A.

Moderate localized pain and/or mild systemic reaction or impairment requiring minor change in normal activities, and associated with some restriction of work activity

Days

B.

Moderate pain and/or moderate impairment requiring moderate change in normal activities, e.g., house-bound or in bed, and associated with temporary loss of ability to work

Days

C.

Severe pain, severe short term impairment, or hospitalization

Days

D.

Mild chronic disability (not requiring hospitalization, institutionalization, or other major limitation of normal activity, and resulting in minor limitation of ability to work

Cases

E.

Moderate to severe chronic disability (requiring hospitalization, special care, or other major limitation of normal activity, and seriously restricting ability to work)

Cases

F.

Total impairment

Cases

G.

Reproductive impairment resulting in infertility

Cases

H.

Death

Cases

1

1

1

1

1