D.A. Townley  -  Plan Administrators Iron Workers Union Local 97 International Association of Bridge, Structural, Ornamental and Reinforcing Iron Workers 
 

health
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Accidental Death & Dismemberment

 

Coverage
The Member and his/her registered dependents are insured against the perils described in the “Schedule of Losses”. The Basic Accidental Death & Dismemberment plan provides coverage 24-hours a day, anywhere in the world, for specified accidental losses occurring on or off the job. If any of the losses listed below in the Schedule of Losses are suffered as the result of an accidental injury which results directly and independently of all other causes and the loss occurs within 365 days of the date of the accident, the benefits indicated below will be paid.

Who is Covered?
Class I: All Members who are eligible as outlined in Part I of this Booklet.
Class II: All spouses under age 70.
Class III: All eligible Dependent Children

Amount of Coverage
Class I: $12,500.00.
Class II: $20,000,00.
Class III: $5,000.00.

 

 
Schedule of Losses
Loss of Life:  The Principal Sum
Loss of Both Hands:  The Principal Sum
Loss of Both Feet:  The Principal Sum
Loss of Entire Sight of Both Eyes:  The Principal Sum
Loss of One Hand and One Foot:  The Principal Sum
Loss of One Hand and the Entire Sight of One Eye:  The Principal Sum
Loss of One Foot and the Entire Sight of One Eye:  The Principal Sum
Loss of One Arm:  3/4 of The Principal Sum
Loss of One Leg:  3/4 of The Principal Sum
Loss of One Hand:  2/3 of The Principal Sum
Loss of One Foot:  2/3 of The Principal Sum
Loss of Entire Sight of One Eye:  2/3 of The Principal Sum
Loss of Thumb and Index Finger of the Same Hand:  1/3 of The Principal Sum
Loss of Speech and Hearing:  The Principal Sum
Loss of Speech or Hearing:  2/3 of The Principal Sum
Loss of Hearing in One Ear:  1/3 of The Principal Sum
Quadriplegia (total paralysis of both upper and lower limbs):  2 Times The Principal Sum
Paraplegia (total paralysis of both lower limbs):  2 Times The Principal Sum
Hemiplegia (total paralysis of upper and lower limbs of one side of the body:  2 Times The Principal Sum
Loss of Use of Both Arms or Both Hands:  The Principal Sum
Loss of Use of One Hand or One Foot:  2/3 of The Principal Sum
Loss of Use of One Arm or One Leg:  3/4 of The Principal Sum
Loss of Four Fingers of One Hand:  1/3 of The Principal Sum
Loss of All Toes of One Foot:  1/4 of The Principal Sum

“Loss” as used with reference to quadriplegia, paraplegia, and hemiplegia means the complete and irreversible paralysis of such limbs. As used with reference to hand or foot, means complete severance through or above the wrist or ankle joint, but below the elbow or knee joint. As used with reference to arm or leg, means complete severance through or above the elbow or knee joint. As used with reference to thumb and index finger, means complete severance through or above the first phalange of all four fingers of one hand. As used with reference to toes, means complete severance of both phalanges of all the toes of one foot. As used with reference to eye, means the irrecoverable loss of the entire sight thereof.

“Loss” as used with reference to speech, means complete and irrecoverable loss of the ability to utter intelligible sounds. As used with reference to hearing, means complete and irrevocable loss of hearing in both ears.

“Loss” as used with reference to “Loss of Use”, means the total and irrevocable loss of use, provided the loss is continuous for 12 consecutive months and such loss of use is determined to be permanent.

All claims submitted under this policy for Loss of Use must be verified by agreement between a licensed practicing Physician appointed by the Policyholder and a licensed practicing Physician appointed by the insurance company, or in the event that the two Physicians so appointed cannot arrive at an agreement, a third licensed practicing Physician shall be binding on the Policyholder and the insurance company. This procedure may be waived by the insurance company at its sole discretion.

 


Exposure and Disappearance
If by reason of an accident covered by the policy an Insured Person is unavoidably exposed to the elements and, as a result of such exposure, suffers a loss for which indemnity is otherwise payable hereunder, such loss will be covered under the terms of the policy. 

 


Repatriation Benefit
When injuries covered by this policy result in the loss of life of an Insured Person outside 50km from their permanent city of residence and within 365 days of the date of the accident, the Company shall pay the actual expenses incurred for preparing the deceased for burial and shipment of the body to the city of residence of the deceased but not to exceed the amount of $15,000.00.

 


Educational Benefit
If indemnity becomes payable for the Accidental Loss of Life of an Insured Person of the Policyholder, the insurance company shall:
  1. Pay the lesser of the following amounts to or on behalf of any Dependent Child who, at the date of accident, was enrolled as a full time student in any higher learning beyond the 12th grade level:
    1. The actual annual tuition, exclusive of room and board, charged by such institution per school year.
    2. $10,000.00 per school year.
    3. 5% of the Insured Person’s Principal Sum.
    Such amount will be payable annually for a maximum of four consecutive annual payments, only if the Dependent Child continues his education.
    “Dependent Child” as used herein means any unmarried child under 26 years of age who was dependent upon the Insured Person for at least 50% of his maintenance and support.
    “Institution of Higher Learning” as used herein includes, but is not limited to, any University, Private College, or Trade School.
  2. Pay to or on behalf of the surviving spouse the actual cost incurred within 30 months from the date of death of the Insured Person as payment for any professional or trades training program in which such spouse has enrolled for the purpose of obtaining an independent source of support and maintenance, but not to exceed a maximum total payment of $10,000.00.

