Weekly Wage Replacement Benefit

The Trust Fund pays you a weekly benefit for disability absences during which you are prevented from performing your usual job duties solely as a result of a non-occupational accidental bodily injury or disease, including pregnancy related conditions.  Your disability absence must commence while you are covered under the Trust Fund.   If you are laid off at the time your disability commences, the benefit period will not start until you are recalled to work.  You do not have to be confined at home but your disability must be severe enough to prevent you from performing your regular work.  You must be under the continuous care of a Physician throughout the entire period of your disability. This benefit does not apply to dependents.

IN NO EVENT WILL BENEFITS COMMENCE PRIOR TO THE DATE YOU ARE SEEN BY A PHYSICIAN.

Period of Payment

The Weekly Wage Replacement Benefit is integrated with Employment Insurance Sickness Benefits (E.I.).  Your benefits under this Trust Fund will be reduced by the number of full or partial weeks for which you are entitled to E.I. benefits, whether you apply for them or not.  If you do not qualify for E.I. Sickness Benefits, payments will be made under this Trust Fund, however you must submit proof of your disqualification for E.I.  The maximum benefit period provided by this wage replacement plan is 26 weeks, inclusive of E.I. benefits.  

If your disability is caused by an illness, the short-term disability wage replacement benefit is subject to a 7 calendar day waiting period before payments commence. The waiting period is taken from the date of your first consultation with a Physician who determines you are totally disabled and unable to perform your usual job duties.  If your claim is approved you will receive up to one weeks benefits.  There is no waiting period if your disability was caused by an accident or you are hospitalized, in which case you will receive two weeks benefits.  

No benefits are payable for the next 26 weeks, unless you prove your disqualification for E.I. Sickness benefits.  

If your disability continues beyond the initial two week period and the 26-week E.I. period, you may again claim benefits from this Trust Fund, for a combined maximum period of 26 weeks.

Benefit Amount

The amount of your weekly benefit is specified in the SUMMARY OF BENEFITS at the beginning of this website.  No tax will be withheld from your cheques, but please note that all benefits are subject to Income Tax and you will receive a T4 for all paid amounts by the end of February of the following year.

Successive Disabilities

Successive disabilities separated by less than two weeks of active, full-time work will be considered one disability, unless the subsequent disability is due to an entirely different and unrelated cause.  Disabilities arising from different and unrelated causes will be considered as a new disability providing they commence after you return to full-time work, for at least one full day.  Disabilities arising from the same or a related cause will be considered as a new disability provided you returned to regular, full-time work for a period of at least two weeks.

Exclusions and Limitations

No benefits are payable for:

• any day on which you are not under the care of a legally qualified physician or surgeon; no period of care shall be considered to have started until you have been seen and treated personally by a physician or surgeon; 
• any day you are performing work of any kind, anywhere, for compensation or profit;
• during any leave of absence (including Maternity Leave), except where benefits are provided during post-natal recovery period;
• any day you are receiving Disability Benefits, Early Retirement, or Retirement benefits under any Employer or Union sponsored pension plan;
• any day you are entitled to receive reimbursement under any Workplace Safety and Insurance law or similar legislation;
• any portion of a period of disability resulting from substance abuse, including alcoholism and drug addiction, unless you are participating in a recognized substance withdrawal program;
• any injury caused or contributed to by a Motor Vehicle Accident which occurs in Ontario or Quebec;
• for any disability resulting from intentionally self-inflicted injuries, whether you are sane or insane;
• for any disability resulting from voluntary participation in war, riot or insurrection;
• for the portion of a period of disability during which you are imprisoned in a penal institution or confined in a hospital or similar institution as a result of criminal proceedings;
• for disability which commences on or after the date a strike begins, subject to any provincial Employment or Labour Standards Act.  However, you can fulfill your Qualifying Disability Period during a strike.

Reductions of Coverage

Your benefit under this coverage will be reduced by any income or benefit payable under:

• any other plan or program provided to you by your employer;
• any plan or program of any government or of any subdivision or agency of the government, including any plan or program established pursuant to a provincial automobile insurance act.

Your benefit will not be reduced by benefits payable under the Canada or Quebec Pension Plan.

Subrogation 

If you are entitled to recover compensation for loss of income from a third party as a result of the incident which caused or contributed to the disability, for which benefits are paid or payable, the Insurer will be subrogated to all the rights of your recovery for loss of income, to the extent of the sum of benefits paid or payable by the Insurer.  You shall execute such documents as required by the Insurer.

In the event that you can provide proof to the Insurer that you have not recovered full compensation for loss of income, the Insurer shall determine the proportion of damages actually recovered and share pro rata in that amount.

Should you choose to settle the matter prior to judicial determination, you should understand that the sum reached in settlement would be deemed to be full compensation for loss of income, and the Insurer’s right of subrogation will apply.

The term compensation shall include any lump sum or periodic payments which you receive or are entitled to receive on account of past, present or future loss of income.

Termination of Coverage

Your eligibility for Weekly Wage Replacement terminates upon your retirement.

How to File a Claim for Weekly Wage Replacement Benefits

Claim forms are available from the Claim Office of Benefit Plan Administrators Limited.  If you are claiming for Wage Replacement a specific form must be used.  This form consists of the following sections:

• Attending Physician's Statement
• Member Statement of Claim
• Employer Section

Your physician must complete the "Attending Physician's Statement" portion of the form.  Make sure your physician clearly indicates the diagnosis, date(s) of service and type(s) of service rendered, and an estimated return to work date. 

You and your employer must also complete your sections of the form before it is returned to the Claims Office.  To avoid delay in payment, please make certain that all required information has been provided.  Once the claim has been approved your benefit cheque will be mailed directly to you.  

It is important to note that you will be required to regularly provide medical evidence from your attending physician, who must be a medical doctor.  This medical evidence must be sufficient to establish and maintain your inability to perform the usual functions of your job.  You must be under the continuous care of a physician for the full 26 week period, plus the waiting period, and your treatment must be appropriate to the diagnosis indicated.  Alternative or experimental treatments are not recognized by this Trust Fund.

Remember!  You must be under the continuous personal care of a physician to qualify for Wage Replacement benefits.  

If it appears that you will continue to be disabled after 26 weeks of receiving wage replacement benefits, at approximately 22 weeks, the administrator will send you the appropriate forms for completion (with instructions), so that you may apply for benefits under the Long Term Disability benefit portion of the Trust Fund.

Proof of Loss

Written proof stating the occurrence, character and extent of loss must be submitted to the Claims Office within 6 months after the start of disability for the Weekly Disability Benefit.

The Insurance Company shall have the right and opportunity to examine any person whose injury or illness is the basis of claim, when and as often as it may reasonably require during the pending and payment period, if any, of such claim.