side of the body Monoplegia= the complete and irreversible paralysis of one limb Paraplegia = the complete and irreversible paralysis of both legs. Quadriplegia = the complete and irreversible paralysis of both arms and both legs. Paralysis must be confirmed by a Doctor and based on documented evidence of the Injury that caused the paralysis. The duration of the paralysis must be at least 30 days and expected to be permanent. The benefit amount varies based on the degree of paralysis as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. Puncture Wound: An Injury caused by an object, including a needle, that pierces or penetrates the skin. The puncture wound must be treated by a Doctor within 72 hours after a Covered Accident. This benefit is payable once per Covered Accident. If your Injury qualifies as both a laceration and puncture wound, only one benefit in the higher amount will be payable. Ruptured Disk: You must receive surgical repair of a ruptured disk by a Doctor. The surgical repair must occur within 2 years after the Covered Accident. This benefit is payable once per Covered Accident. Skin Graft: The skin graft is for a burn for which a benefit was paid under the burn benefit in this section. This benefit is payable once per Covered Accident. Traumatic Brain Injury: A brain Injury that is caused by a traumatic sudden impact to the head, neck or shoulders, or a penetration of the head. The traumatic brain Injury must be initially treated by a Doctor within 90 days after a Covered Accident. The diagnosis by a Doctor must occur within 90 days after the Covered Accident. The diagnosis must include a Glasgow Coma Scale score of 8 or less (or equivalent) and the inability to perform independently 2 or more of the following activities of daily living: Eating; Bathing; Dressing; Toileting; Transferring; and Maintaining continence. This benefit is payable once per Covered Accident. Tendon/Ligament/Rotator Cuff: The tendon, ligament or rotator cuff must be torn, ruptured or severed and repaired through surgery within 12 months after a Covered Accident. The benefit amount varies based on the number of repairs required and the services received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. Torn Hip, Knee, Shoulder Cartilage: You must receive surgical repair of torn hip, knee or shoulder cartilage. The Injury must be treated by a Doctor within 60 days after a Covered Accident. Surgical repair of the tear must occur within 6 months after the Covered Accident. The benefit amount varies based on the type of service received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. If you receive more than one cartilage tear in a Covered Accident, a separate benefit is payable for each location (hip, knee, or shoulder) of the tear.
Accident Insurance Plan for Noblesville Schools Employees Page 20 Page 22