LONG TERM DISABILITY BENEFIT
(Refer to your Identification Card and Collective Agreement for the amount of benefit.) In the event that you become Totally Disabled for the required period of time known as the Qualifying Disability Period, and you are under the continual treatment of a legally qualified Physician, you will receive a monthly LTD benefit. Great West Life (the insurer) requires that application for Premium Waiver or LTD benefits be received within 12 months of the date of disability. When an employee is receiving wage loss benefits for non-occupational disabilities, application forms are sent to the Member automatically. However, when an employee is collecting wage loss benefits from WCB, application is not automatic and must be submitted through the Administrator. The employee must advise the Administrator of his status with WCB and their intention to apply for LTD. The application for benefits should be made a few months in advance of the 12-month mark. It is important to open a claim file with GreatWest Life even if benefits are currently being received from WCB. A premium waiver, once approved, maintains the Life Insurance benefit in force, while disabled, up to age 65, without any premium payable - so it is very important for the Member, that application be made in accordance with the insurer’s rules.
Qualifying Disability Period
A Member must be Totally Disabled for a period of 52 consecutive weeks or for the duration of the weekly benefit period provided under the Weekly Income Benefit, whichever is greater. Prior to the commencement of the LTD benefit, disabled Members may attempt to return to work for up to 30 days in aggregate, before a new Qualifying Disability Period for the LTD benefit will be required and the disability considered a new claim. No LTD benefits are payable beyond the end of the month in which the Member turns age 65.
Maximum Disability Period
Nervous or mental or emotional non-psychotic sickness or disorder - to age 65, but you must be under the care of a Psychiatrist and receiving treatment; Psychosis - to age 65, but you must be under the care of a Psychiatrist and receiving treatment; Drug addiction or alcoholism - to age 65. If substance abuse contributes to your disability, the treatment program must include participation in a recognized substance withdrawal program. Other Sickness - to age 65; Accidental Injury - to age 65. Benefits will not be payable beyond age 65.
You are considered Totally Disabled if you are incapacitated to the extent that you are not able to perform any and every duty of any occupation or employment that pays at least 60% of your pre-disability inflation-indexed gross earnings and for which you are or may reasonably become qualified by reason of education, training or experience.
The amount payable under this benefit for Total Disability is calculated by deducting from your benefit any other sources of income. These are specified in the Master Policy and include the following:
• wages or retirement benefits payable from your employer or employer’s pension or retirement plan;
• any payments on account of your disability from any Workers’ Compensation law or similar law;
• payments received from the Canada or Quebec Pension Plan, (Disability or Retirement Benefits) excluding payments made in respect of dependent children;
• any income or benefit payable under any other plan or program of any government or the Crown or of any subdivision or agency of the government or the Crown, including any plan or program established pursuant to a Provincial Automobile Insurance Act. All Source Maximum: Your total monthly income while disabled (Long Term Disability Benefit plus any income listed above and Canada or Quebec Pension Plan family benefits) cannot exceed 85% of your gross monthly earnings as of the date your disability commenced if the benefit is taxable, or 85% of your net monthly earnings as of the date your disability commenced, if the benefit is non-taxable. If your total income exceeds 85%, your Long Term Disability Benefit will be reduced accordingly.
If a Member, who has satisfied some but not all of the Qualifying Disability Period, returns to work for up to 30 days in aggregate and again becomes Totally Disabled, according to the terms and conditions of this policy, as a result of the same sickness or injury, such later period of disability will be deemed by the Plan to be a continuation of the previous period of disability and the Qualifying Disability Period will be extended by the number of days worked by the Member during that period. If a Member, who has received benefits under the Long Term Disability benefit of this policy, returns to work for a period of 180 days or less and again becomes Totally Disabled, according to the terms and conditions of this policy, as a result of the same sickness or injury, such later period of disability will be deemed by the Plan to be a continuation of the previous period of disability. No new Qualifying Disability Period will be required, however, no benefits are payable for any period of such employment.
Exclusions and Limitations
If an employee has been absent from work due to sickness or bodily injury at any time during the 4-week period immediately preceding the effective date of his insurance under this benefit, his insurance shall not cover any disability which is due to the same or a related sickness or bodily injury until he shall have completed, subsequent to his last day of absence, a period of 4 consecutive weeks of employment without absence from work due to the same or a related sickness or bodily injury. Benefits are not payable for the following:
- disabilities resulting from self-inflicted injuries or attempted suicide;
- disabilities as a result of participation in a war, riot, insurrection or criminal act;
- a disability resulting from an accident which occurs while you are operating a motor vehicle and the blood contains more than 80 milligrams of alcohol in 100 millilitres of blood (.08%);
- any period of disability, or portion thereof during which you are not under the care of a legally qualified Physician, and no such period of time shall be counted towards the Qualifying Disability Period;
- for the portion of a period of disability during which you are:
(a) imprisoned in a penal institution, or
(b) confined in a hospital, or similar institution, as a result of criminal proceedings;
- any period of disability, or portion thereof, during any leave of absence;
- for a disability which commences on or after the date a strike or layoff begins, except as outlined in the Master Policy;
- any period in which the person does not participate or cooperate in a reasonable and customary treatment program.
A reasonable and customary treatment program is systematic treatment that:
(a) is performed or prescribed by a legally licensed doctor of medicine; and
(b) is of the nature and frequency usually required for the condition involved.
Where considered appropriate by Great West Life for the severity of the condition, the treatment must be prescribed by and, if appropriate, performed or supervised by a certified specialist for the condition involved. If substance abuse contributes to a person’s disability, his treatment program must include participation in a recognized substance withdrawal program.
In the event of any payment under this coverage, the Insurer shall be subrogated to all of your rights of recovery therefore against any person or organization and you shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. You shall do nothing to prejudice such rights.
If you are disabled, the Insurer may recommend that you undergo some suitable rehabilitation training program which would take into account the nature and limitations of your disability. Further details on this aspect will be provided in the event that you become disabled.