D.A. TOWNLEY  -  Plan Administrators  
 

health benefits

 
 
 

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT

The Basic Accidental Death and Dismemberment plan covers you 24 hours a day, anywhere in the world, for specified accidental losses occurring on or off the job. If you suffer any of the losses listed below in the Schedule of Losses as the result of an accidental injury which results directly and independently of all other causes and the loss occurs within the 365 days of the date of the accident, the benefits below will be paid.

 

Amount of Coverage

Employee An amount equal to the Group Life Insurance amount but not to exceed $500,000.00
Spouse (under age 70) $20,000.00
Dependent Children (to age 23 or 25 if F/T student) $5,000.00

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Schedule of Losses

Loss of Life The Principal Sum
Loss of Both Hands The Principal Sum
Loss of Both Feet The Principal Sum
Loss of Entire Sight of Both Eyes The Principal Sum
Loss of One Hand and One Foot The Principal Sum
Loss of One Hand and the Entire Sight of One Eye The Principal Sum
Loss of One Foot and the Entire Sight of One Eye The Principal Sum
Loss of One Arm Three-Quarters of The Principal Sum
Loss of One Leg Three-Quarters of The Principal Sum
Loss of One Hand Two-Thirds of The Principal Sum
Loss of One Foot Two-Thirds of The Principal Sum
Loss of The Entire Sight of One Eye Two-Thirds of The Principal Sum
Loss of Thumb and Index Finger of the Same Hand One-Third of The Principal Sum
Loss of Speech and Hearing Two-Thirds of The Principal Sum
Loss of Hearing in One Ear One-Third of The Principal Sum
Quadriplegia (total paralysis of both upper and lower limbs) Two Times The Principal Sum
Paraplegia (total paralysis of both lower limbs) Two Times The Principal Sum
Hemiplegia (total paralysis of upper and lower limbs of one side of the body) Two Times The Principal Sum
Loss of Use of Both Arms or Both Hands The Principal Sum
Loss of Use of One Hand or One Foot Two-Thirds of The Principal Sum
Loss of Use of One Arm or One Leg Three-Quarters of The Principal Sum
Loss of Four Fingers of One Hand One-Third of The Principal Sum
Loss of All Toes of One Foot One-Quarter of The Principal Sum

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Exposure & Disappearance
If, by reason of an accident covered by the policy, an Insured Person is unavoidably exposed to the elements and, as a result of such exposure, suffers a loss for which indemnity is otherwise payable hereunder, such loss will be covered under the terms of the policy.
If the body of an Insured Person has not been found within one year of disappearance, forced landing, stranding, sinking or wrecking of a conveyance in which such person was an occupant, then it shall be deemed subject to all other terms and provisions of the policy, that such Insured Person shall have suffered Loss of Life within the meaning of the policy.

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Repatriation Benefit
When injuries covered by this policy result in Loss of Life of an Insured Person outside 50km from their permanent city of residence and within 365 days of the
date of the accident, the insurance company shall pay the actual expenses incurred for preparing the deceased for burial and shipment of the body to the city of residence of the deceased but not to exceed the amount of $15,000.00


Rehabilitation Benefit
When injuries shall result in a payment being made by the insurance company under the Accidental Death & Dismemberment Indemnity section of this policy, the insurance company shall pay in addition: The reasonable and necessary expenses actually incurred up to a limit of $15,000.00 for special training of the Insured Person provided:

(a) such training is required because of such injuries and in order for the Insured Person to be qualified to engage in an occupation in which he would not have been engaged except for such injuries,

(b) expenses be incurred within three years from the date of the accident,

(c) no payment shall be made for ordinary living, travelling or clothing expenses.


Family Transportation
When injuries covered by the policy result in an Insured Person being confined to a hospital, outside 100km from his/her permanent city of residence, within 365 days of the accident and the Attending Physician recommends the personal
attendance of a member of the immediate family, the insurance company shall pay the actual expenses incurred by the immediate family member for transportation by the most direct route by a licensed common carrier to the
confined Insured Person but not to exceed the amount of $15,000.00 The term “member of the immediate family” means the spouse (or commonlaw spouse) parents, grandparents, children age 18 and over, brother or sister of the Insured Person.


Seat Belt Rider
Benefits under the policy shall be increased by 10% if the Insured Person’s injury or death results while he/she is a passenger or driver of a private passenger type automobile and his/her seatbelt is properly fastened. Verification of actual use of the seat belt must be part of the official report of the accident by the investigating officer.


In-Hospital Indemnity Benefit
If an Insured Person suffers a loss under the Table of Losses as a result of a covered accident and requires that an Insured Person be confined to a hospital for more than five (5) consecutive days, the insurance company will pay:
a. a monthly benefit of one (1) percent of the Insured Person’s applicable Principal Sum; or
b. for periods of less than one (1) month, one thirtieth (1/30) of the above monthly benefit per day. Benefits are retroactive to the first (1st) day of hospital confinement.

