health
benefits

Short Term Disability

• Plan Summary
• Definitions
• General Information
• Exclusions
• Claims
  
   

General Information

Benefit 
We will pay short term disability (STD) benefits when you are totally disabled and prevented from working as a result of an accident or sickness for which Workers’ Compensation benefits are not payable. 

The elimination period is a period of time, when you are continuously disabled, which must be completed before your claim for benefits will be considered. Benefits commence on the day after the elimination period expires or on the first day you were seen and treated by a Physician or chiropractor – whichever is later – and will be paid only during periods of disability when you are under his or her regular care and following the treatment prescribed. Certification of disability beyond a 6 week period must be made by a Physician. 

The weekly benefit amount, the elimination period, and the maximum benefit period are shown in the Schedule of Benefits.

Recurrent Disability
A Recurrent disability will be considered part of the prior disability if, after receiving STD benefits, you returned to work on a full-time basis and were able to perform all the essential duties of your occupation for less than 2 weeks. Once you have resumed work on a full-time basis and have been at work for 2 consecutive weeks, any subsequent injury or sickness will be considered a new disability.

Extended Benefit
If you are totally disabled when this insurance terminates, your STD benefits will continue as though your insurance had not terminated, up to the maximum benefit period, provided you remain totally disabled.

Coordination with other Income Sources
Your STD payment will be coordinated with benefits received from other sources so that the total benefits received, for the same disability, will not exceed your normal take home pay on the date you became totally disabled.

Third Party Liability
Benefits will be paid for disabilities due to an accident in which a third party is liable. However, you must reimburse us when you receive payment from the third party.

Are Benefits Taxable?
Yes. Benefits are taxable because your employer pays the cost of your STD Plan. 

Termination of Benefit Your benefit payments will cease on the earliest date one or more of the following occurs:

1. you are no longer disabled 
2. you are no longer receiving continuing medical care and treatment from your Physician
3. you fail to submit satisfactory proof of continuing disability as required by us
4. you refuse a medical examination by a Physician chosen by us
5. you are no longer following the treatment recommended for your disability
6. you leave the province, state, or country where you normally work and live, for reasons other than to obtain treatment that is not available locally or that may be available sooner elsewhere. Such treatment must be recognized by the government plan (i.e. the Medical Services Plan of British Columbia and similar programs in other parts of Canada) as medically necessary. If you normally reside outside Canada, such treatment must be approved by us.
7. you perform any work for compensation or profit
8. the end of the maximum benefit period indicated in the Schedule of Benefits
9. you retire
10. you die.

1. arising from any of the following:
   1. self-inflicted injury or sickness
   2. participation in a criminal offense
   3. civil commotion, insurrection, any act of war (whether declared or not) or hostilities between nations, or service in the armed forces of any nation
   4. a pregnancy related sickness
      1. during any period of formal maternity leave and/or parental leave
      2. during any period in which Employment Insurance (EI) benefits are being paid
   5. substance abuse, including but not limited to alcoholism or drug addiction, unless you are receiving continuing treatment for substance abuse from your Physician 
   6. medical or surgical care which is cosmetic, unless considered medically necessary as a result of injury or sickness
2. that commenced prior to the date you were otherwise eligible for benefits or during a period when you were not eligible for benefits for any reason, unless we agree in writing
3. while you are
   1. in a jail or penitentiary
   2. on leave of absence or paid vacation
   3. receiving benefits for the same or related disability from WCB or similar legislation
4. if you become disabled during a strike or lockout at your place of employment; however, your right to benefits will be reinstated when the strike or lockout ends.

1. Obtain a claim form from your Plan Administrator, as soon as possible after you become totally disabled.
2. Complete the employee’s statement and sign the form on both sides.
3. Return the form to your Plan Administrator for completion of the employer’s portion.
4. Have your Physician complete and sign the medical portions of the form.
5. We must receive satisfactory proof of claim within 30 days following the end of the Elimination period. Failure to submit a claim within the 30-day limit will not invalidate the claim if special circumstances prevail.
6. We may request supplementary reports to update the medical information on file. Any cost for completion of medical reports will be your responsibility.
7. Incomplete claim forms will cause a delay in the payment of your benefits.