Long Term Disability

If you became disabled for an extended period of time, would you be able to manage your financial responsibilities? Long Term Disability (LTD) Insurance is designed to support you through such difficult times by helping you meet your day to day financial obligations should illness or injury keep you off the job for more than six months.

coverage provided by Cooperators Life Insurance

Benefit Amount

The amount of insurance for which any Employee is covered under this Policy is a monthly taxable benefit at 65% of the Employee’s Monthly Salary to a maximum Monthly Benefit of $8,125.

While benefits are payable to an insured Employee under this Policy Co-operators Life will also pay an amount equal to 15% of the pre-disability Salary.

A change in the amount of an Employee’s insurance due to a change in classification, Salary or insurance schedule, shall take effect automatically on the date the increase is received provded written notificat5ion is recived by Co-operaotrs Life within 31 days of the change and premiums are paid on the increased amounts. When an Employee is entitled to a retroactive increase, a change in the amount of insurance shall be made the date the Employee actually received the increase, provided the Employee is Actively at Work on that date. If the Employee is not Actively Working the insurance will not be increased until the Employee returns to Active Work.

Overall Maximum

At the time of a claim and throughout the claim, the applicable Monthly Benefit as determined in the Policy will be limitied to an Overall Maximum of 85% of the Monthly Salary for which the Employee was insured immediately prior to the start of Total Disability.

Benefits payable for periods of Total Disability of less than a full month shall be pro-rated based on the actual number of days in the applicable month.

Rehabilitation Benefit

“Rehabilitation Program” is a program provided to an Employee at the sole discretion of the Co-operators Life. A Rehabilitation Program may include Rehabilitation Assessment and/or Rehabilitative Employment and/or Rehabilitative Treatment and/or Rehabilitation Services recommended and approved by theCo-operators Life. The duration of a Rehabilitation Program must be approved by the Insurance Company.

“Rehabilitation Assessment” may be a medical and/or psychological and/or vocational evaluation of an Employee’s rehabilitation potential and, where deemed appropriate by the Co-operators Life, to establish an appropriate rehabilitation program.

“Rehabilitative Employment” is a work trial, which may be full-time , part-time or modified work.

“Rehabilitative Treatment” is medical and/or psychological and/or vocational intervention designed to assist the Employee to return to Active Work and includes, without limitation, vocational and physiotherapy programs.

“Rehabilitative Services” can involve training strategies or work related activities that can be expected to enhance to Totally Disabled Employee’s abilitiy to secure employment or to return to Active Work at the Employee’s own occupation or other gianful employment and may be limited to assistance with resume preparation and job search.

Approval of Rehabilitation Program

Co-operators Life shall have sole discretion in determining whether or not a Rehabilitation Program is appropriate and/or provided for any Employee.

Once the Rehabilitation Program is approved, the Insurance Company may issue, if eligible, Weekly Benefits to a Totally Disabled Employee who continues to participate and co-operate in an approved Rehabilitative Program.

The Rehabilitation Program wil not extend beyond the end of the Employee’s Own Occupation period or 24 months from the date or Total Disability, whichever is later, unless an extension of the duration is recommended and approved in writing by Co-operators Life.

Calculation of Monthly Benefits during a Rehabilitation Employment Period

Where the Employee participates in Rehabiliative Employment approved by the Co-operators Life, the applicable Monthly Benefit will continue during the period of Rehabilitative Employment, but will be reduced by 50% of the Rehabilitative Earnings. “Rehabilitative Earnings” means the total earnings from Rehabilitive Employment.

The Monthly Benefit may be further reduced by any amount necessary to reduce the total income the Employee receives from all sources to 100% of the Monthly Salary for wich the Employee was insured immediately prior to the start of Total Disability.

Benefits will cease on the earliest of:

  • the date the Employee refuses to participate or co-operate in any Rehabilitation Program recommended or approved by the Insurance Company including but not limited to any Rehabilitation Program offered through: any worker’s compensation act or similar statute, Auto Plan Benefits or Canada Pension Plan, or
  • the withdrawal of Co-operators Life’s approval of an Employee’s Rehabilitation Program.

None of the preceding will be construed to extend the period that any Employee would have been entitled to benefits due to Total Disability had the Employee not participated in the Rehabilitation Program.

