RL-ACC3-CERT2-23-IN 19 D12967 (11/25) “Speech therapist” for this benefit means a person other than you or any family member, who is a licensed health care professional in the state in which treatment is received and providing treatment or advice in accordance with the license. A speech therapist is trained to evaluate and treat voice, speech, language, or swallowing disorders–e.g., hearing impairment, that affect speech (oral-motor-work) and communication. Urgent Care Facility Treatment: Examination and treatment by a Doctor in an Urgent Care Facility within 30 days after a Covered Accident. This benefit is payable once per Covered Accident. X-ray: An x-ray must be prescribed by a Doctor. This benefit is payable within 90 days of a Covered Accident and is payable once per Covered Accident. COMMON INJURIES BENEFITS We will pay a COMMON INJURIES benefit as shown on the SCHEDULE OF BENEFITS if you receive any of the services or meet any of the conditions described below as the result of Injuries received in a Covered Accident. The Injury must occur while you are covered under the Policy. Burns: The burn must be treated by a Doctor within 3 days after a Covered Accident. The benefit amount varies based on the burn classification as shown on the SCHEDULE OF BENEFITS. If your burn meets more than one of the burn classifications, the higher amount will be payable. This benefit is payable once per Covered Accident. Concussion: The concussion must be diagnosed by a Doctor within 3 days after a Covered Accident. The diagnosis must be confirmed by the use of some type of medical imaging procedure; i.e. x-ray, CT scan or MRI. Dislocations: The Dislocation must be diagnosed by a Doctor within 90 days after a Covered Accident. The benefit amount will vary based on whether the Dislocation is Complete, Complete Requiring Surgical Repair or Incomplete as shown on the SCHEDULE OF BENEFITS. Dislocations that are Complete or Complete Requiring Surgical Repair must be repaired by a Doctor. If you receive more than one Dislocation in the same Covered Accident, a benefit is payable for all Dislocations. However, the benefit will be no more than two times the benefit amount for the joint involved which pays the highest benefit amount. If you receive a Dislocation and a Fracture 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. This benefit is payable 2 times per joint per lifetime of the Policy. Subsequent Dislocations of the same joint after this maximum in a different Covered Accident are not covered. Emergency Dental Work: Natural teeth must be damaged due to a Covered Accident and either extracted or repaired by the placement of a crown. The benefit amount varies based on the type of services received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident regardless of the number of teeth involved. Eye Injury: The eye Injury must be treated by a Doctor within 90 days after a Covered Accident. The Injury must require surgery or the removal of a foreign object by a Doctor. The benefit amount varies based on the type of services received as shown on the SCHEDULE OF BENEFITS. This benefit is payable once per Covered Accident. No benefit is payable for examination with anesthesia or for an Injury to the eyelid which is the moveable fold of skin and muscle that covers the eye. Fractures: The Fracture must be diagnosed by a Doctor within 90 days after a Covered Accident. The Fracture must require treatment by a Doctor. If the Doctor diagnoses the Fracture as a Chip Fracture, the benefit will be reduced to a percentage of what would have been paid for a Non-Surgical Repair Fracture of the same bone. The benefit amount varies based on the type of services received as shown on the SCHEDULE OF BENEFITS. If you receive more than one Fracture in a Covered Accident, a benefit is payable for all Fractures. However, the benefit will be no more than two times the benefit amount listed for the bone which pays the highest benefit amount.