Accidental Death, Disease and Dismemberment Insurance

We tend to think of accidents as things that happen to other people. But it can happen to anyone, and even accident survivors may be left with devastating injuries which have significant financial implications.

coverage provided by Cooperators Life Insurance

Under this benefit a Covered Loss means a Critical Disease Benefit, Accidental Death Benefit or an Accidental Disease/Dismemberment Benefit.

Critical Disease Benefit

Co-operators Life will pay to the Employee an amount equal to 10% of the Basic Life Insurance Amount to a maximum of $50,000, provided the Employee has been diagnosed with a Critical Disease prior to age 65 and while insured under this Provision and has been Totally Disabled from that disease for at least nine (9) months. Benefits are limited to the first covered Critical Disease in the Employee’s lifetime.

Accidental Death Benefit

If Co-operators Life is furnished with proof that an Employee’s death occurs as a direct result of accidental bodily Injuries occasioned solely through external, violent and accidental means without negligence on the Employee’s part, Co-operators Life will pay an amount equal to 100% of the Principal Sum to the Employee’s beneficiary.

Accidental Disease/Dismemberment Benefit

If Co-operators Life is furnished with proof that an Employee, sustains one of the following losses, as a direct result of a Critical Disease or resulting directly and independently of all other causes from bodily Injuries occasioned solely through external, violent and accidental means, without negligence on the Employee’s part, Co-operators Life will pay in accordance with the following coverage table:

Coverage Table

Principal amount                                                      $10,000

 

LossPercent of Principal Sum
paraplegia (total paralysis of both lower limb)200%
hemiplegia (total paralysis of one side of the body)200%
quadriplegia (total paralysis of all four limbs)200%
loss of use of both arms200%
loss of use of both legs200%
loss of use of one arm and on leg on the same side of the body200%
loss of both arms or both legs100%
loss of both hands or of both feet100%
loss of sight of both eyes100%
loss of one hand and one foot100%
loss of use of both hands100%
loss of use of both feet100%
loss of use of one hand or arm and one leg100%
loss of sight of one eye and loss of or loss of use of one hand or one foot100%
loss of speech and hearing in both ears100%
loss of use of one hand and one foot100%
loss of one arm75%
loss of use of one arm75%
loss of one leg75%
loss of use of one leg75%
loss of one hand66 2/3%
loss of one foot66 2/3%
loss of speech66 2/3%
loss of hearing in both ears66 2/3%
loss of sight of one eye66 2/3%
loss of use of one hand66 2/3%
loss of use of one foot66 2/3%
loss of or loss of use of the thumb and index finger of the same hand33 1/3%
loss of or loss of use of four fingers of one hand33 1/3%
loss of hearing in one ear33 1/3%
loss of all toes of one foot25%

Additional Benefits

Under certain circumstances, the ADD&D Insurance plan will provide the following benefits:

Rehabilitation Benefit

Coverage: A maximum of $10,000 within three years of the Accident

In the event an Employee sustains a Covered Loss and the loss requires that the Employee participate in a rehabilitiation program in order to be qualified to engage in an occupation in which the Employee would not have engaged exept for such Covered Loss, Co-operators Life will pay the reasonable and necessary expenses actually incurred for the services of  a licensed rehabilitation provider, within 3 years form the date of the Covered Loss.

Payment by Co-operators Life for the total of all expenses incurred by any Employee will not excced $10,000 as the result of any 1 Covered Loss. Payment does not include incidental expenses including without limitation charges for room and board, ordinary living, travelling or clothing expenses.

Family Transportation Benefit

Coverage: A maximum of $5,000 per Accident

If an Employee sustains a Covered Loss and is confined as an inpatient in a Hospital located at least 150 kilometres from the Employee’s residence and is under Regular care and attendance of a Physician or surgeon, Co-operators Life will pay the reasonable expense actually incurred by all members of the Employee’s immediate Family for hotel accommodation in the vicinity of the Hospital and return transportation by the most direct to the Employee.

This benefit will not exceed the aggregate amount of $5,000 for all accommodation and trasportation expenses. Payment will not be made for incidental expenses including without limitation charges for board or other ordinary living, travelling or clothing expenses. If transportation occurs in a vehicle or device other than one operated under a license for the conveyance of passengers for hire, then reimbursement of transportation expenses will be per kilometre travelled.

Home Alteration and Vehicle Modification Benefit

Coverage: A lifetime maximum of $10,000

If an Employee sustains a Covered Loss and subsequently requires the use of wheelchairto be ambulatory, Co-operators Life will pay the reasonable and necessary expenses incurred for the purpose of making the Employee’s home and vehicle wheelchair accessible.

Benefits are payable for the cost of alterations to the Employee’s principal residence and the cost of modification to 1 motor vehicle utilized by the Employee, when such modifications are approved by licensing authorities where required. The expenses are subject to a maximum of $10,000 in the Employee’s lifetime.

