The Labourers’ Local 493 Welfare Trust Fund, self-insures the Short-Term Disability benefit. This means that the Labourers’ Local 493 Welfare Trust Fund has the sole legal and financial liability for this benefit and funds the claims. The Short-Term Disability Plan is not insured by the Co-operators Life Insurance Company. Co-operators Life Insurance Company has no liability whatsoever to plan members including any liability for benefits provided under the Short-Term Disability plan.
What am I covered for?
Your short-term disability coverage is designed to provide you with income protection if you become totally disabled (as defined in the Plan text) while covered under this plan. You may become eligible for benefits after satisfying the elimination period indicated in the schedule of benefits.
Independent Medical Assessment
It is a condition prior to the initial payment of benefits and any continuing payment of benefits that if we require, you will undergo medical assessment(s) by one or more medical practitioners chosen by us.
Participation in Rehabilitation Program
It is a condition prior to and while you are receiving benefits, that you will participate in any rehabilitation program that we consider appropriate, including but not limited to rehabilitation program offered through worker’s compensation legislation or similar statute.
Payment of Short-Term Disability Benefits
We will pay a weekly benefit after we receive satisfactory proof that you:
- are and have been totally disabled since the disability date,
- have suffered a loss of income,
- are receiving and following reasonable and customary treatment prescribed and rendered by a general physician or a specialist if we consider it appropriate, and
- have satisfied all of the other relevant conditions contained in the policy,
When will benefits begin?
Your benefits will begin the day following the end of the elimination period indicated in the schedule of benefits. The elimination period is the period of time you must be disabled before you qualify to make a claim for benefits. If first-day hospitalization is indicated as covered in the schedule of benefits, then benefits will begin the day following the end of the elimination period or the first day you are hospitalized, whichever is earlier.
How long will benefits be paid?
Benefits will not continue past the number of weeks from the date you became disabled, as indicated in the schedule of benefits.
Recurrence of Total Disability
Your total disability is considered a recurrence if it arises from the same or related sickness or injury within 4 weeks from the date your benefits ended.
Benefits are pro-rated for partial weeks
Benefits payable for periods less than a full week will be pro-rated at 1/5th or 1/7th (as indicated in the schedule of benefits).
Are my benefits taxable?
Your benefit payments are taxable. According to information provided by Labourers’ Local 493 Welfare Trust Fund and our current records the tax status is stated in the schedule of benefits.
Rehabilitation Program
A rehabilitation program is a program provided at the sole discretion of Co-operators Life. If you participate in rehabilitative employment approved by us your benefit will be reduced by 50% of your rehabilitative earnings. The weekly benefit payable during rehabilitative employment will be calculated after 2 weeks of earnings have been reported to us, payable weekly, and adjusted periodically.
Your benefit may be further reduced by any amount necessary to reduce the total income you receive to 100% of the weekly salary for which you were covered immediately prior to the start of your disability.
Your Short-Term Disability benefits will be suspended during a period of time where:
- you refuse to participate or co-operate in any rehabilitation program recommended or approved by us including but not limited to any rehabilitation program offered through, workers compensation legislation or similar statute, auto plan benefits or Canada Pension Plan, or
- Co-operators Life withdraws approval of your rehabilitation program
Benefit Reductions
All Source Maximum – Ceiling on the Short Term Disability Benefit
Your benefit will be limited to the lesser of the amount of coverage for which you are covered or the all source maximum indicated in the schedule of benefits.
All Source Compensation – Direct Reductions
Your benefit will be reduced directly by one or more of the following, which you are receiving or entitled to receive at the time your benefits commence and/or while benefits, are paid:
- government plan benefits (which are considered eligible earnings in accordance with the Employment Insurance regulation),
- any auto plan benefits (provided that benefits payable under the Employment Insurance regulation are not taken into account),
- Canada or Quebec pension plan retirement benefits you apply for, were approved for and received after your disability date,
- compensation for loss of income you receive from a third party or are entitled to receive after your disability date.
All Source Compensation – Indirect Reductions
Your benefit will be further reduced if the total of the following all source compensation and your weekly benefit exceeds the all source maximum indicated on the schedule of benefits, by:
- any amount you are entitled to under any salary replacement benefit as a result of your disability, and
- any compensation for wage or profit you receive or are eligible to receive while employed excluding rehabilitative earnings which are considered under the rehabilitation program, and
- payment (considered eligible earnings in accordance with the Employment Insurance regulation) made to you by your plan sponsor as a result of the termination of your employment, and
- any disability benefits you are eligible to receive under any other group plan.
