Other Long Term Disability

Eligibility and Commencement of Insurance

If you meet the eligibility requirements outlined in the summary of benefits, participation in the LTD Program is a condition of employment.

If a member is not actively at work on the date his insurance would have otherwise began, such insurance will begin on the first day they are subsequently actively at work.

If the member is not actively at work on the date his insurance would have otherwise began, due solely to a paid leave or a statutory holiday, then they will be considered actively at work on such date.

Change of Insurance

Any increase or decrease or other change in the amount of insurance will become effective on the date the member first becomes eligible for such change provided a written request for change is received by the plan administrator and premiums have been paid on the increase.

If a member is not actively at work on the date his insurance would have otherwise changed, such insurance will change on the first day he is subsequently actively at work.

If the member is not actively at work on the date their insurance would have otherwise changed due solely to a paid leave or a statutory holiday, then they will be considered actively at work on such date.

Waiver of Premium

• Premiums will be waived for a member who becomes totally disabled while insured under this policy prior to attaining age 65, if they submit proof of claim satisfactory to the benefits provider. Premiums will continue to be waived for as long as the total disability persists. For the purpose of this provision, premiums will cease to be waived on the earliest of the following dates:
  • the date on which the member is unable or unwilling to provide satisfactory proof of total disability to the benefits provider if such proof is not provided within three months of the request,
  • the date on which the member ceases to be totally disabled,
  • the date on which the member attains age 65 or 35 years of pensionable service under the Municipal Pension Plan or any other registered pension plan arising out of employment with an employer and a minimum age of 55,
  • the date the member retires,
  • the date payment of the LTD benefit under this policy ceases.

• Under this policy, any provision for an increase in coverage is suspended during total disability.
• A recurrence of total disability within six months after the termination of a previous period of total disability for which premiums have been waived under this policy shall be deemed a continuation of the previous period if due to the same or related causes.

Termination of a Member’s Insurance

A member who is not receiving benefits under the Core LTD Program or the “Other” LTD Benefits shall cease to be entitled to coverage for “Other” Long Term Disability on the earliest of the following dates:

• the period of time equal to the member’s applicable elimination period before the last day of the month during which the member attains the age of 65 years;
• the date the member no longer meets the definition of member;
• the 32nd day of an unpaid leave of absence;
• the date the member temporarily occupies a position that is not eligible for coverage in accordance with the definition of member in the definitions section;
• the date of the member’s termination of service; and
• the period of time equal to the member’s applicable elimination period before the last day of the month during which the member attains 35 years of pensionable service and a minimum age of 55 pursuant to the terms of the Municipal Pension Plan (MPP) or other school district pension arrangement.

Continuation of Insurance

Maternity Leave, Parental Leave or Compassionate Care Leave

Coverage will be maintained for the complete period of the maternity, parental or compassionate care leave. The benefits provider must be informed of the scheduled date of return to work before the beginning of the leave.

Strike or Lock-out

Coverage for a member who ceases to be actively at work due to a strike or lockout is subject to the following:

• If the elimination period starts during a strike or lockout, LTD Benefits will not be paid to a disabled member until the end of the elimination period or the end of the strike or lockout, whichever is last to occur;
• If the elimination period starts before a strike or lockout, LTD Benefits will be paid if the member is totally disabled at the end of the elimination period, regardless of the strike or lockout.

Legal Obligation in the Event of Termination of Coverage

If federal or provincial legislation requires the benefits provider to continue a member’s coverage beyond the date coverage would have otherwise terminated, coverage will be continued to the end of the period required by law but not beyond the date this LTD Program terminates.

Secondments, Elections, Appointments or leaves for Public Office

Members who are seconded, elected, on paid leave of absence, appointed to union positions or elected/ appointed to a public office/duty will continue to have coverage for LTD Benefits during their service to the union or while doing the public office/duty.

Unpaid Leaves of Absence

An unpaid leave of absence of 31 days or less will not impact coverage.

Notice and Proof of Claim

You must submit the initial written notice of a claim for LTD Benefits to the benefits provider within 30 days of the expiry of the elimination period and initial written proof within 60 days of the expiry of the elimination period.

In the event of the recurrence of total disability, you must submit written notice of a claim for LTD Benefits to the benefits provider within 30 days of such recurrence and written proof within 60 days of such recurrence.

Subsequent written proof satisfactory to the benefits provider of continuing total disability must be submitted to the benefits provider at its request.

If this policy terminates, no payment will be made unless the notice and proof of a claim is submitted to the benefits provider within 120 days of this policy’s termination date.

Failure to submit notice or proof of claim within the prescribed time limit does not invalidate the claim, provided that the notice and proof of the claim are sent as soon as reasonably possible. However, no payment will be made if the notice and proof of claim are sent more than 12 months from the date the benefits provider becomes liable.

