Long Term Disability (LTD)

Definitions

As used in this Benefit

Elimination Period means the period, as specified in the Benefit Schedule, of continuous Total Disability that must be completed before Long Term Disability Benefits commence under this Benefit.

If a Participant can and does continue his coverage under this Benefit throughout any absence or leave (other than a Maternity, Parental or Family-Related absence or leave) as described in the policy, and such Participant becomes Totally Disabled during such leave, the Elimination Period will be deemed to commence on the date the Participant is scheduled to return to active work.

Net Monthly Earnings means the gross monthly Earnings in effect immediately prior to commencement of Total Disability less all income taxes and contributions to the Canada/Quebec Pension Plan and Employment Insurance payable thereon, or any other contribution to a public income replacement plan.

Maximum Benefit Period means the maximum period during which monthly benefits are payable, as specified in the Benefit Schedule.

Evidence of Insurability

Evidence of insurability satisfactory to the Insurer will be required of a Participant applying for any benefit amount of Long Term Disability in excess of the amount specified in the Benefit Schedule as the Non-Evidence Maximum of Insurability under the Participant Long Term Disability Benefit.

Payment Of Benefit

Upon receipt of Proof of Claim satisfactory to the Insurer that

  1. a Participant became Totally Disabled while insured under this Benefit and remained Totally Disabled during the Elimination Period; and
  2. the Participant is under Continuing Medical Care of a Physician, as defined under the DEFINITIONS provision of the policy;

the Insurer will pay monthly Long Term Disability Benefits for as long as the Participant is Totally Disabled, in accordance with applicable policy provisions, up to the Maximum Benefit Period.

The “health related portion” of the Maternity Leave taken by a Participant is considered to be a period of Total Disability for the purposes of benefit payment under this Benefit, whether the Participant’s insurance was continued during the leave or not. The maternity benefits payable under any public or private plan are deducted from the benefits payable to the Participant for this period, in accordance with the provisions of the contract.

For a Total Disability that begins during the voluntary leave portion of a Maternity Leave, or during a Parental or Family-Related Leave, benefits are payable from the later of the following dates, provided the current benefit remained in force and provided the Participant is still Totally Disabled and insured under this Benefit:

  1. the end of Elimination Period;
  2. the scheduled date of return to work.

The amount of Long Term Disability Benefit payable will be the amount specified in the Benefit Schedule based on the monthly Earnings in effect immediately prior to the initial date of Total Disability.

Long Term Disability Benefits are payable at the end of each monthly period of Total Disability, commencing on the date the Elimination Period is completed.

The Elimination Period commences on the later of the following dates:

  1. the day after the last day the Participant was Actively At Work, if they consult a Physician within 14 days of the beginning of Total Disability; or
  2. the first day the Participant consults a Physician if they do so more than 14 days after the Total Disability began.

Any payments for a period of less than one month will be at the daily rate of 1/30 of the monthly benefit.

Long Term Disability Benefits may be taxable in accordance with the Benefit Schedule.

Reduction of Long Term Disability Benefits, Limitations and Exclusions

  1. Direct Offset: Long Term Disability Benefits otherwise payable to the Participant under this Benefit will be reduced by
    1. any benefits the Participant is eligible to receive under any Workers’ Compensation Act or similar legislation; and
    2. any disability benefit the Participant is eligible to receive under the Canada Pension Plan or the Quebec Pension Plan excluding
      1. benefits payable on behalf of his Dependents; and
      2. any increase in benefits due solely to cost-of-living, after benefit payments commence; and
    3. any indemnity payable for loss of time under any government plan requiring or providing automobile insurance benefits on a no-fault basis;
    4. any disability benefit payable by a private pension plan.
  2. Indirect Offset: In addition, the Insurer will further reduce Long Term Disability Benefits by any amount by which the total monthly income of the Participant from all sources exceeds
      1. 100% of his gross monthly Earnings immediately prior to Total Disability, if the Long Term Disability Benefits are included in his income under the Income Tax Act (Canada); or
      2. 100% of his Net Monthly Earnings immediately prior to Total Disability, if the Long Term Disability Benefits are not included in his income under the Income Tax Act (Canada).