Education Benefit

Coverage: The lesser of 5% of the employee’s basic life insurance amount or $5,000 per year for each Dependent Child, paid for a maximum of 4 consecutive years.

In the event an Employee’s death occurs as a direct result of a Covered Loss under this Provision, Co-operators Life will pay to the Employee’s beneficiary the Education Benefit state below for each of the Employee’s Dependent Children who are, at the time of the Employee’s death enrolled as full-time students:

  1. in an institution for higher learning above the secondary school level as defined in the province, territory or country of residence; or
  2. at the secondary school level but who will enroll as full-time students in an institution for higher learning within three hundred and 365 days after the date of death of the Employee.

 

The Education Benefit is equal to the reasonable and necessary expenses actually incurred for tuition and books, subject to the lesser of a maximum of 5% fo the Employee’s Basic Life Insurance Amount of %5,000, for each year the Dependent Child continues the education, but not to exceed 4 years, which must run consecutively, with respect to any 1 Dependent Child.

The benefit will be paid each year immediately upon receipt of satisfactory proof that the child is enrolled as a full-time student in an institution for higher learning, but payment will not be made for expenses incurred prior to the death of the Employee, or for incidental expenses including withoutllimitation room, board or other ordinary living, travelling or clothing expenses.

If none of the Employee’s Dependent Children satisfy the above requirements, Co-operators Life will pay an amount of two thousand five hundread dollars ($2,500) to the Employee’s beneficiary.

Spousal Occupational Training Benefit

Coverage: A lifetime maximum of $10,000 within three years of the Accident

In the event an Employee’s death occurs as a direct result of a Covered Loss under this Provision, Co-operators Life will pay the reasonable and necessary expenses actually incurred for tuition and books for the Spouse of the Employee to participate in a formal occupational training program to become qualified for active employment in an occupation for which the Spouse would not otherwise have sufficient qualification.

Expenses must be incurred within 3 years from the date of the Employee’s death and are subject to a maximu lifetime payment of $10,000. Payment will not include incidental expenses including without limitation charges for room and board, ordinary living, travelling or clothing expenses.

Daycare Benefit

Coverage: $500 per child annually for a maximum of four years

In the event an Employee’s death occurs as a direct result of a Covered Loss under this Provision, Co-operators Life will pay to the Employee’s Dependent Child the Day Care benefit. A Dependent Child is eligible ofr this benefit if:

  • at the time of the accidnet, the Dependent Child is enrolled in a Day Care Centre, or
  • the Dependent Child enrolls in a Day Car Centre within 90 days following the date of the Employee’s accident.

The annual payment will be equal to the lesser of the 5% of the Employee’s Prinicpal Sum or $5,000.

This benefit will be paid each year for 4 consecutive years if the Dependent Child remains enrolled in a Day Care Centre. The first payment will be made:

  • when the Employee’s loss of life becomes payable; and
  • the date Co-operators Life receives written proof the Dependent Child is enrolled in a Day Care Centre.

Future payment will be made for each following year on the date Co-operators Life receives proof that the Dependent Child is actually enrolled in a Day Care Centre. If at the time of the Employee’s death, the Employee has not Dependent Children eligible for the Day Care benefit, Cooperators Lfie will pay an amount of $1,500 to the Employee’s beneficiary.

Repatriation Benefit

Coverage: A maximum of CDN $10,000

If the event the Employee’s death occurs (due to any cause) at least 50 kilometres from the Employee’s normal place of residence, Co-operators Life will pay the reasonable andcustomary expenses incurred for the prearation of the body and its transportation to the funeral home or the place of interment in proximity to the normal place of residence of the deceased.

Seatbelt Benefit

When an Employee sustains a loss as a direct result of an accident, while driving or riding in a vehicle and wearing a properly fastened seat belt, the benefit payable will increase 10%.   The driver of the vehicle must hold a current and valid driver’s license and must not be intoxicated or under the influence of drugs (unless such drugs are taken as prescrived bya a Physician), at the time of the accident. Proof of seat belt use must be provided.

Exposure 

If any Employee is exposed to the elements following the disappearance, forced landing stranding, sinking or wrecking of a conveyance in which the person was an occupant, such exposure shall be deemed an accidental bodily injury.

Disappearance

If the body of an Employee has not been found within one year of the disappearance, forced landing, stranding, sinking or wrecking of a conveyance in which the person was an occupant, then it shall be deemed that the person shall have suffered loss of life.

General Provisions Applicable to All ADD&D Benefits

Maximum Benefit

In no case shall an amount greater than the Principal Sum be paid for all Covered Losses sustained by an Employee resulting directly or indirectly from the same Accident or Critical Disease with the exception of: loss of use of both arms, loss of use of both legs, loss of use of one arm and one leg on the same side of the body, paraplegia, hemiplegia and quadriplegia where the benefit payable is 200% of the Principal Sum.

Total Disability Waiver

If premiums for the Basic Life Insurance coverage under this Policy are being waived, then premiums for the Accidental Death, Disease and Dismemberment benefit will also be waived, but only so long as the Policy remains in force.

