INSURANCE BENEFIT DETERMINATION TABLE IN CASE OF INJURIES

Transcription

1 Annex 1 to Accident Insurance Regulations INSURANCE BENEFIT DETERMINATION TABLE IN CASE OF INJURIES This Annex 1 to Accident Insurance Regulations approved on of the Board of UADB Compensa Vienna Insurance Group constitutes an integral part of the Regulations and is issued in compliance with and subject to the requirements of the legislation of the Republic of Lithuania. I. CENTRAL NERVOUS SYSTEM No. Description Disability rate (%) 1. Residual effects of craniocerebral traumas: 1.1. Paralysis of upper and lower extremities (tetraplegia); very severe cerebral cortical and cerebellar dysfunction; dementia; personality disorders; pelvic organ dysfunction Paralysis of lower extremities with impaired function of pelvic organs Paralysis of one side of the body (hemiplegia); very severe hypoactivity, hyposensitivity, loss of strength in 2 extremities; very severe disorder of coordination Severe hypoactivity, hyposensitivity, loss of strength in 2 extremities; expressed organic disorders of cerebral nerves; coordination impairment; severe muscle hypertonicity in extremities; impaired function of pelvic organs Paralysis of one extremity (monoplegia); speech disorders; expressed coordination impairment; muscle hypertonicity, hyposensitivity and loss of strength in extremities; Parkinson s syndrome Coordination and movement impairment; speech disorders Expressed facial asymmetry; autonomic (vegetative) symptoms; cerebral cortical traumas and speech disorders; vasomotor disorders; singular epileptic seizures (one or twice per year) 7 Note: Residual effects may be attributed to a certain group if at least two symptoms characteristic for the group have been established. When insurance benefit is granted for the effects of injuries of the central nervous system under paragraph 1 of the Annex, and extremity dysfunction is found present, benefits stipulated in Section X (ten) below in

2 respect of injuries of the bones of trunk and extremities shall not be paid. II. CRANIAL AND PERIPHERAL NERVES Traumatic injuries of cranial nerves: 2. Note: In case of clinical picture of neuropathy, insurance benefit shall be paid irrespective of the number of injured nerves Unilateral traumatic injury of cranial nerves Bilateral traumatic injury of cranial nerves Cervicobrachial, lumbosacral plexus or their nerves injury Note: Insurance benefit shall be paid in case of hypoactivity, hyposensivity, muscle atrophy and alterations of skin trophism Impaired peripheral nerve integrity: Note: Insurance benefit shall be paid when there is a clinical picture of neuropathy. In case of injury to multiple nerves in one extremity, insurance benefit shall be paid for the injury to one nerve. In case of injury to the right arm (for right-handers) or left arm (for lefthanders), insurance benefit shall be increased adding 10% to the benefit payable under this paragraph Nerve injury in the area of forearm, wrist, shin and/or tarsus Nerve injury in the area of humerus, elbow, thigh and/or knee 10 III. VISION APPARATUS 5. Unilateral paralysis of accommodation Severe concentric visual field constriction (at least by 10 degrees) Vision impairment as a result of intraocular lens implantation in both posttraumatic eyes:

3 Less than Ptosis of the eyelid, paralysis of eye muscles, eyelid defects affecting eyelid function Unilateral pulsating exophthalmus Effects of injuries to the vision organs: eyeball dislocation; injury to lacrimal passages; strabismus; retinal detachment (as a direct result of eye trauma) Post-traumatic ophthalmic diseases, excl. conjunctivitis; effusion of blood, retinal defects, malformations of the pupil; intraocular lens dislocation. Note: In case of multiple trauma effects indicated in paragraphs 10 and 11, insurance benefit shall be paid under one paragraph only (for the most severe injury) Loss of vision (in the sole eye or both eyes) Total unilateral visual loss Post-traumatic vision acuity impairment Vision acuity Vision acuity Before trauma Post-traumatic Per cent (%) Before trauma Post-traumatic Per cent (%) < < < < < <0.1 30

