Long Term Disability Benefit

Long Term Disability insurance is wage replacement insurance, which provides you a monthly income if you become so totally disabled by a non-occupational accidental bodily injury or disease while insured under this plan and under the age of 65 that you can no longer work for your living. Long Term Disability insurance covers you for those total disabilities that last beyond the period covered by the Short Term Weekly Wage Replacement Plan. This benefit does not apply to dependents.

Definition of Total Disability: You will be considered "totally disabled" during the qualifying period and the next 24 months of a period of disability if you are incapacitated to the extent that solely because of a non-occupational disease or non-occupational accidental bodily injury, you are unable to work at your own occupation or employment for which you are reasonably qualified by education, training or experience. Such disability must result from a medically determinable physical or mental impairment.

Maximum Period of Payment

You will be eligible for your first income payment from the plan after you have completed the qualifying period, which is the first 26 weeks of a period of total disability, or the duration of the Weekly Wage Replacement benefit, whichever is greater. However, you will not receive an income payment if you reach age 65 before you complete the qualifying period.

After completing the qualifying period, you will be eligible for income payments during the continuance of a period of total disability for a maximum of 24 months, or to retirement, or to age 65, if either occurs before 24 months.

A period of total disability is considered to cease:

• when you commence work at a reasonable occupation;
• when you fail to furnish proof of the continuance of total disability or refuse to be examined by a physician;
• when you cease to be under the care of a physician;
• the date of your death.

Amount of Monthly Income

The Long Term Disability benefit will be payable monthly in the amount specified in the “SUMMARY OF BENEFITS”, less any benefits payable under the Canada Pension Plan or Quebec Pension Plan. This shall not include CPP/QPP benefits paid to you on behalf of your dependents.

The benefit is taxable however no tax will be withheld from your monthly payments. You will receive a T4A for all paid amounts by the end of February of the following year.

The maximum income payment from the Long Term Disability plan is described in the “SUMMARY OF BENEFITS”.

Any subsequent changes to your salary or member classification or amendment to the contract will not affect the amount of your benefit.

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.

Continuous Period of Disability

If you become disabled from the same or related causes within 6 months after return to active work, it will be considered one continuous period of disability. If you have returned to active work for one full day and become disabled from different and unrelated causes, it will be considered a new period of disability.

Exclusions and Limitations

No benefits are payable:

• for the portion of a period of disability during which you are not under treatment by a legally qualified physician or specialist.
• for a disability resulting from injury or disease which occurred while the Member is on active duty in the armed forces of any country, or while participating in a riot, insurrection, rebellion or civil commotion.
• for a disability resulting from participation in the commission of a criminal offence.
• for a disability resulting from intentionally self-inflicted injuries or illness while sane or insane.
• for a disability resulting from an accident which occurs while you are operating a motor vehicle and your blood contains more than 80 milligrams of alcohol in 100 milliliters of blood (.08%).
• for 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.
• an illness or injury caused or contributed to by a Motor Vehicle Accident that occurs in Ontario or Quebec.
• during any leave of absence (including Maternity/Paternity Leave).
• if you are receiving disability benefits, early retirement benefits or retirement benefits under any Employer or Union sponsored pension plan.
• for disability for which you are entitled to receive reimbursement under any Workplace Safety and Insurance law or similar legislation.
• for the portion 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 a 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.
• to an insured individual who refuses to participate in a rehabilitation program which is deemed appropriate by the Insurer, the attending physician or on the advice of independent medical opinion.

Canadian Residency Required

No benefits are payable if the Member resides outside Canada for any period exceeding 90 consecutive days or a total of 180 days in any 365-day period unless the Member:

• has previously notified and received approval in writing from the Insurer, or
• remains under the regular care of a licensed physician deemed appropriate by the Insurer, and
• proof of the ongoing disability can be determined on evidence satisfactory to the Insurer in English or French within 90 days of request.

Extended Insurance

If your Long Term Disability insurance terminates during a period of total disability, the Insurer continues to be liable as though the provision remained in force. If a recurrence of disability occurs within 6 continuous months after termination of this benefit, the Insurer shall continue to pay your benefits but only for the remainder of the original maximum benefit period. Such disability must have been caused by an accident or sickness that occurred before termination. The Insurer shall not be liable for benefits after termination of either the contract or Long Term Disability Income benefit once a replacing Insurer is bound contractually or as a matter of law.

Termination of Coverage

Your eligibility for Long Term Disability terminates the earlier of your retirement or attainment of age 65.

How to File a Claim for Long Term Disability Benefits

After approximately 22 weeks of receiving combined Weekly Wage Replacement and Employment Insurance sickness benefits, the Claims Office 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 Plan.

When the forms have been fully completed by yourself, your employer and your physician, forward the forms to the Claims Office. Your claim will be validated and forwarded to the Insurance Company for assessment. Your benefit cheques will be mailed directly to you.

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

Proof of Loss

Written proof stating the occurrence, character and extent of loss must be submitted to the administrator within 6 months after the end of the qualifying period for Long Term Disability Insurance. The qualifying period is 26 weeks, therefore you must apply within one year of leaving work due to disability.

Written proof of the continuance of disability must be furnished to the Insurer at such intervals as it may reasonably require. As part of the proof, the Insurer shall have the right to require satisfactory evidence that the Member has made application for all benefits referred to in the reductions provision and that he has furnished all required proofs for such benefits. If the Member did not make such application, he must provide satisfactory evidence that he was not eligible for such benefits. The Insurer shall also have the right to require satisfactory evidence of the amount of such benefits payable.

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.