Employee Disability Benefit

If an Employee insured under this coverage become Totally Disabled and the Total Disability results in a loss of Salary and if satisfactory proof is received by the Co-operators Life, Co-operators Life will, subject to the provisions of this coverage, pay to the Employee the amount of Monthly Benefit in force on the date of Total Disability while the Employee remains so disabled. Notwithstanding the terms of the Recurrent Disability provision, no Monthly  Benefit shall be paid beyond:

  1. 24 months from the date of Total Disability following the Elimination Period, or
  2. the date the Employee ceases to be Totally Disabled, or
  3. the date of the Employee’s 65th birthday, or
  4. the date of death of the Employee, or
  5. retirement or normal retirment date as determined by th Employer or the date the Employee withdraws or elects to receive pension funds, whichever first occurs, or
  6. the date Co-operators Life deems the Employee to have failed to furnish satisfactory evidence of continuance of Total Disability satisfactory to the Insurance Company, or
  7. the date the Employee engages in any occupation or performs any work of any sort for wage, remuneration or profit, or
  8. the date the Employee refuses to submit to a Medical Examination by a Physician chosen by Co-operators Life, or
  9. the date the Employee refuses to participate in a Rehabilitation Program considered appropriate by Co-operators Life.

whichever first occurs.

Disability payments shall commence on the 120th calendar day of continuous/consecutive Total Disability.

If after the 24th month from the date of Total Disability following the Elimination Period, satisfactory proof is received by Co-operators Life that an Employee is then Totally Disabled in accordance with the terms of this Policy, Co-operators Life will, subject to the provisions of this coverage, continue to make payments to the Employee, at the rate of Monthly Benefits the Employee received in accordance with the first paragraph of this provision, while the Employee remains so disabled. In any event the benefit shall not be paid beyond:

  1. the date the Employee ceases to be Totally Disabled, or
  2. the date of the Employee’s 65th birthday, or
  3. the date of death of the Employee, or
  4. retirement or normal retirment date as determined by th Employer or the date the Employee withdraws or elects to receive pension funds, whichever first occurs, or
  5. the date Co-operators Life deems the Employee to have failed to furnish satisfactory evidence of continuance of Total Disability satisfactory to the Insurance Company, or
  6. the date the Employee engages in any occupation or performs any work of any sort for wage, remuneration or profit, or
  7. the date the Employee refuses to submit to a Medical Examination by a Physician chosen by Co-operators Life,

whichever first occurs.

Benefits payable ofre periods of Total Disability of less than a full month shall be pro-rated based on the actual number of days in the applicable month.

For the purpose of determining the elimination period for any claim, if the period of disability is interrupted by a return to work for a period of 14 consecutive days or less where there is an elimination period of 119 days or more then, the elimination period will be considered to be uninterrupted, but the days at work will not be included.

 

Total Disability Waiver of Premium

If an Employee becomes entitled to payment of benefits due to Total Disability, Co-operators Life will waive the premiums which fall due under this coverage with respect to that Employee, for as long as the period of Total Disability continues. The waiver will commence with the first premium that falls due after the first benefit payment is made.

Recurrence of Disability

If, following a period of loss of earnings for which benefits had been paid under this Policy, the Employee returns to work for profit or gain for a period of 6 consecutive months or more and suffers no further loss of earnings during this time, any further period of Total Disability and loss of earnings due to the same or related cause will be considered as resulting from a new Injury or Sickness and the full term of benefits and the elimination period will be restored.

If, following a period of loss of eanings for which benefits had been paid under this Policy, the Employee returns to work but for a period of less than 6 consecutive months and then becomes Totally Disabled again due to the same or a related Injury or Sickness, the disability shall be treated as a continuation of the previous period of disability.

Progressive Disability Benefit

An Employee may qualify for Long Term Disability Benefits under this Policy if the Employee has been diagnosed as having a chronic disease that is progressive and degenerative in nature and the usual course of the disease is such that it will lead to the Employee becoming Totally Disabled, and the disease has progressed to a stage where the Employee is unable to perform the substantial duties of the Employee’s occupation. The Employee must be Actively Working for and Employer on a part-time or reduced work load basis. Where mutually agreed, the Employee may accept alternative employment.

The 119 day elimination period requirement may be fulfilled based on the percentage of duties or hours that are lost because of your condition, provided that:

(a) the reduction of hours or duties due to the Total Disability must occur on or after the Effective Date of the Employee’s Long Term Disability Benefit coverage under this Policy, and

(b) the Elimination Period is served over a period no greater than 5 times the applicable Elimination Period. The Elimination Period need only be served once for any one disability.

Monthly Benefits may be extended beyond the second anniversary of the Date of Disability, if, due to the nature of the disease, it is certain (in Co-operators Life’s judgement) that the Employee will become Totally Disabled as the disease progresses, but in no case, will Benefits extend beyond the attainment of your 65th birthday.

After the initial coverage for the Long Term Disability Benefit has been established, the Long Term Disability Benefit will not be further reduced in the future due to an increase in the amount of compensation paid by the Employer if such increase was due solely to a cost of living adjustment or a merit increase, provided the total annual increase does not exceed 7%. The amount of any annual increase in excess of 7%, or compensation increases for other reasons, would be taken into account in calculation of the Monthly Benefit Payable under this Provision.