This benefit is limited to:
a. a monthly amount not to exceed $1,000.00; and
b. a total of twelve (12) months for any covered accident.

Successive periods of hospital confinement for loss from the same covered accident separated by a period of less than three (3) months will be considered as one (1) period of hospital confinement. The term “Hospital” is defined as an establishment which meets all of the following requirements:

(1) holds a license as a hospital (if licensing is required in the Province);
(2) operates primarily for the reception, care and treatment of sick, ailing or injured persons as in-patients;
(3) provides 24-hour a day nursing service by Registered or Graduate Nurses;
(4) has a staff of one or more licensed Physicians available at all times;
(5) provides organized facilities for diagnosis, and major medical surgical facilities; and
(6) is not primarily a clinic, nursing, rest or convalescent home or similar establishment nor is not, other than incidentally, a place for alcoholics or those addicted to drugs.


Permanent Total Disability Indemnity
When, as the result of injury and commencing within 365 days of the date of the accident, an Insured Person is totally and permanently disabled and prevented from engaging in each and every occupation or employment for compensation or profit for which he is reasonably qualified by reason of his education, training or experience, the insurance company shall pay, provided such disability has continued for a period of twelve consecutive months and is total, continuous and permanent at the end of this period, the Principal Sum less any other amount paid or payable under the Accidental Death & Dismemberment Indemnity Coverage of the policy as the result of the same accident.


Day Care Benefits
If indemnity becomes payable under the policy for accidental Loss of Life ofan Insured Person, the insurance company will pay an amount equal to the
lessor of the following amounts:
(1) The actual cost charged by such day care centre per year, or
(2) 3% of the Insured Principal Sum, or
(4) $5,000.00 per year, on behalf of any child who was an Insured Person’s dependent at the time of such loss and is under age 13 and is currently enrolled or subsequently enrolled in an accredited day care center within 90 days following such loss. The benefit is payable annually for a maximum of four consecutive payments but only if the Dependent Child continues his or her enrollment in an accredited day care centre.



Educational Benefit Rider
If indemnity becomes payable for the accidental Loss of Life of an Insured Person, under the policy, the insurance company shall:
1. Pay the lesser of the following amounts to or on behalf of any Dependent Child who, at the date of accident, was enrolled as a full time student in any higher learning beyond the 12th grade level:
(a) The actual annual tuition, exclusive of room and board, charged by such institution per school year.
(b) $10,000.00 per school year.
(c) 5% of the Insured Person’s Principal Sum.
Such amount will be payable annually for a maximum of four consecutive annual payments, only if the Dependent Child continues his education. “Dependent Child” as used herein means any unmarried child under 26 years of age who was dependent upon the Insured Person for at least 50% of his maintenance and support. “Institution of Higher Learning” as used herein includes, but is not limited to, any University, Private College, or Trade School.

2. Pay to or on behalf of the surviving spouse the actual cost incurred within30 months from the date of death of the Insured Person as payment for any professional or trades training program in which such spouse has enrolled for the purpose of obtaining an independent source of support and maintenance, but not to exceed a maximum total payment of $10,000.00.


Home Alteration and Vehicle Modification
If an Insured Person receives a payment under Section III - Coverage herein and was subsequently required (due to the cause for which payment under Section III - Coverage was made) to use a wheelchair to be ambulatory, then this benefit will pay, upon presentation of proof of payment:
(a) The one-time cost of alterations to the injured person’s residence to make it wheelchair accessible and habitable; and
(b) The one-time cost of modifications, necessary to a motor vehicle owned by the injured person, to make the vehicle accessible or driveable for the Insured Person. Benefit payments herein will not be paid unless:
(i) Home alterations are made on behalf of the Insured Person and carried out by an experienced individual in such alterations and recommended by a recognized organization providing support and assistance to wheel-chair users; and
(ii) Vehicle modifications are made on behalf of the Insured Person and carried out by an experienced individual in such matters and modifications are approved by the Provincial vehicle licensing authorities.

The maximum payable under both Items A and B combined will not exceed $15,000.00.


Beneficiary Designation
In the event of accidental Loss of Life, benefits shall be payable as designated in writing by the Insured Person under the Policyholder’s current basic Group Life Insurance policy. In the absence of such designation, benefits shall be payable to the Estate of the Insured Person. All other benefits shall be payable to the Insured Person.


Exclusions
The accident insurance plan does not cover any loss resulting from:
• Suicide or self-inflicted injuries;
• Full-time service in the Armed Forces;
• Declared or undeclared war or any act thereof;
• Injuries received during aircraft travel except for the purposes of transportation where the Insured Person is travelling as a passenger.


 

 

Form Links
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Related Links
Government of BC site for PharamCare

 
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