Short Term Disability (STD)

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 Short 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.

Hospitalization means:

  1. to be admitted to a Hospital as an in-patient for more than 18 consecutive hours; or
  2. any Hospital stay during which the Participant undergoes surgery performed by a Physician and which required local or general anaesthesia, excluding any minor surgery that can be performed in the office of a Physician.

Maximum Benefit Period means the maximum number of weeks during which benefits are payable. This period is specified in the Benefit Schedule. If this benefit, in accordance with the Benefit Schedule, is carved out with the Employment Insurance Act (El) as a standard wrap around plan, the Maximum Benefit Period includes the number of weeks during which El benefits are paid by Human Resources Development Canada.

Net Weekly Earnings means the gross weekly 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.

Total Disability or Totally Disabled means the inability of the Participant as a result of an Illness or Accident to perform all the usual duties of his main occupation and which requires Continuing Medical Care.

A Participant who needs a driver’s licence issued by the government to perform the duties of his regular occupation is not considered disabled simply because his licence has been revoked or has not been renewed.

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

To qualify for Short Term Disability Benefits, any Accident causing the Total Disability, as defined in the DEFINITIONS above, must be confirmed by a Physician and sustained not more than 30 days prior to the onset of such disability.

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 Short Term Disability Benefit payable under this Benefit will be the amount specified In the Benefit Schedule based on the Earnings in effect immediately prior to commencement of Total Disability.

The Short Term Disability payments may be taxable in accordance with the Benefit Schedule.

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

The Elimination Period is expressed in calendar days and 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 week will be at the daily rate of 1/7th of the Short Term Disability Benefit.

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 Short 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 the Maximum Benefit Period specified in the Benefit Schedule;
  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 Short Term Disability Benefits payable by the Insurer to the Participant will be reduced by the amount produced by the following formula:(A + B) x C
    A = Income earned from any rehabilitative activity
    B = Earnings of the Participant immediately prior to commencement of Total Disability
    C = Benefits otherwise payable under this Benefit
  5. while the Participant is taking part in a disability management program, the Insurer will reduce his Short Term Disability Benefits so that his total income from all sources, if any, does not exceed 100% his Net Earnings immediately prior to commencement of Total Disability if this Benefit is non-taxable, or 100% of his gross Earnings immediately prior to commencement of Total Disability if this Benefit is taxable.The Participant’s total income from all sources includes any of the following listed below that they have received or is eligible to receive:
    1. any weekly benefits payable under this Benefit;
    2. any weekly Earnings or payment from the Employer;
    3. any disability benefits payable under the Canada Pension Plan or the Quebec Pension Plan, but excluding benefits payable on behalf of his Dependents and any increase in benefits after benefit payments commence due solely to the cost-of-living;
    4. any disability benefits payable under the Workers’ Compensation Ad or similar legislation or any other government plan, excluding benefits payable under the Employment Insurance Ad;
    5. any benefits payable from a retirement or pension plan provided by the Policyholder, excluding any increase in benefits after benefit payments commence due solely to the cost-of-living;
    6. any indemnity payable for loss of time under any government plan requiring or providing automobile insurance benefits on a no-fault basis, provided that these plans have been approved as an acceptable limitation and still permit this Benefit to be registered for premium reduction under the Employment Insurance Ad, as amended from time to time.

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 Short Term Disability Benefits under the policy.

Recurrent Total Disability

Successive periods of Total Disability occurring after the Short Term Disability Benefits became payable are considered to be the same period of Total Disability unless they are separated by at least:

  1. 2 consecutive weeks of active full-time employment, if Total Disability is due to the same cause or related causes; or
  2. 1 day of active full-time employment, if Total Disability is due to an entirely unrelated cause.

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 fur the initial Total Disability minus any payments already made will be payable for the remainder of the Maximum Benefit Period.

Reduction of Short Term Disability Benefits, Limitations and Exclusions

  1. Reduction of Short Term Disability Benefits: Short Term Disability Benefits payable under this Benefit will be reduced by
    1. any benefits the Participant is eligible to receive under any Workers’ Compensation Act or similar legislation;
    2. any disability benefits 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 the 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;
      1. the Automobile le Insurance Act of the Province of Quebec;
      2. the Ontario Motorist Protection Plan; or
      3. any other government no-fault automobile insurance plan provided that these plans have been approved as an acceptable limitation and still permit this Benefit to be registered for premium reduction under the Employment Insurance Act, as amended from time to time;
    4. any income replacement benefits paid to the Participant under any other federal or provincial legislation: and
    5. any benefit paid to the Participant under any employee benefit plan established by the Policyholder,
    6. any severance or wrongful dismissal payments.

The Insurer may, at its discretion, estimate the amount of a government plan award pending notice of the actual award.

The Insurer may also reduce the Short 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.

If the Participant receives a lump-sum payment from any of the sources indicated above, the Insurer will reduce the Short Term Disability payments by this amount, calculated on a weekly basis.

  1. Limitations: No benefits are payable for a Total Disability period
    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, for a 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.
  2. Exclusions: No benefits are payable for a Total Disability resulting directly from any one of the following causes:
    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 a criminal offence;
    3. cosmetic surgery or treatment, unless such surgery or treatment is required as a result of an Illness or injury;
    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.

Termination of Benefits

Short Term Disability Benefits payable under this Benefit 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 the Participant fails to furnish satisfactory proof of continued Total Disability to the Insurer;
  4. the date payments have been paid up to the Maximum Benefit Period for any 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 under this Benefit. However, if a Participant is Totally Disabled prior to this Age Limit and on attaining it they are still so disabled and has not yet received 117 day of benefit payments for that disability, notwithstanding the Age Limit of this Benefit, coverage will be extended to the earliest of
    1. the date such Participant has received 117 days of benefits;
    2. the date such Participant ceases to be Totally Disabled; or
    3. the date such Participant retires.

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

Written proof of a claim must be submitted to the Insurer within 180 days of the date Total Disability commenced.

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