4 < < < < < Note: 1. Total blindness - visual acuity from light-perception up to 0.01 (inability to count fingers at a distance of 2 m). 2. If visual acuity of the injured eye before trauma is not known, it shall be deemed to be the same as that of the non-injured eye. 3. When visual acuity is impaired in both eyes as a result of trauma, each eye shall be examined separately. A degree of vision loss in the better eye shall apply as a degree of vision loss in both eyes. IV. HEARING APPARATUS No. 15. DESCRIPTION Severe disorders of the vestibular function: repeated, continuous vertiginous attacks with autonomic reactions, uncertainness in gait Disability rate (%) Total loss of auricle Unilateral hearing impairment. Note: data of audiogram, impedometry, speech hearing shall be assessed Hearing for whisper is 0-1 m and hearing for normal voice is 1-3 m (audiogram shows 30 to 50 db HL) No hearing for whisper at the auricle, hearing for normal voice 0-1 m (audiogram shows 60 to 80 db HL) 10 4

5 18. Complete hearing loss in one ear (no hearing for voice; audiogram shows <91 db) Complete hearing loss in both ears 60 V. RESPIRATORY SYSTEM 20. Loss of nasal bones, cartilage, soft tissues Loss of nostrils and nasal tip Loss of nostril(s) or nasal tip Nasal breathing impairment. Insurance benefit shall depend on the degree of impairment (assessed using rhinomanometre, normal inspiration and expiration ml/sec.): a) profound unilateral (<100 ml/sec.) or severe bilateral (<200 ml/sec.) impairment; b) total bilateral impairment (0 ml/sec.) Loss of smell and taste Loss of smell Pos-traumatic chronic sinusitis developing within a period of one year Injury to the laryngeal or trochaic function: Constant intubation with tracheostomy tube Dysphonia Aphonia Articulation impairment Cases of injury to the respiratory apparatus resulting in: st degree respiratory disturbance nd degree respiratory disturbance rd degree respiratory disturbance 60

6 29. Fracture of ribs or sternum resulting in thoracic deformation with severe restriction of respiratory movement 10 Note: If insurance benefit has been paid under paragraph 29, benefit under paragraph 28 will be reduced with the paid-down amount. VI. CARDIOVASCULAR SYSTEM 30. Cardiovascular insufficiency caused by injury to heart or great vessels: (symptoms of cardiovascular insufficiency are assessed according to NYHA classification, ECG, physical load tests, ultrasound examination, long-term ECG and BP monitoring): st degree cardiac insufficiency with mild objectively identified rapid pulse, shortness of breath after physical exercising, swellings nd degree cardiac insufficiency with severe objectively identified profound shortness of breath during physical exercising, cardiac rhythm disorders, liver and lung problems, permanent swelling, ascites, bulging neck veins rd degree cardiac insufficiency with profound objectively identified respiratory rhythm impairment, cardiac rhythm disorders, expectoration of blood, fluids in pleural and pericardial cavities, ascites, permanent swelling Blood circulation impairment caused by injuries to peripheral vessels: Mild swelling, weakened pulsation Severe swelling, cyanosis, profound weakened pulsation Profound swelling, cyanosis, lymphostasis, alterations of trophism 15 Note: post-traumatic residual effects may be attributed to a certain group if at least two symptoms characteristic for the group have been established. VII. DIGESTIVE SYSTEM 32. Chewing impairment caused by the fracture of facial bones or mandible traumas: Severe disorder of chewing and closure of the mandible 7 6

