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For Employees Only
The Long Term Disability (L.T.D.) benefit provides a monthly benefit of
$3,500 for eligible Employees who are Totally Disabled, as
defined below, for a continuous period of time in excess of 52
weeks.
Elimination Period
L.T.D. benefits start after 52 consecutive weeks of Total
Disability, provided the Employee is covered for this benefit at the
commencement of his/her disability. This period may be reduced or
increased to coincide with the date of the last payment under
the Wage Indemnity benefit.
Benefit Duration
Benefits will be paid as long as the Employee remains totally disabled,
but not beyond age 65. No benefits, however, will be
paid for a Total Disability resulting from:
- any period during
which the Employee is not under the regular care and attendance of a
legally licensed physician, who is a
registered specialist in the field of medicine which is
applicable to the disability or the Employee is not undergoing a course
of medical treatment or participating in a program of
rehabilitation which, in the opinion of the Insurer, is
medically required.
- any period while on a pregnancy leave
of absence.
- any period while in receipt of pregnancy benefits, parental leave benefits, pregnancy related
sickness benefits or any combination of such benefits under the
Employment Insurance Act.
- any period while eligible to receive a benefit from WCB or other occupational
disease law.
Reductions
The total amount of monthly income an Employee receives
from this benefit shall be reduced so that the total benefit
from all sources shall not exceed 85% of his/her indexed
pre-disability monthly earnings (if the benefit is taxable) or
85% of his/her indexed net pre-disability monthly earnings (if
the benefit is non-taxable). All sources, as used in the
preceding sentence includes this benefit in addition to benefits
received due to this disability from:
- The Canada Pension
Plan, Quebec Pension Plan (but does not include any benefits
which apply to the Employee’s spouse and child(ren) as a
result of this disability)
- Any Workers Compensation Law,
provincial disability law or any similar law
- Any government
legislated no-fault automobile insurance plan including the
Quebec Automobile Insurance Act, but only to the extent
permitted by such legislation
- A pension or retirement plan of
his/her Participating Employer or of a related employer
- Any
benefit plan provided to the Employee by or through or
administered by his/her Participating Employer or related
employer which has not been referred to elsewhere
- Any group,
association or franchise insurance plan which has not been
referred to elsewhere
- Any plan or program of any government
or of any sub-division or agency thereof which has not yet been
referred to elsewhere
- Any plan or arrangement resulting in
the payment of any salary, wage or other payment by any employer
during the Employee’s disability, whether such payment
involves the rendering of services by the Employee or not
- Damages received from a third party arising out of the same
circumstances that caused the disability.
If the Employee
receives a lump sum settlement from any of the sources described
above, the Employee ’s monthly income benefit under this
benefit will be reduced by the amount that he/she would have
normally received if the payments were being made on a monthly
basis.
"Total Disability" and "Totally Disabled"
mean...
- During the qualifying disability period and the
first 24 months of total disability in a continuous period of
disability thereafter, the complete incapacity, as determined
by the Insurer, due to a medically determinable physical or
mental impairment, as prevents the Employee from performing substantially
all of the essential duties of his/her own occupation.
- Thereafter, in the same period of disability, the complete
incapacity, as determined by the Insurer, due to a medically
determinable physical or mental impairment, to earn more than
75% of his/her indexed pre-disability monthly earnings.
However, if the Employee engages in any occupation or business except as
specifically provided in this Benefit, he/she will be deemed to
be no
longer totally disabled.
Successive Disabilities
If an Employee receives benefits for a disability, returns to work, and
again becomes Totally Disabled while covered, the later
disability will be regarded as a continuation of the prior one
unless he/she has been back to full-time work for at least 6
months. However, if the later absence is due to an unrelated
cause and he/she had returned to full-time work, it will be
considered a new disability.
Most Disabilities Covered
The Plan covers most types of disability. It does not cover
disability resulting from an act of war, intentionally
self-inflicted injury, attempted suicide whether sane or insane,
disability during imprisonment, participating in any riot or
civil commotion; commission of, or an attempt to commit, a
criminal offense or provoking an assault excluding offenses
related to operation of a motor vehicle with a blood alcohol
content in excess of the legal limit in the province of
residence of the Employee.
To Help Get Back To Work...
A "rehabilitation program" means a training or work
related activity that can be expected to facilitate the
Employee's return
to gainful employment.
Once an Employee has completed the qualifying disability period,
he/she will be eligible to enter a rehabilitation program, if approved
in advance by the Insurer, without the Insurer deeming that
he/she has ceased to be totally disabled.
During participation in a rehabilitation program, the Employee's
monthly income benefit will continue, but it will be reduced so
that the total of the monthly income being received under
this Benefit and the sources described in the Reductions
section does not exceed 100% of the indexed pre-disability
monthly earnings (after tax earnings if the monthly income
benefit is non-taxable).
If the Employee participates in a rehabilitation program,
his/her monthly
income benefit will not terminate until the earliest of:
- age 65.
- the end of any period deemed to be reasonable
by the Insurer.
- the date on which the Employee would otherwise cease
to be Totally Disabled as defined in this Benefit.
- the date
on which the Employee would otherwise cease to receive a monthly income
benefit from the Insurer.
The Insurer may pay the expenses incurred by the Employee, other than
usual employment expenses, which are associated with the rehabilitation program, provided the expenses have been
approved, in writing, by the Insurer prior to being incurred.
How to File a Claim
SEND CLAIM TO THE ADMINISTRATOR, DO NOT SEND CLAIM TO THE
INSURANCE COMPANY.
To claim for Long Term Disability benefits, a special claim form
is required.
This form consists of the following sections:
(a) Attending Physician’s Statement
(b) Employer’s Statement
(c) Employee’s Statement
The Physician should complete the “Attending Physician’s
Statement” portion of the form. He or she must clearly
indicate his or her diagnosis, date(s) of service and type(s) of
service rendered.
The “Employer’s Statement” should be
completed by the employer. The date the Employee last worked
must be shown on this form.
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