The total monthly income of a Participant from all sources, whether they receive or are eligible to receive this income, will include all of the following:

  1. any Long Term Disability payments under this Benefit;
  2. any monthly Earnings or payments from the Employer;
  3. any disability benefits payable under the Quebec Pension Plan, excluding benefits payable on behalf of Dependents and any increase in benefits after benefit payments commence due solely to the cost-of-living;
  4. any disability benefits payable under the Canada Pension Plan, excluding benefits payable on behalf of Dependents and any increase in benefits after benefit payments commence due solely to the cost-of-living;
  5. any disability benefits payable under any Workers’ Compensation Act or similar legislation or any other government plan, excluding the Employment Insurance Act;
  6. any disability benefits payable under any other group or association insurance plan;
  7. any disability benefit payable by a private pension plan, excluding any increase in benefits after benefit payments commence due solely to cost of living;
  8. any indemnity for loss of time payable under any government plan requiring or providing automobile insurance benefits on a no-fault basis.

In the event that a lump-sum payment is made under any of the above­ mentioned sources in 1) and 2) in lieu of monthly payments, monthly benefits will be reduced by the equivalent monthly payment over a period of 60 months or by the number of months of disability for which the lump sum is paid, whichever is the lesser. The Insurer may also reduce the monthly Long Term Disability payments even if the Participant, who is required to make the necessary application, fails or refuses to exercise his rights under the above-mentioned legislation or plans. The Insurer may, at its discretion, estimate the amount of a government plan award pending notice of the actual award.

Limitations: No benefits are payable for a period of Total Disability

  1. during which the Participant is not under Continuing Medical Care, for the Illness or bodily injury causing the Total Disability;
    1. during the voluntary leave portion of the Maternity Leave as described under the DEFINITIONS section, for a total disability occurring during this period;
    2. during a Parental or Family-related Leave taken by a Participant, as provided for under provincial or federal legislation, for Total Disability occurring during this period;
    3. during any work stoppage due to a strike, lock-out, Leave of Absence or lay-off, for a Total Disability occurring during this period;
    4. during the imprisonment of the Participant due to conviction of an offence;
    5. if the Participant remains outside Canada for longer than 3 months for any reason whatsoever, unless the Insurer gives prior written consent to continue paying benefits during this period.

No benefits are payable for any period of Total Disability beginning during the first 12 months of coverage of a Participant, if such Total Disability was directly or indirectly the result of an Illness or Accident that was treated by a Physician or for which prescribed drugs were taken during the 3 month period immediately prior to the effective date of such coverage.

However, if the policy has been in force for less than 12 months, and the Participant has been covered under any comparable benefit, for any period of time immediately prior to the Effective Date of the policy, that period of time will apply in determination of the 12 month coverage period. For Non-Unionized Support Staff, coverage under a comparable benefit must be under the Employer’s previous group insurance policy.

  1. Exclusions: No benefits are payable for a Total Disability resulting directly or indirectly from any one of the following:
    1. war, whether the war be declared or not, or service in the armed forces of any country, or participation in a riot, insurrection or civil commotion;
    2. committing, or attempting to commit a criminal offence;
    3. cosmetic surgery or treatment, unless such surgery or treatment is required as a result of an Accident that occurred while the Participant was insured under this Benefit;
    4. alcohol or drug abuse unless, for such abuse, the Participant is actively taking part in a therapeutic program supervised by a Physician on an on-going basis, is receiving Continuing Medical Care or treatment for rehabilitation and is staying in an established treatment centre qualified to provide the necessary treatment or care;
    5. driving a motorized vehicle while impaired by drugs, or with an alcohol level that exceeds the limit set under the Criminal Code of Canada.

Recurrent Total Disability

Successive periods of Total Disability due to the same cause or related causes are considered to be the same period of Total Disability unless they are separated by at least

  1. 3 consecutive weeks of active full-time employment during the Elimination Period; or
  2. 6 consecutive months of active full-time employment immediately following a period of Total Disability for which Long Term Disability Benefits were paid under this Benefit.

