health
benefits

Wage Indemnity

• The Plan
• Recurrent Disability
• Coordination with other Income Sources
• Third Party Liability
• Are Benefits Taxable?
• Termination of Benefit
• Exclusions
• Claims
• Extended Benefit


 

The Plan
The Plan will pay Wage Indemnity (WI) benefits when you are Totally Disabled and prevented from working as a result of an accident or sickness for which WorkSafe Compensation benefits are not payable.

The elimination period is a period of time, when you are continuously disabled, which must be completed before your claim for benefits will be considered. Benefits commence on the day after the elimination period expires or on the first day your were seen and treated by a physician or chiropractor whichever is later and will be paid only during periods of disability when you are under his or her regular care and following the treatment prescribed. Certification of disability beyond a 6 week period must be made by a physician.

Recurrent Disability
A recurrent disability means a disability that is related to or due to the same cause(s) as a prior disability for which you received benefit payments. A recurrent disability will be considered part of the prior disability if, after receiving WI benefits, you returned to work on a fulltime basis and were able to perform all the essential duties of your occupation for less than 2 weeks. Once you have resumed work on a full-time basis and have been at work for 2 consecutive weeks, any subsequent injury or sickness will be considered a new disability.

Extended Benefit
If you are Totally Disabled when this insurance terminates, your WI benefits will continue as though your insurance had not terminated, up to the maximum benefit period, provided you remain Totally Disabled.

Coordination with other Income Sources
Your WI payment will be coordinated with benefits received from other sources so that the total benefits received, for the same disability, will not exceed your normal take home pay on the date you became Totally Disabled.

Third Party Liability
Benefits will be paid for disabilities due to an accident in which a third party is liable. However, you must reimburse the Plan when you receive payment from the third party.

Are Benefits Taxable?
Benefits are taxable as your employer contributes to the cost of your WI Plan.

Termination of Benefit
Your benefit payments will cease on the earliest date one or more of the following occurs:

1. you are no longer disabled;
2. you are no longer receiving continuing medical care and treatment from your physician;
3. you fail to submit satisfactory proof of continuing disability as required by the Plan;
4. you refuse a medical examination by a physician chosen by the Plan;
5. you are no longer following the treatment recommended for your disability;
6. you leave the province, state or country where you normally work and live, for reasons other than to obtain treatment that is not available locally or that may be available sooner elsewhere. Such treatment must be recognized by the government plan (i.e. the Medical Services Plan of British Columbia and similar programs in other parts of Canada) as medically necessary. If you normally reside outside Canada, such treatment must be approved by the Plan.
7. you perform any work for compensation or profit;
8. the end of the maximum benefit period indicated in the Schedule of Benefits;
9. you retire; or
10. you die.

Exclusions
Benefits are not payable for any period of disability:

1. arising from any of the following:
   1. self-inflicted injury or sickness;
   2. participation in a criminal offense;
   3. civil commotion, insurrections, any act of war (whether declared or not) or hostilities between nations, or service in the armed forces of any nation;
   4. pregnancy related sickness
      1. during any period of formal maternity leave and/or parental leave;
      2. during any period in which Employment Insurance (EI) benefits are being paid;
   5. substance abuse, including but not limited to alcoholism or drug addiction, unless you are receiving continuing treatment for substance abuse from your physician; or
   6. medical or surgical care which is cosmetic, unless considered medically necessary as a result of injury or sickness.
2. that commenced prior to the date you were otherwise eligible for benefits or during a period when you were not eligible for benefits for any reason, unless the plan has agreed in writing;
3. while you are
   1. in a jail or penitentiary;
   2. on leave of absence or paid vacation;
   3. receiving benefits for the same or related disability from WCB or similar legislation; or
   4. if you become disabled during a strike or lockout at your place of employment; however, your right to benefits will be reinstated when the strike or lockout ends.

Claims
The following steps must be taken as soon as possible after becoming "disabled" (unable to work):

1. Obtain an E.I. Claims Kit from a post office or the Employment Office. The physician's report must be completed and a copy sent to the Administrator's office.
2. If the Member is not eligible for EI Sick benefits, he/she must obtain the 2-page Machinists, Fitters & Helpers Industrial Union Local No. 3 Benefit Plan Wage Indemnity Benefits Claim form from the Administrator's office, as he/she is entitled to submit a claim to the Wage Indemnity Plan, provided that a copy of the EI rejection letter accompanies the claim. Claimants must be under the care of a physician and be treated in person during the period claimed for.
3. Complete Section 1 of the claim form.
4. The attending physician must complete Section 2 of the claim form. If there is any charge for completing this form, it is the claimant's responsibility.
5. Send the second page of the claim form to the employer to complete Section 3.
6. All pages of the claim form must be completed and presented to the Administrator's office within 30 days unless specified circumstances prevent such.