Third Party Liability

When an Employee becomes Totally Disabled as a result of an Injury or Sickness for which a third party is, or may be, directly or indirectly, either in whole or in part legally liable, no benefits will be paid under this Policy unless the Employee:

  1. agrees to repay Co-operators Life the full amount of the benefits paid or to be paid (the “T.P. Benefits”) les such amount Co-operators Life, in its sole discretion, agrees to allow for legal fees, and
  2. takes all steps necessary to recover from the third party the total of the T.P. Benefits advanced or to be advanced under this Policy, including without limitation, directing the Employee’s lawyer to repay Co-operators Life the full amount of the T.P. Benefits paid directly from any monies recived from any judgement or seeltment, and
  3. enters into a Reimbursement Agreement with Co-operators Life outlining the terms and conditions under which the T.P. Benefits are to be repaid, and
  4. the Employee must obtain the written consent of Co-operators Life before compromising or settling the action or cause of action with the third party. Failure to obtain the consent of Co-operators Life will disentitle the Employee to future benefits under this Policy and will relieve Co-opators Life of all of its obligations to the Employee under this Policy. Co-operators Life whall not unreasonably withhold consent.

Income from Other Sources

In this Provision:

“Government Plan Benefits” means any benefits which, as a result of Injury or Sickness, are payable to an Employee directly or indirectly form any government agency to replace income and includes without limitation any benefits which the Employee has received or is entitled to receive under the Canada Pension Plan, Quebec Pension Plan, any worker’s compensation act or similar statute or any Criminal Injuries Compensation Legislation.

“Auto Plan Benefits” means any benefits which, as a result of an automobile accident, are payable to an Employee to replace income, whether payable by a government run plan or a private insurer and includes without limitation benefits which the Employee has received or is entitled to receive under any provincial motor vehicle accident insurance plan if the benefits payable under the Employment Insurance act are not taken into account when determining the amount of benefits payable under the provincial plan, including without limitation the Manitoba Public Insurance Corporation Act and the Saskatchewan Automobile Accident Insurance Act.

“All Source Benefits” means:

  • the total amount of compensation which, as a result of Sickness or Injury, the Employee has received or is entitled to receive from any source including without limitatin compensation received from any:
    • Employer funded pension plan,
    • Employer funded salary replacement,
    • other insurance plan whether group or association,
    • Government Plan Benefits,
    • Auto Plan Benefits,
    • damages paid or payable from any legal action except thsoe damages which the Insurance Company in its sole discretion deems to be compensation for a loss other than a loss of income, and
  • any compensation which the Employee receives while employed or while performing work of any sort, and
  • any payment made by the Employer to the Employee as a result of the termination of the Employee’s contract of employment.

“Salary” means the amount of salary for which the Employee was insured immediately prior to the start of the Total Disability.

Direct Deduction

Where an Employee is Totally Disabled, the amount of Monthly Benefit payable will be reduced directly by the amount of any Government Plan Benefit and/or Auto Plan Benefit which the Employee is receiving or is entitled to receive, excluding any benefits payable as a result of the Employee’s marital or dependent status. Any Monthly Benefit payable to an Employee shall not be further reduced as a result of any cost of living increases provided after commencement of disability benefits under any Government Plan  and/or Auto Plan.

Indirect Reduction – All Source Maximum

The following limitation shall apply to the amount of benefits payable under this Policy to the Employee. This limitation overrides any obligation of the Co-operators Life to pay benefits to the Employee under this Policy. Benefits payable under this Policy will be reduced according to the following formula:

Benefits payable = 85% of Salary minus the All Source Benefits.

Where an Employee does not qualify for any portion of the All Source Benefits because of failure to apply (or appeal where so advised by Co-operators Life) in a timely and satisfactory manner, Co-operators Life reserves the right to reduce the amount of insurance payable by the amount of All Source Benefits for which the Employee would have been eligible had a proper application or appeal been made.

If the Employee receives or has the option of receiving part or all of the All Source Benefits as a lump sum payment, the benefit payable under this Provision will be reduced as follows:

  1. if the Employee has the option of receiving the payment as a monthly payment, the benefit payable will be reduced as if the Employee had elected to receive a monthly payment, or
  2. if the Employee had no option of receiving the payment as a weekly payment, the lump sum payment will be converted into a weekly payment using the following formula:

F=LS/MB

F=Factor based on the number of months for which the Co-operators Life deems the lump sum payment to have been made.

LS=Lump Sum Payment.

MB=Monthly Benefit

Nothing is this provision shall prevent the Co-operators Life from recovering any overpayment of benefits paid under this Policy which may arise as a result of a lump sum payment of the All Source Benefits which, if it hav been paid in instalments or had been paid beginning at the date the Employee became eligible to receive such a benefit would have resulted in a reduction or cessation of benefit hereunder.