Successive periods of Total Disability due to entirely unrelated causes are considered to be the same period of Total Disability, unless they are separated by at least 1day of active full-time employment.

Whenever successive periods of Total Disability are considered to be the same period of Total Disability, the Elimination Period will not be applied a second time and the same amount as for the initial Total Disability minus any payments already made will be payable for the remainder of the Maximum Benefit Period.

Disability Management

The Insurer may at any time require a Totally Disabled Participant to participate in a disability management program or to take up rehabilitative employment that is considered appropriate by the Insurer.

The Insurer will actively co-ordinate all disability management program services listed below and will also facilitate and ensure case follow-up:

  1. co-ordination of access to health care services;
  2. support program for returning to work;
  3. negotiations for a gradual return to work,
  4. rehabilitation program, which may include evaluation, treatment, training, placement and job search services.

If a Totally Disabled Participant, while receiving Long Term Disability Benefits, takes part in a disability management program or takes up rehabilitative employment under the supervision of his Physician and with the approval of the Insurer:

  1. the Participant will still be considered Totally Disabled while taking part in this program, subject to a maximum of 24 months;
  2. if, while taking part in this program, a Participant becomes Totally Disabled again, the terms and conditions of this Benefit will re-apply to the Participant as if they had been Totally Disabled during the rehabilitation period;
  3. the Maximum Benefit Period during any period of Total Disability will continue to apply even if the Participant is taking part in an approved disability management program or rehabilitative employment;
  4. if, while taking part in this program, the Participant earns any income, the Long Term Disability Benefits payable by the Insurer to the Participant will be reduced by
    1. 50% of his pre-disability Earnings, if this Benefit is taxable, or
    2. 50% of his pre-disability Net Earnings, if this Benefit is non-taxable.
  5. while the Participant is taking part in a disability management program, the Insurer will reduce his Long Term Disability Benefits so that his total income from all sources, if any, as listed in the INDIRECT OFFSET provision of the REDUCTION OF LONG TERM DISABILITY BENEFITS, LIMITATIONS AND EXCLUSIONS section of this Benefit, does not exceed 100% of his Net Earnings immediately prior to the commencement of Total Disability if this Benefit is non-taxable, or 100% of his gross Earnings immediately prior to the commencement of Total Disability if this Benefit is taxable.

A Participant who refuses to take part in a disability management program, does not participate in such program in good faith or does not take up rehabilitative employment considered appropriate by the Insurer will no longer be eligible for monthly benefits payable under this Benefit.

Termination of Benefits

Long Term Disability Benefits will cease on the earliest of

  1. the date the Participant ceases to be Totally Disabled;
  2. the date the Participant engages in any gainful occupation other than an approved gainful occupation for the purpose of rehabilitation;
  3. the date set by the Insurer the participant was required to provide satisfactory proof of total disability or to undergo a medical examination requested by the Insurer, but neglected or refused to do so;
  4. the date payments have been paid up to the Maximum Benefit Period for any one period of Total Disability;
  5. the date the Participant refuses to participate in a disability management program or to take up rehabilitative employment considered appropriate by the Insurer; and
  6. the date the Participant attains the Age Limit specified in the Benefit Schedule.

Extension of Benefit After Termination

If a Participant is Totally Disabled on the date his insurance terminates, the Insurer will continue insurance for that Total Disability as if the insurance under this Benefit for that Participant were still in force, provided such Total Disability continues uninterrupted, subject to all other provisions of the policy.

Notice And Proof of Claim

Initial written notice of a claim must be submitted to the Insurer within 30 days of the expiry of the Elimination Period and initial written proof, within 180 days of the expiry of the Elimination Period.

In the event of the recurrence of Total Disability, written notice of a claim must be submitted to the Insurer within 30 days of the date of such recurrence and written proof within 180 days of the date of such recurrence.

Subsequent written proof satisfactory to the Insurer of continuing Total Disability must be submitted to the Insurer at its request.