7 32.2. Profound impairment of mandible closing and opening movement, jaw malformations Loss of mandible: Note: in case of loss of the mandible, insurance benefit under paragraph 32 shall not be paid Partial loss Total loss Loss of tongue: Up to a half Up to a half and more Total loss Severe narrowing of the oral cavity, formation of salivary fistula 15 Narrowing of oesophagus or pharynx caused by burns or injuries: 36. Note: The narrowing must be confirmed by objective examination methods Obstructed swallowing of soft food Obstructed swallowing of liquid food Total obstruction (gastrostomy) Residual effects of traumatic injuries to the digestive organs: Faecal incontinence Adhesive diseases, partial intestinal obstruction Artificial anus Abnormal pancreatic endocrine function Abnormal pancreatic exocrine function nd degree hepatic failure rd degree hepatic failure 80

8 38. Removal of the following organs as a result of traumatic injury to digestive organs: Part of liver or gall-bladder Spleen Part of stomach, pancreas or bowels Total stomach removal 40 VIII. URINARY AND GENITAL SYSTEM Nephrectomy 39. Where insurance benefit is payable under this paragraph, no benefit shall be granted under paragraph 4.1 of the Temporary Disability Determination Table (traumatic injury to internals involving surgical interventions), as contained in this Annex Urinary excretion disorders: Renal function impairment: a) 2 nd degree renal insufficiency b) 3 rd degree renal insufficiency Note: If insurance benefit has been paid under paragraph 39 of the Annex, benefit under paragraph 40.1 shall be reduced with the paid-down amount Severe ureteral or urethral narrowing, reduction in urinary bladder capacity Complete ureteral or urethral obstruction, genital fistula Effects of injuries to genital organs: Unilateral removal of ovary, Fallopian tube, testicle Partial penectomy Total penectomy Bilateral removal of ovaries or Fallopian tubes, or hysterectomy a) in women under 40 b) in women above

9 IX. INJURIES TO SOFT TISSUES 42. Profound, disfiguring burn, frostbite or injury scars of the frontal or lateral parts of the face or neck. Insurance benefit under this paragraph shall not be paid in case of full or partial reimbursement of costs of cosmetic plastic surgery on other grounds stipulated in the insurance regulations Hypertrophic, keloid scars of the trunk and extremities, deforming soft tissues and/or making it hard to wear clothes or shoes: covering < 1% of the area covering 1-2% of the area covering 3-4% of the area covering 5-10% of the area covering > 10% of the area covering > 15% of the area 10 Note: Palm of the insured person is deemed to correspond to 1% of the surface of the body. X. INJURIES OF TRUNCAL AND EXTREMITY BONES. SPINE SPINE 44. Spinal function impairments caused by spinal trauma: Insurance benefits shall be calculated and paid under paragraph 1 or 3 of the Temporary Disability Table. CLAVICLE; SHOULDER GIRDLE 45. Violation or limitation of pectoral girdles function after: Fractures of clavicula Fractures of scapula 15 20

10 46. Stiffness in the shoulder joint after resection of the humeral head Stiffness in the shoulder joint Limited mobility of the shoulder joint 10 Note: In case of injury to the right arm (for right-handers) or left arm (left-handers), insurance benefit shall be increased by adding 10% to the benefit payable under respective paragraphs. Functional assessment of the shoulder girdle and shoulder joint shall be based on C.R. Constant s score and Modified Keitel Index. ARM 49. Loss of arm and/or scapula Loss of arm after exarticulation at the shoulder joint or humeral stump in the middle part Loss of arm humeral stump in the lower third part Loss of forearm after exarticulation at the elbow joint Loss of forearm below the elbow joint 60 Note: In case of injury to the right arm (for right-handers) or left arm (left-handers), insurance benefit shall be increased by adding 10% to the benefit payable under respective paragraphs. ELBOW JOINT 54. Immobility of the elbow joint Limited mobility of the elbow joint 5-9 Note: In case of injury to the right arm (for right-handers) or left arm (left-handers), insurance benefit shall be increased by adding 10% to the benefit payable under respective paragraphs. Functional assessment of the elbow joint shall be based on C.R. Constant s score and Modified Keitel Index. RADIOCARPAL (WRIST) JOINT; HAND 56. Loss of the hand at the wrist or carpal bones Immobility of the radiocarpal joint Limited mobility of the radiocarpal joint Hand function impairment

