Coverage

This benefit applies to eligible working members under the age of 70 and does not apply to Dependents.  The benefit is payable, in addition to any other insurance benefits, for paralysis, loss of life, limb, sight, speech, hearing or paralysis which is the result of accidental bodily injuries and which occur within 365 days from the date of the accident.  

This coverage applies 24 hours a day, 365 days a year, on or off the job, anywhere in the world, including while traveling, as a passenger only, in commercial or chartered aircraft.

Benefit Amount

The amount of your Accidental Death & Dismemberment Insurance is specified in the “SUMMARY OF BENEFITS” earlier in this website. The percentages specified below for Accidental Death or Dismemberment will be limited to the maximum Accidental Death & Dismemberment benefit specified in the “SUMMARY OF BENEFITS”. 

In the event of your death, the Benefit Amount is payable to the beneficiary you have named under your Group Life Insurance Plan or in the absence of such designation, to your Estate.

SCHEDULE OF LOSSES

Accidental Death, Dismemberment, Loss of Sight & Paralysis

If such injuries shall result in any one of the following specific losses within one year from the date of accident, Chubb Life Insurance Company of Canada will pay the percentage of the Benefit Amount specified below, which is equal to the amount stated in the “SUMMARY OF BENEFITS” section; provided, however, that not more than one (the largest) of such benefits shall be paid with respect to injuries resulting from one accident.

“Brain Death” means irreversible unconsciousness with total loss of brain function; and complete absence of electrical activity of the brain, even though the heart is still beating. 

"Loss" shall mean, with respect to hand or foot, actual severance through or above the wrist or ankle joint; with respect to arm or leg, actual severance through or above the elbow or knee joint; with respect to eye, the total and irrecoverable loss of sight; with respect to speech, the total and irrecoverable loss of speech which does not allow audible communication in any degree; with respect to hearing, the total and irrecoverable loss of hearing which cannot be corrected by any hearing aid or device; with respect to thumb and index finger, actual severance through or above the first phalange; with respect to fingers, the actual severance through or above the first phalange of all four fingers of the same hand; with regard to toes, the actual severance of both phalanges of all toes of the same foot.

If you suffer complete severance of a hand, foot, arm or leg as described, the Insurance Company will pay the amount specified even if the severed limb is surgically reattached, whether successful or not.

"Loss" as used with reference to Quadriplegia (paralysis of both upper and lower limbs), Paraplegia (paralysis of both lower limbs) and Hemiplegia (paralysis of upper and lower limbs of one side of the body), means the complete and irrecoverable paralysis of such limbs.

"Loss of Use” shall mean the total and irrecoverable loss of function of an arm, hand, leg, foot, or thumb and index finger, provided such loss of function is continuous for twelve consecutive months and such loss of function is thereafter determined on evidence satisfactory to the Insurance Company to be permanent.

Cosmetic Disfigurement Benefit

If you suffer a third degree burn in a non-occupational accident, the Insurance Company will pay a percentage of the Principal Sum, depending on the area of the body which was burned according to the following table:

The maximum percent of Principal Sum Payable (C) is determined by multiplying the Area Classification (A) by the Maximum Allowable percent for Area Burned (B).  In the event of a 50% surface burn, the Maximum Allowable percent for Area Burned (B) is reduced by 50%.  This table only represents the maximum percent of the Principal Sum payable for any one accident.  If the Insured suffers burns in more than one area as a result of any one accident, benefits will not exceed $25,000.

Repatriation Benefit

When injuries covered by this policy result in a loss of life outside 150 km from your city of permanent residence or outside of Canada and occurs within 365 days from the date of the accident, the Insurance Company will pay the actual expense incurred for preparing the deceased for burial and shipment of the body to the city of residence of the deceased, but not to exceed $15,000.00.

Rehabilitation Benefit

When injuries shall result in a payment being made by the Insurance Company under the Schedule of Losses excluding the Loss of Life benefit provided by the policy, the Insurance Company will also pay the reasonable and necessary expenses actually incurred up to a limit of $15,000 for special training provided:

• such training is required because of such injuries and in order for you to be qualified to engage in an occupation in which you would not have been engaged except for such injuries;
• expenses be incurred within two years from the date of the accident;
• no payment will be made for ordinary living, traveling or clothing expenses.

Family Transportation Benefit

When injuries covered by this policy, result in your confinement as an inpatient in a hospital outside 150 km from your city of permanent residence or outside of Canada and requires personal attendance of a member of your immediate family as recommended by the attending physician, in writing, the Insurance Company will pay for the expense incurred by the member of your immediate family, for the transportation by the most direct route by a licensed common carrier to you while confined, but not to exceed $15,000.00.

"Member of your immediate family" means your spouse, legal or commonlaw, parents, grandparents, and children over age 18, brother or sister.