No action or proceedings may be initiated against the benefits provider to recover any claim prior to the expiration of 60 days after written proof has been filed or after two years following the expiration of the time in which proof of claim is required.

Claims

Claims under this policy must be submitted to the benefits provider on the appropriate form. Any benefits will be paid to the member.

Medical Examinations

From time to time, the benefits provider will be entitled to have a claimant examined by a physician or physicians of its choice.

Misstatement of Age

If the age of any individual has been misstated, the benefits payable under this policy will be based on the actual age of the individual concerned at the relevant time. If the age has been misstated, premium adjustments will be made for the full-time insurance that has been in force.

Amount of Insurance

The amount of insurance in force for each member is determined by their classification, as determined and recorded by the plan administrator. The policyholder or plan administrator, on their behalf, must notify the benefits provider in writing on a regular monthly basis of any change in the amount of insurance of any member.

Assignment

The rights or interests of a member under this policy cannot be assigned.

Amount of LTD Benefit

The monthly LTD Benefit for a member covered by this policy shall be determined according to the benefit schedule selected by the member’s employer to a maximum benefit of $10,000 monthly (see summary of benefits for details). This information shall be as recorded and maintained by the plan administrator.

The amount of the LTD Benefit payable under this LTD Program will be based on the member’s average monthly earnings in effect for the 12 months immediately before the date of disability. If a member was promoted, received a wage increase or was on an approved leave, including maternity, parental or compassionate care leave, in the 12 months immediately before the date of disability, the member’s coverage will be based on the new earnings subject to verification of the earnings by the employer.

Payment of LTD Benefit

Upon receipt of proof satisfactory to the benefits provider that:

• a member became totally disabled while insured under this policy and remained totally disabled during the elimination period; and
• the member is under continuing medical care

The benefits provider will pay LTD Benefits to the member in accordance with applicable policy provisions. LTD Benefit payments are payable monthly at the end of each month, in arrears, following the completion of the elimination period.

For the first two (2) years of Core LTD Benefit payment the Core LTD Benefit amount for any member will be paid over the number of calendar months the member was expected to work with their Employer immediately prior to the commencement of Disability. Members will not receive Core LTD Benefits for the full calendar month(s) they were not expected to work.

Any payments for less than one month will be at the daily rate of 1/30 of the monthly LTD Benefit.

When a member continues to be covered under this policy while on maternity, parental or compassionate care leave, then the elimination period for any total disability that begins during such leave will be deemed to begin on the date the member is scheduled to return to active employment, provided the member is then still totally disabled and insured under this policy.

As a result of variances in elimination periods under this policy and the core long-term disability program, the LTD Benefit under this policy may be payable before the date the Core Long Term Disability becomes payable.

Direct Offsets (Reductions)

LTD Benefits otherwise payable to the member under this policy will be reduced by:

• any benefits the member is eligible to receive under any Workers’ Compensation Act or similar legislation;
• any amount the member is eligible to receive under the Canada Pension Plan or the Quebec Pension Plan at the date of total disability, including early retirement benefits but excluding:
  • benefits payable on behalf of his dependents;
  • any increase in these benefits due solely to the cost of living after LTD Benefits commence under this policy;
• subject to the provisions of the Insurance (Vehicle) Act [RSBC] c. 231 and regulations thereunder any indemnity payable for loss of time under any government plan requiring or providing automobile insurance benefits on a no-fault basis;
• the amount of benefits payable from any other disability income plan, including employer-paid sick leave and disability pension income, but excluding a private disability insurance plan or income received in respect of a previous unrelated disability; and
• subject to the provisions of the Insurance (Vehicle) Act [RSBC] c. 231 and regulations thereunder any net proceeds of a third-party claim. Net proceeds of a third-party claim paid in a lump sum will be subject to the third-party claims provision.

If any direct offsets are paid in a lump sum, monthly LTD Benefits will be reduced by the equivalent monthly payment for the number of months of disability for which the lump sum is paid.

The benefits provider may also reduce the monthly LTD Benefit payments if the member who is required to make the necessary application fails or refuses to exercise his rights under the above-mentioned legislation or plans.

The benefits provider may, at its discretion, estimate the amount of payments available from any source of income that would be subject to this provision.