Definitions

a. loss of a hand shall mean complete severance at or above the wrist.

b. loss of a leg shall mean complete severance at or above the knee joint.

c. loss of an arm shall mean complete severance at or above the elbow joint.

d. loss of a foot shall mean complete severance at or above the ankle.

e. loss of a toe shall mean complete severance of two entire phalanges of the toe.

f. loss of a thumb shall mean complete loss of one entire phalanx of the thumb.

g. loss of an index finger shall mean the complete loss of two entire phalanges of the index finger.

h. loss of sight, loss of hearing or loss of speech shall mean total and irrecoverable loss of that faculty. If that faculty can be recovered or partially recovered by the use of some device or rehabilitative program it shall be deemed that there was not loss for the purposes of this provision.

i. loss of use must be caused by tendon, nerve or bone damage. Such loss of use must be total and irrecoverable and must be continuous for a period of 12 months after which any benefit is payable, provided such disability is determined to be permanent.

j. Paralysis shall mean complete and irreversible paralysis caused by brain, spine, muscle or nerve damage as a result of an accident or Covered Critical Disease which has continued for a period of 12 months from the date of the accident or diagnosis of Critical Disease, after which any benefit is payable under this benefit Provision.

k. Institution for higher learning for the Education benefit, includes any university, college or trade school.

l. Hospital, for the Family Transportation benefit, means an institution licensed as a hospital, open at all times for the care and treatment of injured persons, with organized facilities for diagnosis, major surgery and with 24 hour nursing services. Hospital will not include a facility or part of a facility primarily used for the aged, the treatment of drug addiction or alcoholism, rehabilitative care, custodial or educational care, or a rest home, nursing home or convalescent hospital.

m. Regular Care and Attendance, for the Family Transportaion benefit, means observation and treatment to the extent necessary under existing standards of medical practice for the condition causing the confinement.

n. Immediate Family, for the Family Transportation benefit, means a person who is the spouse, son, daughter, father, mother, brother, sister of the Employee. Other relatives may be considered in the event that no “immediate family” are living.

o. Seat Belt, for the Seat Belt benefit, shall mean those belts that form a restraint system and includes infant and child restraint systems when properly used with a seat belt, including restraint belts which are part of a stretcher used in the transportation of sick and injured persons by ambulance.

p. Vehicle means any automobile, station wagon, van, jeep-type automobile, truck ambulance or any type of motorized behicle used by municipal, provincial or federal police forces and which are designed primarily for carrying passengers and odinarily operated on the public streets and highways.

Exclusions

No Accidental Death

ADD&D Conversion

If an Employee’s Basic Acciental Death, Disease & Disease/Dismemberment Insurance coverage terminates on or before the Employee’s 65th birthday or as a result of termination of employment or termination of Employee’s eligbible for insurance under this Policy, then the Employee may apply for Accidental Death and Dismemberment coverage of the type then being offered by Co-operators Life.

The Accidental Death & Dismemberment coverage will not include any Total Disability benefit (or Critical Disease or Disease Dismemberment benefit) provisions. The maximum amount of Accidental Death & Dismemberment coverage which the Employee may convert will not exceed the full amount of Accidental Death * Dismemberment Coverage in effect at the time of termination. The maximum amount of coverage available for conversion is $100,000.

The Conversion Policy will be issued only if a written application and the first 12 months premium is received by Cooperators Life at its Regina Office within 31 days after the date of termination of the Employee’s insurance under the Policy. The Coversion Policy shall become effective on the dat following the date the application and 12 months premium is received by Co-operators Life.

What the Plan Does Not Cover

No Accidental Death, Disease/Dismemberment Benefits will be paid if the Employee’s Covered Loss is caused by or results directly or indirectly from one or more of the following:

  • suicide or attempted suicide or self-infliceted Injury, regarless of mental state, or
  • committing, attempting or provoking an assault or criminal offense, or
  • a situation where the Covered Loss results from Injuuries sustained in, or directly or indiretly from, a Vehicle accident where the Employee was driving the Vehicle involved in the accident and had either:
    • alcohol in his or her blood in excess of 80 milligrams of alcohol per hundred millilitres of blood; or
    • his or her capacity impaired as a result of drug or alcohol usage, or
  • Disease, or bodily or mental infirmity , or medical or surgical treatment of any kink, except surgical reattachment, or
  • death where there is no visible contusion on the exterior of the body (except death by drowning), or
  • any drug, poison, gas or fumes, voluntarily or otherwise taken administered, absorbed or inhaled, other than as a result of an accident arising from a hazard incident to the Employee’s occupation, or
  • insurrection or war (whether war be declared or not) or participation in any riot, or active service in the armed forces of any country, or
  • travel or flight in any aircraft or descent from such aircraft if the Employee is a pilot or a member of the crew of the aircraft, or if such flight is made for the purpose of instruction, training or testing.