In-Hospital Confinement Monthly Income

In the event you sustain an injury which results in a payment being made under the Schedule of Losses, excluding the Loss of Life Benefit, and you are hospital confined as an in-patient and are under the care of a legally qualified and registered physician or surgeon other than himself, the Insurance Company will pay for each full month, one percent (1%) of your Principal Sum, subject to a maximum benefit of $2,500, or one-thirtieth of such monthly benefit for each day of partial month, retroactive to the 1st full day of such confinement but not to exceed 365 days in the aggregate for each period of hospital confinement.

“Hospital” as used herein means a legally constituted establishment which meets all of the following requirements: 

• operates primarily for the reception, care and treatment of sick, ailing or injured persons as in-patients;
• provides 24 hour a day nursing service by registered or graduate nurses;
• has a staff of one or more licensed physicians available at all times;
• provides organized facilities for diagnosis and surgical facilities;
• is not primarily a clinic, nursing home or convalescent home or similar establishment nor, other than incidentally, a place for alcoholics or drug addicts;

“In-patient” means a person admitted to a hospital as a resident or bed-patient and who is provided at least one day’s room and board by the hospital.

Spousal Occupational Training Benefit

When injuries to you result in a payment being made by the Insurance Company under the Loss of Life benefit, the Insurance Company will pay in addition, the expenses actually incurred, within three years from the date of the accident, by your spouse for a formal occupation training program for the purpose of specifically qualifying your spouse to gain active employment in an occupation for which your spouse would otherwise not have sufficient qualifications. The maximum payable hereunder is $15,000.00.

Day Care Benefit

If you suffer a loss of life in a covered accident while the policy is in force, the Insurance Company will pay, in addition to all other benefits payable under the policy a "Day Care Benefit" equal to the reasonable and necessary expenses actually incurred, subject to the lesser of 5% of your Benefit amount or a maximum of $5,000.00 per year, on behalf of your Dependent child who is enrolled in a legally licensed Day Care center on the date of the accident or who enrolls in a legally licensed Day Care center within 365 days following the date of the accident.

The "Day Care Benefit" will be paid each year for 4 consecutive years, but only upon receipt of satisfactory proof that your child is enrolled in a legally licensed Day Care center.

“Dependent Child” means either a legitimate or illegitimate child adopted child, step-child or any child who is in a parent-child relationship with you and who is unmarried, twelve (12) years of age and under, and dependent upon you for maintenance and support.

Parental Care Benefit

If you sustained an injury, which results in loss of life within 365 days of the date of accident, the Insurance Company will pay a Parental Care Benefit for an eligible Dependent Parent.

A Dependent Parent is eligible if, at the time of the accident:

• he/she is resident in a licensed nursing care facility; or
• he/she is enrolled in a home health care program; or
• he/she is living in the Insured Person’s residence; or
• he/she is receiving support and care provided by the Insured Person as evidenced by:
  • cancelled cheques
  • Income Tax returns showing the parent as a dependent; or
  • other similar forms of proof.

The amount of the Parental Care Benefit will be the lesser of 10% of the Insured Person’s Principal Sum Amount or $5,000.

“Dependent Parent” means the Insured Person’s parents or grandparents who are dependent upon the Insured Person for support, maintenance and care. 

Special Education Benefit

If you suffer a loss of life in a covered accident while the policy is in force, the Insurance Company will pay, in addition to all other benefits payable under this policy, a “Special Education Benefit” equal to 5% of your Benefit amount, (subject to a maximum of $5,000 per year), on behalf of any Dependent child who, on the date of the accident, was enrolled as a full-time student in any institution of higher learning beyond the 12th grade level, or was at the 12th grade level and subsequently enrolls as a full-time student in an institution of higher learning within 365 days following the date of the accident.

The “Special Education Benefit” is payable annually for a maximum of four consecutive annual payments but only if the Dependent child continues his/her education as a full-time student in an institution of higher learning.

Bereavement Benefit

When injuries covered by this policy result in loss of life within 365 days from the date of the accident, the Insurance Company will pay the reasonable and necessary expenses actually incurred by the Spouse and Dependent children of the insured person for up to six (6) sessions of grief counseling, by a Professional Counselor, subject to a maximum of $1,000.00.

“Professional Counselor” means the treatment or counseling by a therapist or counselor who is licensed, registered or certified to provide such treatment.

Seat Belt Benefit

In the event you sustain an injury which results in a payment being made under the Schedule of Losses, your Benefit amount will be increased by 10%, if at the time of the accident, you were driving or riding in a Vehicle and wearing a properly fastened Seat Belt.

Due proof of Seat Belt use must be provided as part of the written proof of loss.

“Vehicle” means a private passenger vehicle, station wagon, van, or jeep-type automobile.

“Seat Belt” means those belts that form a restraint system.

Home Alteration and Vehicle Modification

In the event you sustain an injury which results in a payment being made under the Schedule of Losses excluding the Loss of Life Benefit and such injury subsequently requires the use of a wheelchair to be ambulatory, the Insurance Company will pay the reasonable and necessary expenses actually incurred within 365 days from the date of accident for:

• the onetime cost of alterations to your principal residence to make it wheelchair accessible and habitable; and
• the onetime cost of modifications necessary to a motor vehicle utilized by you to make the vehicle accessible or drivable for you.