All Source Maximum

In addition to direct offsets, LTD Benefits will be further reduced by any amount by which the total monthly income of the member from all sources exceeds the all source maximum specified in the summary of benefits. The total monthly income of a member from all sources, whether he receives or is eligible to receive this income, will include all of the following:

• LTD Benefits under this policy
• Core LTD Benefits payable under the Core Long Term Disability Program
• any earnings or payments from the employer or other disability income from any other plan sponsored by the Public Education Benefits Trust (PEBT), but excluding earnings or disability benefits in respect of any other regular job with the employer which the member was performing before total disability
• any disability benefits under the Canada Pension Plan or the Quebec Benefit Plan, including early retirement benefits, but excluding benefits payable on behalf of dependents and any increase in benefits after benefit payments commence due solely to the cost of living
• any disability benefits payable for the same total disability under any Workers’ Compensation Act or similar legislation or any other government plan, excluding the Employment Insurance Act
• any benefits payable from a retirement or pension plan, excluding any increase in benefits after benefit payments commence due solely to cost of living
• subject to the provisions of the Insurance (Vehicle) Act [RSBC] c. 231 and regulations thereunder any indemnity for loss of time payable under any government plan requiring or providing automobile insurance benefits on a no-fault basis; and
• subject to the provisions of the Insurance (Vehicle) Act [RSBC] c. 231 and regulations thereunder any net proceeds of a third-party claim. Net proceeds of a third-party claim paid in a lump sum will be subject to the third-party claims provision.

If any of the foregoing are paid in a lump sum, monthly LTD Benefits will be reduced by the equivalent monthly payment for the number of months of disability for which the lump sum is paid.

The benefits provider may also reduce the monthly LTD Benefit payments if the member, who is required to make the necessary application, fails or refuses to exercise his rights under the above-mentioned legislation or plans.

The benefits provider may, at its discretion, estimate the amount of the government plan award pending notice of the actual award.

Recurrent Disability

Successive periods of total disability due to the same cause or related causes are considered to be the same period of total disability unless they are separated by at least:

• Ten working days of active employment during the elimination period; or
• Six consecutive months of active employment immediately following a period of total disability for which LTD benefits were paid under this LTD Program.

Successive periods of total disability due to entirely unrelated causes are considered the same period of total disability unless separated by at least one day of active employment.

Whenever successive periods of total disability are considered to be the same period of total disability, one elimination period will apply.

Disability Management

The benefits provider may at any time require a totally disabled member to participate in a disability management program.

• the benefits provider will actively co-ordinate all disability management program services listed below and will also facilitate and ensure case follow-up:
  • co-ordination of access to health care services;
  • support program for returning to work;
  • negotiations for a gradual return to work; and
  • rehabilitation employment program may include evaluation, treatment, training, placement and job search services.

If a totally disabled member, while receiving LTD Benefits, takes part in a total disability management program under the supervision of his physician and with the approval of the benefits provider:

• the member will still be considered totally disabled while taking part in this program
• if, while taking part in this program, a member becomes totally disabled again, the terms and conditions of this LTD Benefit will apply to the member as if they had been totally disabled during the disability management period
• if, as a result of taking part in this program, the member earns any income, the LTD Benefits payable to the member will be reduced by 50% of the amount of income earned from any rehabilitative activity
• the maximum benefit period during any period of total disability will continue to apply even if the member is taking part in a disability management program
• while the member is taking part in a total disability management program, the provider will reduce his LTD Benefits so that his total income from all sources as listed in the all source maximum section of this policy does not exceed 100% of his gross earnings (net earnings if the LTD benefit is non-taxable) immediately before the commencement of total disability.

A member who refuses to take part in a disability management program or does not participate in such program in good faith will no longer be eligible for LTD Benefits payable under this LTD Program.

Rehabilitative Employment

The benefits provider may at any time require a totally disabled member to participate in a rehabilitation employment program.

If a totally disabled member, while receiving LTD Benefits, takes up rehabilitative employment under the supervision of his physician and with the approval of the benefits provider:

• the member will still be considered totally disabled while taking part in rehabilitative employment, subject to a maximum of 24 months from the date of commencement of rehabilitative employment
• if, while taking part in rehabilitative employment, a member becomes totally disabled again, the terms and conditions of this LTD Benefit will apply to the member as if he had been totally disabled during the rehabilitation employment period
• if, as a result of taking part in rehabilitative employment, the member earns any income, the LTD Benefit will be reduced by 50% of the amount of income earned from any rehabilitative employment
• the maximum benefit period during any period of total disability will continue to apply even if the member is taking part in approved rehabilitative employment
• while the member is taking part in rehabilitative employment, the LTD Benefit will be reduced so that their total income from all sources as listed in the all source maximum provision does not exceed 100% of his gross earnings (net monthly earnings if the LTD benefit is non-taxable) immediately prior to the commencement of total disability.

A member who does not take up rehabilitative employment considered appropriate by the benefits provider will no longer be eligible for LTD Benefits payable under this LTD Program.

