Back

Long Term Disability

Definitions

Disability
means that during the Elimination period and the subsequent 24 months of disability you are prevented, by injury or sickness, from performing each of the essential duties of your own occupation. After that you are prevented from performing each of the essential duties of any occupation for which you are or may become reasonably qualified by education, training, or experience.

Elimination period
means a period of time, when you are continuously disabled, which must be completed before your claim will be considered. It will be calculated from the date disability begins.

Recurrent disability
means a disability that is related to or due to the same cause(s) as a prior disability for which you received benefit payments.

Benefit

We will pay long term disability (LTD) benefits when disability, as defined above, begins while you are insured for the LTD benefit. LTD benefits are paid once a month at month end.

Benefits commence on the day after the Elimination period expires and will be paid only during periods when you are receiving, from your physician, regular care which is appropriate for the condition causing your disability and following the treatment prescribed. We may require consultation and/or treatment by a physician who specializes in the treatment of your condition.

The monthly benefit amount, the elimination period, and the maximum benefit period are shown in the Schedule of Benefits.

Rehabilitation Program

While you are disabled, we may suggest a rehabilitation program to help you return to the work force. This program requires the agreement of your physician and pre-approval by us. It may include, but is not limited to, a return to work on a part time or full time basis, therapy, vocational evaluation, or job preparation. Income you receive under this program will be integrated with your monthly benefit.

Recurrent Disability

A Recurrent disability will be considered part of the prior disability if, after receiving LTD benefits, you returned to any occupation on a full time basis and were able to perform all the essential duties of this occupation for less than 6 months. If you return to any occupation on a full time basis for 6 months or more, a recurrence of disability will be treated as a new period of disability and you must complete another Elimination period.

Extended Benefit

If you are disabled when the Plan terminates, your LTD benefit will continue as though your coverage had not terminated, up to the maximum benefit period, provided you remain disabled.

Coordination with other Income Sources

Your monthly LTD benefit may be reduced by any amount of disability and/or retirement benefit that you are eligible to receive from other income sources. The maximum amount payable from all sources of income is 85% of:

1. your monthly basic earnings, if benefits are taxable
2. your take home pay, if benefits are nontaxable.

For details of other income sources and how your monthly benefit is calculated, contact your Plan Administrator.

Waiver of Premium

The premiums for your LTD benefit will be waived while you are receiving monthly benefits.

Third Party Liability

Benefits will be paid for disabilities due to an accident in which a third party is liable. However, you must reimburse us when you receive payment from the third party.

Are Benefits Taxable?

These Benefits are non-taxable.

Termination of Benefit

Your benefit payments will cease on the earliest date one or more of the following occurs:

1. you are no longer disabled
2. you are no longer receiving regular medical care and treatment from your physician
3. you fail to submit satisfactory proof of continuing disability as required by us
4. you refuse a medical examination by a physician chosen by us
5. you are no longer following the treatment recommended for your disability
6. you refuse to participate in a rehabilitation program
7. your current earnings exceed 80% of your Indexed pre-disability earnings
8. you reach age 65
9. the end of the maximum benefit period indicated in the Schedule of Benefits
10. you retire
11. you die.

Exclusions

Benefits are not payable for any period of disability:

1. arising from any of the following:
   a) self inflicted injury or sickness
   b) participation in an assault or criminal offense, or an act incident thereto
   c) civil commotion, insurrection, any act of war (whether declared or not) or hostilities between nations, or service in the military forces of any nation
   d) a pregnancy related sickness
   i) during any period of formal maternity leave and/or parental leave
   ii) during any period in which Employment Insurance (EI) benefits are being paid
   e) substance abuse, including but not limited to alcoholism or drug addiction, unless you are confined in a public general hospital or you are satisfactorily participating in a withdrawal program approved by us
   f) medical or surgical care which is cosmetic, unless considered medically necessary as a result of injury or sickness
2. that commenced prior to the date you were otherwise eligible for benefits or during a period when you were not eligible for benefits for any reason, unless we agree in writing
3. while you are
   a) in a jail or penitentiary
   b) on leave of absence
   c) involved in a strike or lockout, if the disability commenced after notice of strike or lockout was given
   d) receiving sick pay, vacation pay, or any other salary or wage from your normal or any occupation (except as provided under the rehabilitation program).

Claims

1. We must receive written notice of claim within 30 days of the date disability begins. On receipt of written notice of claim, we will provide you with a claim form.
2. Complete the employee's statement and sign the form on both sides.
3. Return the form to your Plan Administrator for completion of the employer's portion.
4. Have your physician complete and sign the medical portions of the form.
5. Forward the claim form (satisfactory proof of claim) to us within 90 days following the end of the Elimination period.
6. We may request supplementary reports to update the medical or vocational information on file. Any cost for completion of reports will be your responsibility.

Note: Incomplete claim forms will cause a delay in the payment of your benefits.