health
benefits

Long Term Disability

• General
• Classification and Amount
• Benefit Payment Waiting Period
• Waiver of Premiums
• Calculation of the Monthly Integrated Benefit
• Payment
• Recurrent Disability
• Extension of Benefit Payments
• Limitations
• Policyholder Subsidy
• Eligibility for Total Disability Benefits
• Amount of Benefit
• Definitions
   

General
If a Member becomes Totally Disabled while insured for the Long Term Disability Benefit, the Plan will pay the benefits for which that Member is eligible in accordance with the provisions of this policy.

1.  
   1. the Canada Pension Plan or Quebec Pension Plan; and
   2. any workers’ compensation legislation in Canada; and
2. any government disability or retirement benefit plans in any other jurisdiction.

1. engages in any occupation for wage or profit, except as allowed by the provisions of this policy;
2. fails to provide written proof satisfactory to the Plan of continuance of Disability;
3. fails to submit to any medical examination by Physicians of the Plan’s choice;
4. refuses to follow the treatment recommended for his or her disabling condition by a Physician whose specialty encompasses such disabling condition;
5. is no longer receiving regular and ongoing care of a Physician;
6. refuses to enter into any Rehabilitation Program that is considered to be appropriate by the Plan;
7. fails to agree in writing to reimburse the Plan, following written request to do so, for any amounts owed to the Plan;
8. ceases to be Disabled;
9. dies;
10. starts to draw a Union Pension; or
11. has received benefits for the Maximum Benefit Payment Period as shown in the Policy.

1. the Member is receiving benefits under the Long Term Disability Benefit of this policy, or is completing the Benefit Payment Waiting Period on the date the insurance terminated;
2. the Member was Disabled on the date the insurance terminated;
3. the Member has remained Disabled since the date the insurance terminated; and
4. notice of Disability is given by the Member to the Plan within six months from:
   1. the commencement date of Disability with respect to a Member who resides in the province of Quebec,
   2. the termination date of insurance with respect to a Member who resides in a province other than Quebec.

1. The Plan will not pay benefits for any Period of Disability which directly or indirectly results from or is contributed to by a disability due to:
1. a self-inflicted sickness or injury caused while sane or insane,
2. any act related to insurrection or war or participation in a riot, or
3. the Member’s commission or attempted commission of any criminal offense (including an offense related to driving a vehicle while under the influence of alcohol).
2. No amount will be paid for any period:
1. during which the Member is imprisoned, or
2. on formal leave of absence taken by the Member
3. a Member collects Union Pension benefits.
3. The Plan will not pay benefits for a Period of Disability due to:
   1. the chronic use of alcohol or drugs (prescribed or otherwise), or
   2. the use of any hallucinogen,
   unless the Member is under active treatment and is participating in a medically supervised rehabilitation program. All substance abuse claims will be paid a maximum WI benefit of 6 weeks, provided they are in a rehabilitation centre and remain there for the full course of treatment.
4. No amount will be payable for any Period of Disability which results from or is caused by a condition: 
   for which the Member was treated or attended by a Physician, or for which prescription drugs were taken, during the 3 month period prior to the effective date of insurance, 
   until the Member has performed all the duties of his or her regular occupation (on a Full-Time and Full-Pay Basis) for a 12 month period after the effective date of his or her insurance.

1. the Member became Totally Disabled while insured for the Total Disability Benefit,
2. the Member’s Total Disability has continued for a period in excess of the Benefit Payment Waiting Period shown in the policy, and
3. as a result of the Disability, the Member
1. is absent from work,
2. incurs a loss of Earnings, and
3. is not engaged in any occupation for wage or profit, except as specified under the subsection “Rehabilitation Program”.

1. 50% of the Member’s monthly Net (After-Tax) Earnings under an approved Rehabilitation Program; and
2. an amount equal to the amount by which the Member’s
   1. Income from All Sources, plus
   2. 100% of the Member’s monthly Net (After-Tax) Earnings under the Rehabilitation Program
   exceeds 100% of the Member’s monthly Inflation-Indexed, Pre-Disability Net (After-Tax) Earnings.

1. no longer available,
2. no longer published, or
3. changed so that it no longer reasonably reflects the rate of change in the cost of living,

1. disability or retirement benefits provided under the Canada Pension Plan or Quebec Pension Plan (Primary and Secondary Income benefits);
2. any salary continuation from the Employer;
3. any indemnity for loss of time provided under any other group disability plan, including any professional association plan;
4. any retirement income provided under any retirement or pension plan of any other employer if the income commenced after the commencement date of Disability;
5. any indemnity for which the Member is eligible under any Employment Insurance Act, Workers’ Compensation Law or similar legislation;
6. any amount paid or payable under any no-fault automobile insurance policy for disability, loss of income, or wage replacement, if permitted by law;
7. Disability benefits paid by the Plan under this policy.

1. during the Own Occupation Disability Period, is prevented from performing the substantial duties of his or her own occupation;
2. after the Own Occupation Disability Period, is prevented from performing any gainful occupation
1. for which the Member is or may become reasonably qualified by training, education, or experience, and
2. which will enable the Member to earn at least 67% of his or her Inflation-Indexed, Pre-Disability Earnings.