Failure to Apply for Other Benefits
Except for retirement benefits, benefits listed as All Source Compensation are considered paid when you are entitled to them, whether or not they have been awarded or received. If it has not been awarded or received, we have the right to estimate the income according to the terms of any plans or legislation involved (not applicable to the first 16 weeks of disability). Retirement benefits are considered payable when they are actually received.
Where you do not qualify for part or all of the all source compensation because of failure to apply in a timely and satisfactory manner (or appeal where so advised by Co‑operators Life),
we reserve the right to reduce your benefit by the amount which you would have been eligible for or received had a proper application or appeal been made.
Lump Sum Conversion to Weekly Benefit
Where you receive or have the option of receiving part or all of the all source compensation as a lump sum payment, we will, acting reasonably, pro-rate the lump sum payment and reduce your benefit as if the lump sum had been paid on a weekly basis.
Repayment of Benefits
Where you receive all source compensation that includes compensation for a period for which benefits have been paid, we will convert the payment to a weekly payment and recalculate your benefit that should have been paid. You are responsible to repay us any overpayment.
When do my Short-Term Disability Benefits Terminate?
No benefits will be paid beyond:
- the number of weeks as indicated in the schedule of benefits, or
- the date you cease to be totally disabled, or
- the date you reach the termination age as indicated in the schedule of benefits. However, if you are totally disabled on this date, you will, subject to satisfying any other conditions in the policy, be entitled to a maximum of 15 weeks of benefits, or
- the date of your death, or
- the date you retire or were scheduled to retire.
No benefits will be payable during any period while you are:
- serving a sentence for a criminal or provincial offense whether you are imprisoned in a halfway house, a correctional facility, or any other form of detention, or
- becomes disabled during a work stoppage, including but not limited to strike, lock-out or suspension, or
- on a temporary leave of absence or maternity/parental or compassionate (family) leave and receiving employment insurance (EI) benefits or maternity or parental benefits from any other source, or
- refusing to participate or co-operate in a reasonable and customary treatment program approved by Co-operators Life, or
- working in any occupation, except as provided for under the rehabilitation program.
A reasonable and customary treatment program is systematic treatment that is:
- generally accepted and recognized by the Canadian medical profession as effective, appropriate and essential in the treatment of the medically diagnosed condition, and
- of a nature, intensity, frequency and duration essential to the diagnosis or management of the medically diagnosed condition involved, and
- prescribed and rendered by a physician or where considered appropriate by us for the nature of the medically diagnosed condition, the treatment must be prescribed and rendered by a specialist.
Maternity/Parental/Compassionate Leave or Temporary Leave or Lay-off
If you become totally disabled while on maternity/parental/compassionate leave, a temporary leave, or lay-off, provided premiums have been paid the elimination period will commence on your disability date and benefits will begin on the later of the end of the elimination period or the date you were scheduled to return to active work.
A scheduled leave is deemed to commence on the date agreed upon by you and your plan administrator and end on the date you were scheduled to return to active work. If a child is born prior to the date upon which your maternity leave is scheduled to commence, the leave is deemed to commence on the date of birth.
If your plan sponsor is required to provide benefits during the health-related portion of your maternity leave as a result of law or legislation, the elimination period will begin on the date your child is born and benefits will begin after you have satisfied the elimination period.
What limitations are there on STD benefits?
No Short-Term Disability Benefits will be payable for any period of total disability resulting from any of the following:
- insurrection, war (whether declared or not), voluntary participation in a civil riot or commotion, or
- committing or provoking an assault, committing or attempting to commit a criminal offense, or
- a situation where the disability results from injuries sustained in, or directly or indirectly from, a vehicle accident where you were driving a vehicle involved in the accident and had either:
- alcohol in your blood in excess of 80 milligrams of alcohol per hundred millilitres of blood, or
- your ability to operate the vehicle impaired by drugs or alcohol or a combination of the two, or
- cosmetic surgery which is purely for cosmetic reasons, except where attributable to sickness or injury. Disability due to the donation of an organ or tissue will be considered as necessary medical care.
When to submit a STD claim
Co-operators Life must receive written notice of a claim for Short Term Disability benefits within 30 days from the end of the elimination period. Failure to furnish proof within this time will not invalidate nor reduce any claim if it is shown not to have been reasonably possible to furnish the proof and that the proof was furnished as soon as was reasonably possible, but in no event will this be more than 90 days from the end of the elimination period.
If the plan text terminates, or the Labourers’ Local 493 Welfare Trust Fund coverage under this plan terminates, claims will not be paid after the termination date regardless of when they were incurred.