Benefit payments herein will not be paid unless:

• home alterations are made by a person or persons experienced in such alterations and recommended by a recognized organization, providing support and assistance to wheelchair users; 
• vehicle modifications are carried out by a person or persons with experience in such matters and modifications are approved by the Provincial vehicle licensing authorities.

The maximum payable under both Items a) and b) are subject to a maximum benefit the greater of $15,000 or 10% of the Principal Sum, to a maximum of $50,000.00. 

Exposure and Disappearance

Loss resulting from unavoidable exposure to the elements shall be covered to the extent of the benefits afforded you.

If your body has not been found within one year of the disappearance, stranding, sinking or wrecking of the conveyance in which you were riding at the time of the accident it shall be presumed, subject to all other conditions of this policy, that you suffered a loss of life resulting from bodily injuries sustained in an accident covered under this policy.

Identification Benefit

In the event accidental Loss of Life is sustained by you not less than one hundred and fifty (150) kilometers from your normal place of residence and identification of the body by a Member of the Immediate family has been requested by the police or a similar governmental authority, the Insurance Company will reimburse the reasonable expenses actually incurred by such member for:

• transportation by the most direct route to the city or town where the body is located; and
• hotel accommodation in such city or town, subject to a maximum duration of three (3) days.

The reimbursement of such expenses incurred is subject to the accidental loss of life indemnity being subsequently payable in accordance with the terms of this policy following the identification of the body as the Insured Person.  The Insurance Company will pay 10% of the principal sum up to the maximum of $10,000.00, for all such expenses.

Payment will not be made for board or other ordinary living, traveling or clothing expenses, and transportation must occur in a vehicle or device operated under a license for the conveyance of passengers for hire.

Benefits payable under this section will be limited to only one (1) policy in the event this benefit is contained in two (2) or more policies issued to the Policyholder by the Insurance Company.

Serious Illness Benefit

If, while coverage is in effect but only after coverage has been in effect for a period of ninety days you are then diagnosed with any one of the covered illnesses listed below and the Insured person satisfies the following conditions:

• has been hospitalized as an in-patient continuously for at least 48 hours, and
• survives for a period of thirty days thereafter, and
• the Insured Person is under age 65.

The Insurance Company will pay 10% of the principal sum up to the maximum amount of $10,000.00.

Covered Serious Illnesses

• Encephalitis
• Parkinson’s Disease
• Tuberculosis
• Yersinia Pestis
• Acute Poliomyelitis
• Typhoid Fever
• Necrotizing Fascitis
• Acute Rheumatic Fever
• Meningitis 

ACE INA Life Insurance shall only be obligated to pay the serious illness benefit once notwithstanding that an Insured Person may be diagnosed with more than one of the covered illnesses.

Waiver of Premium

If you are under age 65 and become totally disabled* while you are insured under this plan and satisfactory evidence of your total disability is provided to ACE INA Life Insurance on an annual basis, payment of premium will be waived until the earlier of the following occurs:

• you return to active employment with your employer;
• you attain age 65;
• the master policy underwritten by ACE INA Life Insurance is terminated.

Once you return to active employment with your employer, your coverage will continue only upon the commencement of premium payments.

*You will be considered totally disabled if you are unable to engage in any business or occupation and perform in any work for compensation or profit for a time period in accordance with the waiver of premium requirements under the Group Life Insurance policy issued to your employer.

Exclusions

The Plan does not cover any loss, which is the result of:

• intentionally selfinflicted injuries, suicide or any attempt thereat, while sane or insane;
• war or any act thereof;
• flying in an aircraft owned or leased by your employer, yourself or a member of your household, or aircraft being used for any test or experimental purpose, firefighting, power line inspection, pipeline inspection, aerial photography or exploration;
• flying as pilot or crew member in any aircraft or device for aerial navigation;
• fulltime, active duty in the armed forces.

NOTE: Accidental Death and Dismemberment benefits cease in accordance with the “TERMINATION OF COVERAGE”, provision, or upon attainment of age 70, whichever is earlier.

Beneficiary

For employee death benefits, you may name a beneficiary/beneficiaries and, from time to time, change such named beneficiary/beneficiaries, subject to Provincial law, by written request filed with the administrator.   

The change will take effect as of the date such request was executed, but without prejudice to the Insurance Company for any payments made before such request is received at its Head Office.  

The beneficiary/beneficiaries you designate for the Life Insurance benefit will also apply to Accidental Death & Dismemberment benefit.

How To File Claims

You should acquaint your beneficiary/beneficiaries with the fact that in the event of your death or dismemberment, they should contact your employer and the Trust Fund administrator immediately.  A claim form will then be forwarded with specific instructions as to how it is to be completed.

Before submitting the claim form, ensure that all questions, have been answered, that the claimant and the insured are clearly identified by full name, return mailing address, and name of employer and Union.   Faulty or missing information will only result in a delay in processing claims.

When the above have been completed, forward the form and all attachments to the administrator.   Your claim will be forwarded for assessment and your benefit cheque will be mailed directly to you or your beneficiary.