Limitations and Exclusions

No amount of Monthly Benefit will be payable for any period of Total Disability resulting directly or indirectly from any of the following:

  • insurrection, war (whether declared or not), civil riot or commotion, regardless of whether the Employee was actually participating therein, or
  • committing, attempting or provoking an assault or a criminal offence; or
  • Medical Care which is cosmetic in nature, or Medical Care which is not medically necessary to treat an Injury or Sickness. Period of Total Disability due to thedonation of an organ or tissue will be considered as necessary Medical Care; or
  • use of drugs or alcohol unless the Employee is being actively supervised by and receiving continuous treatment from a rehabilitation centre or an institution provincially recognized for that treatment; or
  • any Injury or Sickness for which a Third Party is, or may legally be liable, except as provided for in the Third Party Liability provision.

No Amount of Insurance will be payable during any period while the Employee is:

  • not under the continuing care and treatment of a Physician considered appropriate by Co-operators Life, or
  • imprisoned, or
  • on Maternity Leave, Parental Leave or any other leave of absence, or
  • Totally Disabled and living our of Canada and not under the care of a Physician in Canada.

No further Amount of Insurance will be payable from the date the Employee refuses to co-operate or participate in any rehabilitative program which is considered appropriate by Co-operators Life.

Pre-Existing Condition

No monthly benefit shall be payable udner this provision for any period of Total Disability which was caused by or resulting directly or indirectly from a Pre-Existing Condition, unless the Employee has not required treatment, medication or medical advice for a period of 90 days while insured under this Policy, or unless the Employee has been insured under this Policy for at least 12 months and has not been absent from work due to the Pre-Existing Conditions for at least  12 months. Time away from work up to 10 cummulative working days during the 12 month period will be interpreted as not being absent from work.

For Rostered Employees whose employment has terminated and who return to work within 12 months from the date last Actively at Work with the Employer, the original date of employement will be used to determine the effective date for any Pre-Existing Condition.

Claims

Notice

Written notice of Injury or Sickness, upon which a claim may be based under this section must be given to theCo-operators Life at its Office in Regina, within 30 days of the date Co-operators Life is liable.

Failure to give notice within this time shall not invalidate nor reduce any claim if it is shown not to have been reasonably possible to give notice and that notice was given as soon as was reasonably possible.

Forms

Please contact ELCIC Group Services for forms

Co-operators Life, upon receipt of notice, will furnish the forms for Proof of Loss. If these forms are not furnished within 30 days of the receipt of notice, it shall be deemed that the claimant has complied with the Proof of Loss requirements of this Policy when written proof covering the occurrence, character and extent of loss for which a claim is made is submitted within the time fixed in this Policy for filing Proof of Loss.

Proof of Loss

Written Proof of Loss must be furnished to Co-operators Life at its Office in Regina. In the case of a claim, proof must be furnished within 90 days form the date the Insurance Company is liable and subsequent written proof of the continuance of Total Disability must be furnished to the Insurance Company at such intervals as Co-operators Life may reasonably require.

Failure to furnish proof within this time shall not invalidate nor reduce any claim if it is shown not to have been resonably possible to furnish the proof and that the proof was furnished as soon as was reasonably possible, but in not event shall this be more than 12 months after becoming eligible.

Time of Payment

Subject to due Proof of Loss, benefits shall be paid as agreed to by Co-operators Life and an Employer during any period for which Co-operators Life is liable. Any balance remaining unpaid on the termination of this period will be paid immediately upon receipt of due proof. All other benefits, if any, provided in this Policy will be paid within 30 days of receipt of proof thereof.

Extension of Time

If any time limitation of this Policy with respect to giving notice of claim or furnishing Proof of Loss is less than that permitted by the law of the Province in which the insured Employee resides at the time of becoming insured under this Policy, such limitation is herby extended to agree with the minimum period permitted by law.

Medical Examination

Co-operators Life shall have the right and opportunity to conduct any investigations relating to applications or claims and to obtain independent medical or vocational assessments of any Covered Person, as often as it may reasonably require.

Limitation of Actions

Except where or when applicable legislation permits the use of a different limitation period, every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act or any other applicable legislation.

Where or when applicable legislation permits the use of a different limitation period, no action or proceeding at law or in equity shall be brought against Co-operators Life for payment of benefits under the Policy or for any other related damages:

  • prior to the expiration of 60 Days after the claim form has been filed in accordance with the requirements of the Policy: or
  • unless brought:
    • where no benefits have been paid, within one year from the expiration of the time within which the claim form is first required (see Notice provision) by the Policy or from the date on shich Co-operators Life first denies the claim for benefits, whichever first occurs; or
    • where benefits have been paid under any provision of the Policy, within 1 year of the date on which Co-operators Life terminates payment of such benefits.

The time limit within which to commence an action shall expire on the date(s) as specifically provided for in this provision and in no event shall it be extended to each and every monthly payment accruing after the date(s).