11 Note: In case of injury to the right arm (for right-handers) or left arm (left-handers), insurance benefit shall be increased by adding 10% to the benefit payable under respective paragraphs. Functional assessment of the radiocarpal joint and hand shall be based on C.R. Constant s score and Modified Keitel Index. HAND DIGITS 60. The first digit (thumb): Partial amputation of nail phalanx Total amputation of nail phalanx Partial amputation of basic phalanx Digit loss Loss of digit and carpal bone (or any part of it) Stiffness in the thumb joint Stiffness in the metacarpophalangeal joint of the thumb 10 Note: In case of injury to the right arm (for right-handers) or left arm (left-handers), insurance benefit shall be increased by adding 10% to the benefit payable under respective paragraphs. 63. The second digit (index finger): Total amputation of nail phalanx Total amputation of middle phalanx Amputation of basic phalanx Digit loss Loss of digit and carpal bone (or any part of it) Flexion contracture, when the digit is half flexed, ankylosis of proximal interphalangeal and metacarpophalangeal joints of the digit 4 Note: In case of injury to the right arm (for right-handers) or left arm (left-handers), insurance benefit shall be increased by adding 10% to the benefit payable under respective paragraphs. 64. The third digit (middle) finger, the fourth digit (ring finger) or the fifth digit (little finger): Partial amputation of nail phalanx 2

12 64.2. Phalangeal stump in the middle or basic phalanx Loss of digit and carpal bone (or any part of it) Flexion contracture, when the digit is half flexed, or ankylosis of the first interphalangeal joint or metacarpophalangeal joint of the digit Flexion contracture, when the digit is completely flexed or extended, ankylosis of two or three joints of the digit Loss of two digits of one hand: First and second digits First and third, first and fourth or first and fifth digits Second and third, second and fourth or second and fifth digits Third and fourth or third and fifth Loss of three digits of one hand: First, second and third/fourth/fifth (1+2+3), (1+2+4), (1+2+5) First, third and fourth/fifth (1+3+4), (1+3+5) Second, third and fourth/fifth (2+3+4), (2+3+5) Third, fourth and fifth (3+4+5) Loss of four digits of one hand 40 Note: In other cases of digit or digit function loss, insurance benefit shall be determined by summing up the benefits set for the loss of the function of separate digits. 68. Loss of all digits of one hand 45 Note: In case of injury to the right arm (for right-handers) or left arm (left-handers), insurance benefit shall be increased by adding 10% to the benefit payable under paragraphs relating to the injuries of hand digits. LEG 69. Loss of leg after exarticulation at the hip joint or femoral stump in the upper third part Loss of leg after exarticulation at the hip joint or femoral stump in the upper third part when there was only one leg before the trauma 90 1

13 70. Femoral stump in the middle or lower third part Leg function impairment due to leg shortening by more than 2.5 cm Loss of shin after exarticulation at the knee joint or tibial stump in the upper third part Loss of shin of the only leg Tibial stump in the middle or lower third part 45 HIP JOINT 74. Immobility of the hip joint Limited mobility of the hip joint 5-10 Note: Functional assessment of the hip joint shall be based on C.R. Constant s score and Modified Keitel Index. KNEE JOINT 76. Immobility of the knee joint Pathological mobility of the knee joint due to ligament rupture Limited mobility of the knee joint 5 Note: Functional assessment of the knee joint shall be based on C.R. Constant s score and Modified Keitel Index. TARSUS JOINT, FOOT 79. Immobility of the tarsus joint Limited mobility of the tarsus joint Loss of foot after exarticulation at the tarsus joint or foot amputation at tarsal bones Loss of distal part of the foot after amputation at metatarsal bones Foot function impairment caused by deformation, nonunion 7 Note: Functional assessment of the tarsus joint and foot shall be based on C.R. Constant s score and Modified Keitel Index. FOOT DIGITS (TOES)