Limitations and Exclusions

No LTD Benefits shall be payable under this policy for total disability resulting directly or indirectly from one of the following:

• Disability where the member is not under the continuing medical care of and following the treatment prescribed by that physician
• where the member refuses to disclose medical information required by the benefits provider or physicians acting for the benefits provider
• Disability due to illness or injury which occurred after the member was placed on layoff status
• during the imprisonment of the member due to conviction of a criminal offence
• war, whether the war be declared or not, or service in the armed forces of any country, or participation in a riot, insurrection or civil commotion
• committing or attempting to commit a criminal offence
• Disability resulting from cosmetic surgery or treatment, unless such surgery or treatment is:
  • required as a result of an Illness or Injury or
  • or gender affirmation or sex reassignment; which occurred while the Member was covered under this LTD Plan

• alcohol or drug abuse unless, for such abuse, the member is actively taking part in a therapeutic program supervised by a physician on an ongoing basis, is receiving continuing medical care or treatment for rehabilitation and is staying in an established treatment centre qualified to provide the necessary treatment or care
• driving a motorized vehicle while impaired by drugs or with an alcohol level that exceeds the limit set under the Criminal Code of Canada or the applicable motor vehicle act
• Disability directly or indirectly related to a pre-existing condition, subject to the following:
  • Members who were covered under a previous long-term disability plan with their employer immediately before the effective date of the employer’s participation in the Core Long Term Disability Program and who were actively at work on that date, will be covered for total disability resulting from a pre-existing condition from that date
  • Members who were not covered under a long-term disability plan with their employer immediately prior to the effective date of the employer’s participation in the Core Long Term Disability Program but who were actively at work on that date will be covered for total disability resulting from a pre-existing condition, six months after the effective date of the employer’s participation in the Core Long Term Disability Program
  • Members who were not actively at work on the effective date of the employer’s participation in the Core Long Term Disability Program will not be covered for total disability resulting from a pre-existing condition until they have completed six continuous months of being actively at work with that employer following the member’s return to work date
  • Members hired following the effective date of an employer’s participation in the Core Long Term Disability Program will not be covered for total disability resulting from a pre-existing condition until they have completed 12 continuous months of being actively at work with that employer after their effective date of coverage.

Third-Party Claim

This Section shall be read subject to the provisions of the Insurance (Vehicle) Act [RSBC] c. 231 and regulations thereunder.

• A member who has applied for LTD Benefits under this Policy must notify the benefits provider in writing as soon as reasonably practicable of the full particulars of any third-party claim.

• The member shall periodically provide the benefits provider with progress reports on the status of the third-party claim upon the benefits provider’s request.

• As soon as a member is reasonably able to do so, the member shall provide the benefits provider in writing with full particulars of the net proceeds of third-party claim supported by copies of any judgement, settlement agreement, release, correspondence including correspondence between the member and his own solicitor, fee agreements between the member and his own solicitor and such further and other documentation and information as the benefits provider may reasonably require.

• A member shall, upon the request of the benefits provider, provide them with the member’s written consent, direction and authorization as may reasonably be required to permit the benefits provider to obtain copies of any documentation or information relative to a member’s third-party claim from the member’s own solicitor, the Insurance Corporation of British Columbia (ICBC) or such other person, agency or entity as may be in possession or control of any documentation or information relevant to the member’s third-party claim.

• Upon payment of a member’s net proceeds of a third-party claim, the member shall forthwith pay to the benefits provider the lesser of the aggregate of all prior LTD Benefit payments in respect of the subject total disability paid to the member under the LTD Program and the net proceeds of third-party claim. Should the member fail to repay this sum as and when recovered, the amount shall be recoverable by the benefits provider from the member in debt and should the benefits provider start legal proceedings in respect thereof, the member shall be required to also pay all reasonable and proper legal fees incurred by the benefits provider in respect of such legal proceedings on a solicitor and own client or full indemnity basis. The amount the member is required to reimburse shall be determined with reference to the dollar amount of the net proceeds of third-party claim and shall not be reduced by reason of the member or others being partially responsible for the damages arising from the events or circumstances causing the total disability.

• In the event that a member’s net proceeds of third-party claim exceeds the aggregate amount of LTD Benefits paid to the member, if then still totally disabled, shall not be entitled to any further LTD Benefit payments under this policy unless and until a sufficient period of time thereafter has elapsed during which the member, but for this provision, would have received LTD Benefits (including any enhancements to the LTD Benefit level implemented during that period) totalling in the aggregate to an amount equal to the amount by which the member’s net proceeds of third-party claim exceeded the amount paid to the benefits provider.

• If required by the benefits provider, the member shall enter a reimbursement agreement containing the member’s express agreement to observe and perform the member’s obligations under this provision and providing for an assignment by the member to the benefits provider of the member’s net proceeds of third-party claim as security for the performance of the member’s said obligations.

Disclaimer:

The information contained on this website is provided for general information purposes only. Every effort has been made to ensure that this information is accurate, but this site is not a substitute for the official Plan documents, nor is it an employment contract. In the event there is a discrepancy between this website and the official Plan documents, the official Plan documents will prevail. For more information, or if you have questions about the information provided on this website please contact your School District Benefits Administrator.