Long Term Disability (LTD) benefits provide a continuing monthly income if sickness or injury prevent an employee from working.

Information available on this page includes:

Eligibility

Qualifying Disability Period

The qualifying disability period starts when an employee first becomes totally disabled and ends after the period outlined in the Schedule of Insurance, provided the disability is continuous and the employee is under age 65.  If the disability is not continuous, the days the employee is disabled will be accumulated to satisfy the qualifying disability period provided:

    1) no interruption is longer that 2 weeks;

    2) the disabilities arise from the same or related disease or injury

The qualifying disability period will be the greater of the period outlined in the Schedule of Insurance, or the duration of the Weekly Disabililty Income Benefit, if applicable.

Maximum Benefit Period

The maximum benefit period is age 65.

Benefits may be payable after the employee's attainment of age 65 if the employee satisfies the Qualifying Disability Period while age 64, in which case the maximum benefit period shall be 12 consecutive months.  In no event shall benefits be payable after the employee's death, recovery or attainment of age 65.

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Subrogation

If an employee is entitled to recover compensation for loss of income from a third party as a result of the incident which caused or contributed to the disability, for which benefits are paid or payable, the Insurer will be subrogated to all the rights of recovery of the employee for loss of income, to the extent of the sum of benefits paid or payable by the Insurer.  The employee shall execute such documents as required by the Insurer.

In the event that the insured employee provides proof to the Insurer that the said employee has not recovered full compensation for loss of income, the Insurer shall determine the proportion of damages actually recovered and share pro rata in that amount.

Should the employee chose to settle the matter prior to judicial determination, the employee understands that the sum reached in settlement will be deemed to be full compensation for loss of income, and the Insurer's right of subrogation will apply.

The term compensation shall include any lump sum periodic payment which the employee recieves or is entitled to recieve on an account of past, present or future loss of income.

Waiver of Premium

The Insurer will waive the payment of premiums for the Long Term Disability insurance for each employee who is receiving benefits under this coverage.  Premiums will be waived beginning with the premium for the first full policy month for which benefits became payable and continuing for each full policy month for which benefits are payable.

Extension of Benefits

If the contract or Long Term Disability Income plan terminates and the employee is totally disabled at such termination, the Insurer continues to be liable as though the coverage remained in force.

If a disability recurs within 6 continuous months after termination of this plan, the Insurer will continue to pay benefits to the employee but only for the remainder of the original maximum benefit period.  Such disability must have been caused by an accident or sickness that occured before termination.  The Insurer shall not be liable for benefits after termination of either the contract or long term disability income plan once a replacing Insurer is bound contractually or as a matter of law.

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Benefit in the Event of Total Disability

If an employee becomes totally disabled before age 65 because of a disease or an accidental injury, the Insurer will pay a monthly benefit during the applicable benefit period.  The amount of the monthly benefit will be the Gross Benefit specified in the Schedule of Insurance, less any income and benefits payable under Reductions of Coverage, subject to the All Source Maximum (where applicable).  Due proof must be submitted to the Insurer that the employee became totally disabled while insured under this coverage and has been continuously disabled for the qualifying disability period.

Totally Disabled, with respect to Classes 003, 004, 005, 006,007 and 008, for the first 24 consecutive months of benefit payment, shall mean the employee is incapacitated to the extent that the employee is not able to perform any and every duty of the employee's occupation or employment for which the emloyee is reasonably qualified by education, training or experience.  Such incapcity must result from a medically determinable physical or mental impairment.

Totally Disabled, with respect to Classes 001 and 002, shall mean the employee is encapacitated to the extent that the employee is not able to perform any and every duty of any occupation or employment for which the employee is reasonable qualified by education, training or experience.  Such incapacity must result from a medically determinable physical or mental impairment.

Benefits will be payable for each month or partial month that such total disability continues beyond the applicable qualifying period.  Benefits will not be payable for more than the applicable maximum benefit period specified in the Long Term Disability section.

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Reductions of Coverage

The amount of the gross benefit specified in the Schedule of Insurance shall be reduced as follows, subject to the All Source Maximum.

    1) by the amount of income payable to the employee under a pension or retirement plan of the employer, or any plan or arrangement resulting in the payment of any salary, wage or other payment by the employer to the employee during the total disability;

    2) by the amount of any income or benefit payable under:

        a)     any other plan or program provided to the employee by or through the employer.  Such plan or program includes any permenent and total disability benefit of group life insurance for which the employee could have elected not to apply;
        b)     any Workers' Compensation law or similar law;
        c)     the Canada Pension Plan or Quebec Pension Plan benefits outlined in the Schedule of Insurance;
        d)    any other plan or program of any government or the Crown or of any subdivision or agency of the government of the Crown, including any plan or program established pursuant to a provincial automobile insurance act.  The Insurer shall not reduce the monthly benefit in respect of benefits payable by the unemployment Insurance Commission;
        e)     a plan sponsored by an association, union or fraternal organization of which the employee is  a member.

An employee must apply for all benefits or income for which he/she may be or may become eligible under any of the preceeding sources.

If an employee is receiving any income or benefit payable under any government plan or program for an injury or disease totally unrelated to the injury or disease that caused the current disability, the Insurer shall not reduce the gross monthly benefit by that amount.

Reduced Monthly Benefit:  If a disabled employee, eligible for full benefits, elects a different and lesser paid occupation not related to the Program of Rehabilitation described below, the gross benefit less reductions shall be further reduced by 50% of the earnings from the lesser paid occupation elected, subject to the All Source Maximum.

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Benefits During Program of Rehabilitation

The Insurer may recommed that a program of rehabilitation be appropriate for an employee elibible for Long Term Disability Benefits.  The insurer will notify the employee in writting of its approval of the program, and the extent, if any, of its support during such program.