14 84. Loss of all toes after exarticulation at the toe joints or amputation at the basic phalanges Loss of the first toe and metatarsal bone or its part Loss of the first toe after exarticulation at the toe joint or phalangeal stump at the basic phalanx Loss of the distal phalanx of the first toe Loss of the second, third, fourth or fifth toes: After exarticulation at the toe joint or phalangeal stump at the basic phalanx Including metatarsal bone or its part Toe function impairment due to immobility of joints 1 Note: In other cases of toe or toe function loss, insurance benefit shall be determined by summing up the benefits set for the loss of the function of separate toes. XI. OTHER LOSSES OF FUNCTIONS 89. Loss of speech 50 TABLE OF BONE FRACTURES No. Trauma Insurance benefit (%) 1. Cranium 1.1. Fracture of cranial fornix bones Fracture of base bones Fracture of fornix and base bones Facial bones: 2.1. Fracture of maxilla, zygomatic bone 7 1

15 2.2. Mandible fracture Fracture of nasal bones Fracture of larynx, thyroid, lingual bones 4 Note: Fracture of the alveolar process of the mandible shall not be considered a jaw fracture. One insurance benefit shall be paid for a bilateral jaw fracture. 3. Traumatic injury to teeth (loss of the whole tooth and/or its root), jaw dislocation: 3.1. Loss of 1 tooth Loss of 2-3 teeth Loss of 4-5 teeth Loss of 6 and more teeth 12 Note: In case of fracture of the dental prosthesis or bridges, insurance benefit shall be granted only in respect of loss of bridge supporting teeth as a result of accident. In all other cases of traumatic injuries to teeth (fracture of tooth or its root, tooth dislocation, tooth displacement into the alveolar bone, splitting of at least ¼ of the tooth), insurance benefit shall be 2% per injured tooth. The benefit shall be reduced by 50% for the loss of parodontal tooth. 4. Spine: Fracture of cervical, thoracic or lumbar vertebrae or their arches 4.1. Note: Maximum 25% of the sum insured (indemnity limit) shall be paid for the fracture of 3 or more vertebrae Fracture of cross-process, lumbar process and ridged process of vertebra Sacrum fracture Coccyx fracture 3 5. Sternum and rib-bones: 5.1. Sternum fractures Fracture of <2 rib-bones Fracture of 3 and more rib-bones Bilateral fracture of rib-bones (3 and more) 6 Note: If rib-bone fracture causes pneumothorax, hemothorax, traumatic pneumonia, exudative pleuritis (when treatment required surgical intervention), relevant insurance benefits shall be increased by

16 adding 5 percentage points. 6. Arm: 6.1. Fracture of scapula, clavicle Proximal humerus fractures Fracture of the humerus corpus Distal humerus fractures Forearm bone fracture (unilateral) Forearm bones fracture (bilateral) Fracture of carpal bones (excl. scaphoid bone) Fracture of scaphoid bone Fracture of metacarpus bones. Insurance benefit shall be paid on a per bone-fracture basis, but not exceeding 6% of the sum insured (indemnity limit) Thumb (basic phalanx) fracture Thumb (nail phalanx) fracture Fracture of hand digits (basic, middle phalanges). Insurance benefit shall be paid on a per bone-fracture basis, but not exceeding 4% of the sum insured (indemnity limit) Fracture of hand digits (nail phalanx) 1 Note: Fracture of several phalanges of one digit shall be considered to be one fracture. 7. Pelvic bones (os ilium, os pubis, os ischii, os coxae): 7.1. Fracture of the hip socket Rupture of symphysis and bone fracture Rupture of more than 2 bones Rupture of symphysis alone Fracture of one bone 5 8. Leg: 1

