You may qualify for long term disability (LTD) benefits after receiving 104 weeks of short term disability payments.
To qualify for LTD you must be severely disabled and unable to perform any job that you are reasonably suited for by your education, training or experience. The insurance company will make a complete review to determine eligibility for LTD benefits.
You will not receive benefits for the period during which you are not under the care of a legally qualified physician or during which you engage in any work for remuneration or profit (except on approved rehabilitative employment program).
If you are eligible you will be entitled to a long term disability benefit of up to $2,500 per month payable until the earlier of your recovery and the end of the month in which you attain age 65.
This amount will be reduced, dollar for dollar, by any payments from the Local 46 Pension Plan or another pension plan, Workplace Safety Insurance Board, and any employer or group association disability plan. In addition, the monthly benefit will be adjusted if necessary to ensure that your total income from all sources will not exceed 80% of your gross income before disability.
If you apply for pension before age 65, the amount of long term disability benefit will be reduced as necessary in order that such benefits will not increase the total monthly income from Local 46 benefit plans, and from the CPP retirement benefit if applicable, to more than $2,225.
The payment of LTD benefits is subject to the following limitations:Pre-existing conditions:
Benefits are not payable for a period of disability which commences within 12 months of the date of becoming eligible for this benefit and which is due to a pre-existing accidental bodily injury or illness, and any later period of disability related to the pre-existing condition.
A pre-existing accidental bodily injury or illness is one for which medical expenses were incurred during the 90 days immediately preceding the date you became eligible for this benefit.
A later period of disability is considered related to a prior period only if it is due to the same accidental bodily injury or illness and is not separated by:
- your return to full-time work; and
- a continuous period of at least 90 days, during which you are (i) actively at work and (ii) incur no medical expenses related to that accidental bodily injury or illness.
Alcohol and drug abuse:
Benefits will be payable for a disability resulting from alcohol, drug or other substance abuse disorder only when you are actively involved in an approved substance abuse rehabilitation program which is supervised by a physician and approved in writing by the insurance company.
Mental and nervous disorder:
The maximum benefit period will be limited to one year for a mental or nervous condition which is diagnosed as a psychoneurotic disorder, personality disorder or any other non-psychotic mental disorder.
Out of Canada:
Benefits will be discontinued during any period that you are out of Canada unless;
- you are receiving regular and continuous treatment from a physician; and,
- evidence satisfactory to the insurance company of regular and continuous treatment is given to the insurance company within 30 days of your departure and thereafter as often as the insurance company reasonably requires.
During this period the insurance company reserves the right to have a physician of its choice examine you.
Benefits will not be payable under the long term disability plan for any period of disability under the following circumstances:
- Any period of time that you are not under the regular care of a physician.
- If the disability commences while you were not actively at work due to suspension of business operations or strike.
- If the disability results from the commission of, or an attempt to commit, any criminal offence.
- If the disability is caused, or contributed to by, war or any act of war, civil commotion, insurrection or hostilities of any kind, or as a result of a motor vehicle accident.
- If the disability results from intentionally self-inflicted injuries while sane or insane.
- If you are confined in a penal institution or other house of correction.
- If you refuse to participate in an employment rehabilitation program approved by your physician and the insurance company (see below).
Disability Features, and ConditionsREHABILITATION FEATURES
As an incentive to encourage you to return to gainful employment, prior to full recovery from a total disability, you may perform certain work without forfeiting benefits under this plan. This plan allows you to receive increased income in connection with work performed in an approved rehabilitation program.
If you are participating in an approved rehabilitation program the monthly benefit will be adjusted if necessary to ensure that your total income from all sources, including all government plans and 50% of the earnings you receive during the first 24 months of rehabilitative employment, will not exceed 80% of your gross income before disability.
Monthly benefits will not be payable if you refuse to participate in a rehabilitation program approved by the Trustees, your physician and the insurance company.
THIRD PARTY CLAIM
If you receive benefits under this coverage and seek compensation from a third party for causing your disability, the claim for compensation will include reimbursement for loss of wages. If you are awarded compensation, you will have to refund to the insurance company any benefits received under this coverage for such disability, up to the amount awarded under the third party claim.
EXTENSION OF BENEFITS
If your coverage terminates for any reason and you are totally disabled on the date of termination, disability benefits will continue during the period of total disability as if coverage had not terminated.
LONG TERM DISABILITY BENEFITS ARE SELF-INSURED
It is important to note that long term disability benefits are self-insured by our Plan. Great-West Life simply adjudicates the claims and administers the benefit. Great-West Life does not insure the long term disability benefits. The liability for the benefits is assumed by the Plan and the related Health Benefits Trust Fund.