D.A. Townley  -  Plan Administrators Machinists, Fitters and Helpers Industrial Union 
 

health
benefits

        
 
 
 
 
 
 
 
 
 
   
   
   
 
 
 
 
   
 

Long Term Disability

For Members Only
The purpose of this benefit is to provide coverage should you become Totally Disabled as a result of an accidental injury or sickness and are unable to work at any occupation, for wage or profit.

Your taxable benefit is determined as follows:

Monthly Benefit Amount Claims incurred on or after November 1, 2009, the plan will pay a $500 monthly LTD Top Up Benefit to those members who claim for and receive CPP Disability benefits. This LTD Top Up benefit will be paid until the end of the month in which the member turns age 65. If the member dies or recovers prior to reaching age 65, the benefit will terminate at the end of the month in which the member dies or recovers. The $500 LTD Top Up benefit will not be paid for occupational illnesses or injuries, as WCB (Worksafe BC) will be responsible for such .

Elimination Period Benefits commence on the 181st day of continuous/ consecutive disability.

Definition of Total Disability Shall mean disability as a result of Injury or Sickness, to the extent that the Member is under the regular care and following the prescribed treatment of a physician and is prevented from engaging in any occupation or performing any work of any sort of wage, remuneration or profit or for which the Member is able or may reasonably become able by means of education, training or experience.

If you become Totally Disabled while you are on a lay-off, you will not be eligible for benefits until the date you are recalled to work. Your benefits will start on that date provided you have served the 180 day qualifying period. If you have not served the qualifying period on the date you are recalled to work, your benefits will start at the end of the 180 days after your recall date.

In no case shall a benefit be paid beyond:

  • the attainment of your 65th birthday, or
  • retirement or normal retirement date, or the date you withdraw pension funds, or
  • the date you engage in any work for wage or profit, or
  • the ate you are no longwr disabled, or fail to furnish satisfactory evidence for the continuance of disability, or
  • the date you refuse to submit to a medical examination by a physician chosen by the insurance company, or
  • your date of death
whichever first occurs.

Successive periods of disability arising from the same or related cause and seperated by less than six months will be treated as one period of continuous Total Disability




Benefit Adjustment
At any time of a claim, your Long Term Disability Benefit will be reduced by any disability benefits you are entitled to receive from the Workers' Compensation Act, Canada Pension Plan or Quebec Pension Plan, any criminal injuries compensation legislation and any automobile insurance act. The reduction will also include any CPP or QPP retirement benefits; however, it will not include any additional amounts payable for dependents or cost of living increases.

If necessary, your Long Term Disability will be further adjusted so that your total income will not exceed 85% of your pre-disability gross salary (net salary if your benefit is non-taxable). This applies to disability benefits from any other other source including: pension plan; employer funded salary replacement/other insurance plan whether group or association; damages for loss of income which are payable from any legal action; employment income other than from an approved rehabilitation program; and severance.




Rehabilitation Program
Based on a determination by The Co-operators, a rehabilitation program may be provided to you which could include: assessment (medical, psychological, vocational, evaluation), treatment (medical, psychological, vocational intervention, including various programs of therapy), employment (work trial, modified/full or part-time work), services (training strategies and work related activities expected to enhance your ability to return to work or secure employment) and a rehabilitation benefit.

The Co-operators will have the sole right and discretion in determining whether a rehabilitation program will be provided to you and the services provided as part of that program. If you do not participate in a rehabilitation program provided either by The Co-operators (i.e. any worker's compensation act or similar statute, auto plan benefits, Canada/Quebec Pension Plan) or The Co-operators withdraws approval of your program, then your disability/rehabilitation benefits under this policy will cease.
While you participate in the rehabilitation program your disability benefits will continue, but will be reduced by 50% of any rehabilitative earnings (total earnings from your rehabilitation employment if your benefit is taxable, total earnings less income tax, EI, CPP/QPP if your benefit is non-taxable). Your benefit may be further reduced so that your rehabilitative earnings plus your disability benefit do not exceed 100% of your pre-disability income (gross if your benefit is taxable, net if your benefit is non-taxable).

Any rehabilitation program will not extend beyond the end of your own occupation period. Nothing in the rehabilitation program or provision will create any basis for any extension of your own occupation period.




Third Party Liability
If you become Totally Disabled due to an injury or disease for which a third party is or may be legally liable, benefits will be paid when you sign (and submit to The Co-Operators) a Reimbursement Agreement.

You will be required to reimburse The Co-Operators for benefits received in accordance with the terms and conditions stated in the Reimbursement Agreement.

You must obtain the written consent of The Co-Operators before compromising or settling the action or cause of action with the third party. Failure to do so may disentitle you to any future benefits under this policy.




Total Disability Waiver of Premium
Premiums will be waived while you are receiving disability benefits commencing with the first premium that falls due after the first benefit payment is eligible to be made.




Exclusions
No benefit will be payable for any disability resulting from or caused by:

  • intentionally self-inflicted injury, while sane or insane, or
  • insurrections, war or hostilities of any kind, or
  • riot or civil commotion regardless of whether you were participating, or
  • injury occurring while committing or attempting to commit a criminal offence, or
  • medical or surgical care which is cosmetic in nature or medical care or surgery that is not medically necessary. However, periods of disability due to the donation of an organ or tissue will be covered, or
  • use of drugs or alcohol unless you are being actively supervised by and receiving continuous treatment from a rehabilitation centre or an institution provincially recognized for that treatment, or
  • injury or sickness for which a third party is liable, except as provided for in the third party liability section.

No benefit will be payable for any disability if you are imprisoned or if you are not under continuous care and treatment by a physician who is certified by the Royal College of Physicians and Surgeons in a speciality appropriate to your sickness or injury.

No benefits will be payable during any period that you are on maternity leave, parental leave or any other leave of absence.

No further benefits will be payable from the date you refuse to participate in any rehabilitation program approved by The Co-operators.




Submitting a Claim
The time limit within which a Long Term Disability claim must be made is 90 days from the date The Co-operators is liable.




Termination Age
Your Long Term Disability coverage terminates at age 65.




How to File a Claim 
SEND CLAIM TO THE ADMINISTRATOR, DO NOT SEND CLAIM TO THE INSURANCE COMPANY.

To claim for Long Term Disability benefits, a special claim form is required. 

This form consists of the following sections:

(a) Attending Physician's Statement
(b) Employer's Statement
(c) Employee's Statement

The Physician should complete the Attending Physician's Statement portion of the form. He or she must clearly indicate his or her diagnosis, date(s) of service and type(s) of service rendered. 

The Employer's Statement should be completed by the employer. The date the Employee last worked must be shown on this form.



 
 

Related Links
Filing a Long Term Disability Claim

 


 
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