CONCUSSION: A Concussion benefit will be payable if the Insured sustains a Concussion as a result of a Covered Accident provided it is diagnosed by a Physician within 72 hours of the Covered Accident. Only one benefit will be paid for each person insured per Covered Accident. DENTAL INJURY: A Dental Injury benefit will be payable if the Insured sustains an Injury as a result of a Covered Accident to his or her natural teeth which requires: (1) extraction; or (2) repair by insertion of a crown. Initial treatment must be provided by a Dentist within 6 months of the Covered Accident. Only one benefit for extraction and one benefit for a crown will be paid for each person insured per Covered Accident. DIAGNOSTIC EXAMINATION: A Diagnostic Examination benefit will be payable if the Insured must undergo one of the following diagnostic examinations as prescribed by a Physician due to Injury sustained as a result of a Covered Accident: (1) Computed Tomography (CT or CAT) scan; (2) Magnetic Resonance Imaging (MRI); (3) Positron Emission Tomography (PET) scan; or (4) Single Photon Emission Computed Tomography (SPECT) scan. Such examination must be performed within 6 months of the Covered Accident. Only one benefit will be paid for each person insured per Covered Accident. DISLOCATION: A Dislocation benefit will be payable if the Insured sustains a dislocation or partial dislocation as a result of a Covered Accident provided it is diagnosed by a Physician within 90 days of the Covered Accident. If the Insured sustains more than one dislocation as a result of such Covered Accident, we will pay one benefit, which is the highest. EMERGENCY TREATMENT: An Emergency Treatment benefit will be payable if the Insured sustains an Injury as a result of a Covered Accident and: (1) he or she is examined or treated in a Hospital emergency room, urgent care facility, Physician's office or Dentist's office; and (2) emergency treatment is received within 72 hours of the Covered Accident. Only one benefit will be paid for each person insured per Covered Accident. EPIDURAL ANESTHESIA INJECTION: An Epidural Anesthesia Injection benefit will be payable if the Insured receives an epidural injection administered for pain management for an Injury as a result of a Covered Accident. The epidural must be: (1) prescribed by a Physician; (2) administered in a Physician's office or Hospital; and (3) received within 6 months of the Covered Accident. A benefit will not be paid for: (1) an epidural injection administered during a surgical procedure; (2) epidural steroid injections; or (3) an epidural administered during labor and delivery. Only 2 benefits will be paid for each person insured per Covered Accident. LRS-9547-0318-IN Page 8.1