17 8.1. Femoral trochanteric fracture Femur caput and/or column fracture Femur corpus fracture Fracture of articular surfaces in tibia or femur Patellar fracture Femoral fracture (excl. tibia) Tibial fracture Fracture of fibula, medial malleolus, posterior malleolus Tibial and fibular fracture Fracture of hucklebone, astragalus Metatarsal fracture Fracture of 2-5 foot phalanges. Insurance benefit shall be paid on a per bone-fracture basis, but not exceeding 3% of the sum insured indemnity limit) Fracture of big toe 2 Notes: Fracture of several phalanges of one toe shall be considered to be one fracture. 9. Other: 9.1. Bone crack In case of open bone fractures or when osteosynthesis was required for fixing and constant alignment of ununited ends of the fractured bones (using metal plates, pins, wire or external fixation devices), insurance benefit shall be increased by adding 10% (one-off compensation) to the benefit payable in respect of the corresponding bone fracture Where joint fracture involved artificial joint implants during the acute period of the trauma, insurance benefit shall be increased by adding 15% to the insurance benefit payable. Note: Multiple fracture of one bone (during the event insured) shall be considered to be one fracture. In case of repeated fracture of the bone at the place of bones scars or metal fixation, insurance benefit shall amount to 50% of the benefit payable in respect of the corresponding bone fracture.

18 TEMPORARY DISABILITY TABLE No. Trauma Insurance benefit (%) 1. Craniocerebral traumas: 1.1. Cerebral haematoma Cerebral haematoma involving opening of the cranial cavity Cerebral commotion with in-patient treatment of at least 3 days Cerebral commotion with outpatient treatment of at least 14 days or 2 days hospitalisation Cerebral contusion Spinal cord commotion with in-patient treatment Spinal cord commotion with outpatient treatment Spinal cord contusion Spinal cord compression 15 Note: In case of simultaneous injuries to the brain and spinal cord, insurance benefit shall be paid in respect of one most severe injury. The first and the last day of in-patient treatment shall be deemed to constitute one day. 2. Joint (bone) dislocation: 2.1. Dislocation of the following joints: shoulder, elbow, hip, mandible, acromial extremity of the clavicle, sternal extremity of the clavicle, patella, knee Repeated dislocation of the shoulder joint Dislocation of the following joints and resultant surgery: shoulder, elbow, hip, mandible, acromial extremity of the clavicle, sternal extremity of the clavicle, knee Dislocation and resultant surgery of wrist, torsus joints Dislocation of wrist, torsus joints Phalangeal dislocation 1 Note: Multiple phalangeal dislocations in one digit shall be considered to be one trauma. 1

19 2.6. Phalangeal dislocation accompanied by impaired tendon integrity Patellar dislocation Dislocation of a cervical vertebra Dislocation of 2 or more cervical vertebrae Diskopathy of cervical vertebra(e) 3 Note: In case of bone dislocation, injuries to soft tissues, muscles, tendons during one event insured, insurance benefit shall be paid for one most severe outcome. 3. Ligamentous, muscular, tendonous, meniscal ruptures Meniscal rupture 3.1. Note: In case of traumatic rupture of both menisci in one knee, insurance benefit shall equal to the benefit payable in case of one meniscus rupture Rupture of menisci and lateral and/or cruciate ligaments Tendon ruptures in the hand, toes (without surgical treatment) Tendon ruptures in the hand, foot, tarsus (without surgical treatment) Tendon ruptures in the hand, toes (with surgical treatment) Tendon ruptures in the hand, foot, tarsus (with surgical treatment) Dislocation of shoulder, elbow, hip joint, ligamentous, muscular, tendonous rupture in the knee (without surgical treatment) Dislocation of shoulder, elbow, hip joint, ligamentous, muscular, tendonous rupture in the knee (with surgical treatment) Rupture of the Achilles tendon (without surgical treatment) Rupture of the Achilles tendon (with surgical treatment) 7 Note: In case of partial ligamentous, tendonous, muscular ruptures as well as occurrence of the consequences listed in paragraph 3 in limbs with degenerative alterations, insurance benefit shall be reduced by 50%. In case of repeated ligamentous, tendonous, meniscal ruptures, insurance benefit shall be reduced by 50%. Insurance benefit for dislocation of bones, injuries to soft tissues, muscles, tendons in one limb occurring during one event insured shall equal to the benefit payable for one most severe outcome. 4. Contusions of internal organs and/or soft tissues:

20 4.1. Contusion of internal organs requiring surgical intervention Thoracic contusion causing pneumothorax, hemothorax, exudative pleuritis, subcutaneous emphysema Thoracic contusion causing pneumothorax, hemothorax, exudative pleuritis (when treatment required surgical intervention) Traumatic eye injury Conjunctival, retinal inflammation caused by a contact with foreign bodies with in-patient treatment of the insured person for more than 6 days Traumatic unilateral rupture of tympanic membrane without resultant hearing impairment Soft tissue injuries in excess of 3 cm and requiring joining of the soft tissues Contusion of soft tissue causing <3 cm impaired tissue integrity and requiring joining of the soft tissues Finger contusion with nail avulsion Punctured injury affecting skin, subcutaneous layer and muscles in a result of one event insured Multiple lacerated injuries with soft tissue damage, when injury to a certain locality of the body covers more than 0.25% of the surface of the body Soft tissue injuries causing multiple haematomas, periosteal inflammation, osteomyelitis, phlegmons, fistulas Note: In case of multiple haematomas, insurance benefit shall be paid when non-resolved bruising is present 3 weeks after the trauma and the number of haematomas is 3 or more, covering more than 5 cm 2 each Scratches extending deep into the skin (papillary layer and deeper) localised in different places of the body Note: Insurance benefit shall be paid for dermal scratches extending to the papillary layer and deeper, localised in different anatomic structures, of which at least one has the area covering at least 2% of the surface of the body, and the injured person is incapable for work for more than 6 days. Traumatic posthemorrhagic, anaphylactic shock, embolism from atherosclerotic plaques 2 6 2

21 Note: Insurance benefit for bone fractures, dislocation of joints, ligamentous, muscular, tendonous ruptures in one extremity occurring during one event insured shall equal to the benefit payable for one most severe outcome. 5. Food-borne intoxication, acute chemical intoxication requiring in-patient treatment of the insured person: 5.1. For 3 6 days For 7 15 days For more than 15 days 7 6. Thermal and chemical burns, frostbites nd degree burns covering at lest 1% of the surface of the body nd degree burns covering at least 5% of the surface of the body rd degree burns covering up to 2% of the surface of the body rd degree burns covering at least 2% of the surface of the body rd degree eye burns Large 1 st degree burn causing burn disease rd degree frostbites covering at least 2% of the surface of the body 5 Note: Palmar surface (including palm and digits) of the insured person s hand is deemed to correspond to 1% of the surface of the body. 7. Pregnancy loss: 7.1. Insurance benefit shall be paid, if pregnancy loss is caused by the risk covered and the duration of pregnancy is more than 22 weeks Tick-borne encephalitis, tick-borne myelitis, tick-borne encephalomyelitis, snakebites, animal bites and/or stings requiring in-patient treatment of the insured person for: days days More than 15 days 7 9. Diagnosed Lyme disease Other injuries:

22 10.1 Elbow, shoulder, hip, neck, knee, wrist, tarsus ligamentous laxity Repeated ligamentous laxity 0.5 Note: Insurance benefit for dislocation of bones, injuries to soft tissues, muscles and/or tendons in one extremity occurring during one event insured shall equal to the benefit payable for one most severe outcome. Insurance benefits for ligamentous laxity shall be paid at least 14 days after signing of the insurance contract. Translation from Lithuanian language is approved by: Insurance director Mangirdas Skačkauskas 2