Any of the following may be eligible for consideration as a rehabilitation program:

    1)    the employee's regular occupation on a part-time basis;
    2)    a formal vocational training program; or
    3)     any other training program deemed suitable by the Insurer.

Long Term Disability benefits will continue to be payable to an employee participating in a rehabilitation program approved by the Insurer for up to 24 consecutive months.  After such 24 months, benefits may be extended upon written approval of the Insurer for up to an additional 24 months, but in no event will benefits be payable for more than 48 months in a rehabilitation program during any one period of total disability.

Expenses incurred by the employee in connection with the program and for which the employee has recieved prior approval from the Insurer will be reimbursed by the Insurer priovide that, in the insurers opinion, they are reasonable and customary.  Expenses which are payable through government programs or a third party Insurer shall not be reimbursed by the Insurer.

Reduced Monthly Benefit:  The gross benefit less reductions will be further reduced by 50% of any earnings received from employment under the rehabilitation program, subject to the All Source Maximum.

An employee's involvement in a rehabilitation program will cease on the earliest of the following dates:

    1)    the date the employee ceases to be Totaly Disabled.
    2)    the date the employee completes the rehabilitation program
    3)    the date it is determined by the Insurer that the employee is not participating in the rehabilitation program to the extent previously agreed upon by the employee and Insurer.

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All Source Maximum

a)     With respect to a disabled employee receiving full benefits:

        If the gross month benefit as outlined in the Schedule of Insurance

        i)    less any benefit reductions specified under Reductions of Coverage;
        ii)   plus any income or benefits specified under Reductions of Coverage;
        iii)  plus any Canada Pension Plan or Quebec Pensions Plan family benefits

exceeds 85% of the employee's net earnings at the date disability commenced, the monthly benefit will be further reduced by the amount of such excess.

b)    With respect to a disabled employee electing a different and lesser paid occupation:

        If the reduced monthly benefit (benefit described under Reductions of Coverage)

        i)    plus any benefit or income specified under Reductions of Coverage;
        ii)   plus any Canada Pension Plan or Quebec Pension Plan family benefits;
        iii)  plus the income from any newly elected occupation excluding income from a Program of Rehabilitation

exceeds 85% of the employees net earnings at the date the disability commenced, the reduced monthly benefit shall be further reduced by the amount of such excess.

c)    With respect to a disabled employee participating in a Program of Rehabilitation:

        If the reduced monthly benefit (benefit described under Program of Rehabilitation)

        i)     plus any benefit of income specified under Reductions of Coverage;
        ii)    plus any Canada Pension Plan or Quebec Pension Plan family benefits;
        iii)   plus the income from the Program of Rehabilitation

exceeds 100% of the employee's net earnings at the disability commeced, the reduced monthly benefit shall be further recudec by the amount of the excess.

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Frozen Benefits

The employee's monthly benefit shall not be reduced due to a government plan or program cost-of-living adjustment occuring after the date on which benefits became payable.

Continuous Period of Disability

If an employee who was receiving Long Term Disability benefits becomes disabled from the same or related causes within 6 months after reutrn to active work, he will be considered disabled for one continuous period.  If an employee has returned to active work for one full day and becomes disabled from different and unrelated causes, he will begin a new period of disability.

Appeal Procedure

If an employee appeals the denial/termination of a Long Term Disability claim he/she must submit to the Insurer, a written notice of appeal.  The notice must be sumbitted to the Insurer within 60 days of the date of the Insurer's denial/termination notice.  Medical or other supportive documentation are the responsibility of the employee.

If the above provision is in conflict with the applicable law of the employee's province of residence, the provision shall be deemed amended to conform with the minimum requirements of the law.

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Exclusions and Limitations

No benefit shall be payable

1)    for any portion of a period of disability unless the employee is recieving ongoing supervision/treatment by a physician deemed appropriate by the Insurer for the impairment which is causing the disability.  The employee will not be paid for any portuion of a period of disability during which he/she does not participate in the treatment program recommended by said physician;

2)    for any portion of a period of disability during which the employee is recieving treatment by a therapist unless such treatment is recommended by a physician deemed appropriate by the Insurer;

3)    for any portion of a period of disability resulting from substance abuse, including alcoholism and drug addiction, unless the employee is participating in a recognized substance withdrawl program;

4)    for disability resulting from injury or disease which occured while the employee is on active duty in the armed forces of any country, state or international organization or for disabilty resulting from war, act of war, whether declared or undeclared;

5)    for disbility resulting from participation in the commission of a criminal offence;

6)    for the portion of a period of disability wich the employee is

    a) imprisoned in a penal institution; or
    b) confined in a hospital, or similar institution, as a result of criminal proceedings;

7)    for disability resulting from intentionally self-inflicted injury or disease or attempted self destruction, whether the employee is sane or insane;

8)    during any leave of absence (including maternity leave) as defined in the Definitions section;

9)    for a disability which commences on or after the date of a strike or layoff begins, subject to any provincial Employment or Labour Standards Act;

10)   to an insured individual who refuses to participate in a rehabilitation program which is deemed appropriate by the Insurer, the attending physician or on the advice of independent medical opinion;

11)   for a disability resulting from an illness or injury while working for compensation for more than 20 hours per week for another employer.

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Canada Residency Requirement

No benefits are payable if the employee resides outside Canada for any period exceeding 90 consecutive days or a total of 180 dyas in any 365 day period, unless;

    i)    the employee has previously notified and received approval in writting from the Insurer, and 
    ii)   the employee remains under the regular care of a licensed physician deemed appropriate by the Insurer, and
    iii)   proof the ongoing disability can be determined on evidence satisfactory to the Insurer in English or French within 30 days of request.