B
COGNITIVE IMPAIRMENT The permanent loss of cognitive function due to a permanent, irreversible injury or illness of the brain including at least two (2) or more of the following permanent impairments: • disorientation in time and place • Mini-mental score of less than twenty (20) out of thirty (30) or equivalent test • requires assistance with two (2) or more Activities of Daily Living defined above;
Or
C The entire and irrecoverable loss of the sight of both eyes;
Or
D
The complete, total and irrecoverable functional loss, as supported by medical evidence, of:
both hands; or both feet; or
• •
•
one hand and one foot.
(INSIGHT 35.0.0) – May 2019 (Updated August 2019) (Updated July 2021) (Updated November 2022) (Updated May 2026)
PC-TPD-05/2026
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