Second Degree: More than 225 square centimeters $500 pp/pa $1,000 pp/pa Third Degree: 20 - 100 square centimeters $1,000 pp/pa $2,000 pp/pa Third Degree: 101 - 225 square centimeters $3,000 pp/pa $5,000 pp/pa Third Degree: More than 225 square centimeters $15,000 pp/pa $20,000 pp/pa Skin Grafts 25% of burn benefit 25% of burn benefit Paralysis Quadriplegia $10,000 pp/pa $15,000 pp/pa Paraplegia $5,000 pp/pa $7,500 pp/pa Hemiplegia $5,000 pp/pa $7,500 pp/pa Uniplegia $2,500 pp/pa $3,750 pp/pa Lacerations Not requiring sutures $125 pp/pa $125 pp/pa Under 3 inches, required sutures $250 pp/pa $250 pp/pa 3 to 6 inches, requires sutures $500 pp/pa $500 pp/pa Over 6 inches, requires sutures $1,000 pp/pa $1,000 pp/pa Emergency Dental Work Crown Repair $450 pp/pa $600 pp/pa Extraction $225 pp/pa $300 pp/pa Eye Injuries Removal of Foreign Object $200 pp/pa $500 pp/pa Surgical Repair $750 pp/pa $1,000 pp/pa Specific Injuries Ruptured Disc $2,000 pp/pa $3,000 pp/pa Tendons/Ligaments $1,000 pp/pa $1,500 pp/pa 1 tear with surgical repair Tendons/Ligaments $2,000 pp/pa $3,000 pp/pa 2 or more tears with surgical repair Tendons/Ligaments $500 pp/pa $750 pp/pa Arthroscopic surgery with no repair Torn Knee Cartilage $500 pp/pa $750 pp/pa Exploratory surgery with no repair Torn Knee Cartilage $2,000 pp/pa $3,000 pp/pa Surgical repair Concussion $200 pp/pa $250 pp/pa Dislocations (Closed Reduction) 3 dislocation benefits per person, per accident maximum Hip $4,000 per dislocation $6,000 per dislocation Knee (except patella) $1,600 per dislocation $2,400 per dislocation Shoulder $1,600 per dislocation $2,400 per dislocation Foot/Ankle $1,600 per dislocation $2,400 per dislocation Wrist $1,600 per dislocation $2,400 per dislocation Lower Jaw $1,600 per dislocation $2,400 per dislocation Elbow $1,600 per dislocation $2,400 per dislocation Bones of the Hand (except fingers) $800 per dislocation $1,200 per dislocation Collarbone $800 per dislocation $1,200 per dislocation 2 or more fingers $250 per dislocation $450 per dislocation 2 or more toes $250 per dislocation $450 per dislocation 1 finger or toe $125 per dislocation $200 per dislocation Open Reduction 200% of dislocation benefit 200% of dislocation benefit Partial Dislocation 25% of dislocation benefit 25% of dislocation benefit Fractures (Closed Reduction) 3 fracture benefits per person, per accident maximum Skull $5,000 per fracture $6,000 per fracture Hip/Thigh $5,000 per fracture $6,000 per fracture Vertebral Body