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For Employees and Dependents
The Basic Accidental Death and Dismemberment plan covers you 24 hours a day, anywhere in
the world, for specified accidental losses occuring on or off the job. If you suffer any of
the losses listed below in the schedule of of losses as a result of an accidental injury which
results directly and independently of all other causes and the loss occurs within 365 days of
the date of the accident, the benefits indicated below will be paid.
Who is Covered/Amount of Coverage
All Employees/Members who are under age 65 — An amount equal to the group
life insurance amount, but not to exceed $5,000,000.00.
All Spouses under age 70 — $20,000.00
All eligible dependent Children — $5,000.00
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 |
The Principal Sum |
| Loss of Hearing in One Ear |
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 |
"Loss" as above used with reference to
quadriplegia, paraplegia, and hemiplegia means the complete and
irreversible paralysis of such limbs; as above used with reference to
hand or foot means complete severance through or above the
wrist or ankle joint, but below the elbow or knee joint; as used
with reference to arm or leg means complete severance through
or above the elbow or knee joint; as used with reference to
thumb and index finger means complete severance through or above
the first phalange; as used with reference to fingers means
complete severence through or above the first phalange of all
four fingers of one hand; as used with reference to toes means
complete severance of both phalanges of all the toes of one foot;
and as used with reference to eye means the irrecoverable loss
of the entire sight thereof.
"Loss" as above used with reference to
speech means complete and irrecoverable loss of the ability to
utter intelligible sounds; as used with reference to hearing
means complete and irrecoverable loss of hearing in both ears.
"Loss" as used with reference to
"Loss of Use" means the total and irrecoverable loss
of use provided the loss is continuous for 12 consecutive months
and such loss of use is determined to be permanent.
All claims submitted under this policy for Loss
of Use must be verified by agreement between a licensed
practicing physician appointed by the Policyholder and a licensed practicing
physician appointed by the Company, or in the event that the two physicians so
appointed cannot arrive at an agreement, a third licensed
practicing physician shall be selected by the first two
physicians and the majority decision of the three physicians
shall be binding on the Policyholder and the Company. This procedure may
be waived by the Company at its sole discretion.
Exposure and 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.
Repatriation Benefit
When injuries covered by this policy result in loss of life of an Insured
Person outside 50 Km from their permanent city of residence and within 365 days
of the date of the accident, the 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
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.
Rehabilitation Benefit
When injuries shall result in a payment being made by the
Company under the Accidental Death & Dismemberment Indemnity
section of this policy, the Company shall pay in addition:
The reasonable and necessary expenses actually incurred up to a
limit of $15,000 for special training of the Insured Person
provided:
- 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/she would not have been engaged
except for such injuries,
- expenses be incurred within three years from
the date of the accident,
- 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 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.
The term "member of the immediate
family" means the spouse (or common-law spouse) parents,
grandparents, children age 18 and over, brother or sister of the
Insured Person.
Conversion Privilege
On the date of termination of coverage or during
the 60-day period following termination of coverage, you may
change your insurance to the BC Life and Casualty Company's
individual insurance policy. The individual policy will be
effective either as of the date that the application is received
by the insurance company or on the date that coverage under the
policy ceases, whichever occurs later. The premium will be the
same as you would ordinarily pay if you applied for an
individual policy at that time. Application of an individual
policy may be made at any office of the BC Life and Casualty Company. The amount of insurance benefit converted to shall not
exceed that amount issued during employment.
Continuance of Coverage
In the case of Members of the Plan who are
- laid-off on a temporary basis,
- temporarily absent from work due to
short-term disability,
- on leave of absence, or
- on maternity leave,
coverage shall be extended for a period of
twelve (12) months, subject to payment of premium.
If a Member of the Plan assumes other
occupational duties during the leave or lay-off period, no
benefits shall be payable for a loss occurring during the
performance of this occupation.
Waiver of Premium
In the event an Insured Person becomes totally
and permanently disabled and his/her waiver of premium claim is
accepted and approved under the Plan's current Group Life
Policy, then the premiums payable under this policy are waived
as of the same date the claim is accepted and approved by the
Group Life Plan Underwriter until one of the following occurs,
whichever is earlier.
- The date the Insured Person attains age 65.
- The date of the death or recovery of the
Insured Person.
- The date the Master Policy is terminated.
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 accident or certified by the investigating
officer.
Home Alteration and Vehicle Modification
If an Insured Person receives a payment for Quadriplegia,
Hemiplegia or Paraplegia as outlined in the schedule of losses
herein and was subsequently required (due
to the cause for which payment under such was
made) to use a wheelchair to be ambulatory, then this benefit
will pay, upon presentation of proof of payment:
- The one-time cost of alterations to the
injured person's residence to make it wheelchair accessible
and habitable; and
- 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:
- 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 wheelchair users; and
- 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 1 and 2
combined will not exceed $15,000.
Educational Benefit
If indemnity becomes payable for the accidental
loss of life of an Insured Member of the Plan, under the policy,
the Company shall:
- 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 institution of higher
learning beyond the 12th grade level:
- The actual annual tuition, exclusive of room
and board, charged by such institution per school year.
- $10,000 per school year.
- 5% of the Insured Employee'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 Employee 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.
- Pay to or on behalf of the surviving spouse
the actual cost incurred within 30 months from the date of death
of the Insured Employee 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.
Day Care Benefits
If indemnity becomes payable under the policy
for accidental loss of life of an Insured Employee, the Company
will pay an amount equal to the lessor of the following amounts:
- The actual cost charged by such day care
centre per year, or
- 3% of the Insured's Principal Sum, or
- $5,000 per year,
On behalf of any child who was an Insured'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 centre 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.
In-Hospital Indemnity Benefit
If an Insured suffers a loss under the Table of
Losses as a result of a covered accident and requires that an
Insured be confined to a hospital for more than five (5)
consecutive days, the insurance company will pay:
- a monthly benefit of one (1) percent of the
Insured's applicable Principal Sum; or
- 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 monthly amount not to exceed $1,000; and
- 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:
- holds a license as a hospital (if licensing
is required in the province);
- operates primarily for the reception, care
and treatment of sick, ailing or injured persons as in-patients;
- provides 24-hour-a-day nursing service by
registered or graduate nurses;
- has a staff of one or more licensed
physicians available at all times;
- provides organized facilities for diagnosis,
and major medical surgical facilities; and
- 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/she is reasonably qualified by reason of his/her
education, training or experience, the 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 and Dismemberment
Indemnity Coverage of the policy as the result of the same
accident.
Exclusions
The Accidental Death and Dismemberment benefit 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 Member is traveling
as a passenger.
How to File a Claim
Contact the Administrator for the proper forms.
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