 


Rehabilitation Benefit
When injuries shall result in a payment being made by the insurance company under the Accidental Death & Dismemberment Indemnity section of this policy, the insurance company shall pay in addition: 

The reasonable and necessary expenses actually incurred up to a limit of $15,000.00 for special training of the Insured Person provided:
  1. such training is required because of such injuries and in order for the Insured Person to be qualified to engage in an occupation in which he would not have been engaged except for such injuries,
  2. expenses be incurred within three years from the date of the accident,
  3. no payment shall be made for ordinary living, traveling or clothing expenses.

 


Family Transportation
When injuries covered by the policy result in an Insured Person being confined to a hospital, outside 100km from his/her permanent city of residence, within 365 days of the accident and the Attending Physician recommends the personal attendance of a member of the immediate family, the insurance company shall pay the the actual expenses incurred by the confined Insured Person but not to exceed the amount of $15,000.00.

The term “member of the immediate family” means the spouse (or common-law spouse) parents, grandparents, children age 18 and over, brother or sister of the Insured Person.

 


Seat Belt Rider
Benefits under the policy shall be increased by 10% if the Insured Person’s injury or death results while he/she is a passenger or driver of a private passenger type automobile and his/her seatbelt is properly fastened. Verification of actual use of the seat belt must be part of the official report of the accident by the investigating officer.

 


Home Alteration and Vehicle Modification
If an Insured Person receives a payment for Quadriplegia, Hemiplegia or Paraplegia as outlined in the Schedule of Losses herein and was subsequently required (due to the cause for which payment under such was made) to use a wheelchair to be ambulatory, then this benefit will pay, upon presentation of proof of payment:
  1. The one-time cost of alterations to the injured person’s residence to make it wheelchair accessible and habitable; and
  2. The one-time cost of modifications, necessary to a motor vehicle owned by the injured person, to make the vehicle accessible or driveable for the Insured Person. Benefit payments herein will not be paid unless:
    1. Home alterations are made on behalf of the Insured Person and carried out by an experienced individual in such alterations and recommended by a recognized organization providing support and assistance to wheel-chair users; and
    2. Vehicle modifications are made on behalf of the Insured Person and carried out by an experienced individual in such matters and modifications are approved by the Provincial vehicle licensing authorities. The maximum payable under both Items A and B combined will not exceed $15,000.00.

 


Day Care Benefits
If indemnity becomes payable under the policy for accidental loss of life of an Insured Person, the insurance company will pay an amount equal to the lessor of the following amounts:
  1. The actual cost charged by such day care centre per year, or
  2. 3% of the Insured Principal Sum, or
  3. $5,000.00 per year,
On behalf of any child who was an Insured Person’s dependent at the time of such loss and is under age 13 and is currently enrolled or subsequently enrolled in an accredited day care centre within 90 days following such loss. 

The benefit is payable annually for a maximum of four consecutive payments but only if the Dependent Child continues his or her enrollment in an accredited day care centre.

 


In-Hospital Indemnity Benefit
If an Insured suffers a loss under the Table of Losses as a result of a covered accident and requires that an Insured be confined to a hospital for more than five (5) consecutive days, the insurance company will pay:
  1. a monthly benefit of one (1) percent of the Insured’s applicable Principal Sum; or
  2. for periods of less than one (1) month, one thirtieth (1/30) of the above monthly benefit per day.
Benefits are retroactive to the first (1st) day of hospital confinement. 

This benefit is limited to:
  1. a monthly amount not to exceed $1,000.00; and
  2. a total of twelve (12) months for any covered accident.
Successive periods of hospital confinement for loss from the same covered accident separated by a period of less than three (3) months will be considered as one (1) period of hospital confinement. 

The term “Hospital” is defined as an establishment which meets all of the following requirements:
  1. holds a license as a hospital (if licensing is required in the Province);
  2. operates primarily for the reception, care and treatment of sick, ailing or injured persons as in-patients;
  3. provides 24-hour a day nursing service by registered or graduate nurses;
  4. has a staff of one or more licensed Physicians available at all times;
  5. provides organized facilities for diagnosis, and major medical surgical facilities; and
  6. is not primarily a clinic, nursing, rest or convalescent home or similar establishment nor is not, other than incidentally, a place for alcoholics or those addicted to drugs.

 


Permanent Total Disability Indemnity
When as the result of injury and commencing within 365 days of the date of the accident an Insured Person is totally and permanently disabled and prevented from engaging in each and every occupation or employment for compensation or profit for which he is reasonably qualified by reason of his education, training or experience, the insurance company shall pay, provided such disability has continued for a period of twelve consecutive months and is total, continuous and permanent at the end of this period, the Principal Sum less any other amount paid or payable under the Accidental Death and Dismemberment Indemnity Coverage of the policy as the result of the same accident.

 


Conversion Privilege
On the date of termination of employment or during the 60-day period following termination of employment, the Member may change his insurance to the American Home Assurance Company’s individual insurance policy. The individual policy will be effective either as of the date that the application is received by the insurance company or on the date that coverage under the policy ceases, whichever occurs later. The premium will be the same as you would ordinarily pay if you applied for an individual policy at that time. Application of an individual policy may be made at any office of the American Home Assurance Company. The amount of insurance benefit converted to shall not exceed that amount issued during employment.

 


Continuance of Coverage
In the case of Members of the Policyholder who are (1) laid-off on a temporary basis, (2) temporarily absent from work due to short-term disability, (3) on leave of absence, or (4) on maternity leave coverage shall be extended for a period of twelve (12) months, subject to payment of premium. 

If a Member of the Policyholder assumes other occupational duties during the leave or lay-off period, no benefits shall be payable for a loss occurring during the performance of this occupation.

 


Waiver of Premium
In the event an Insured Person becomes totally and permanently disabled and his/her waiver of premium claim is accepted and approved under the Policyholder’s current Group Life Insurance policy, then the premiums payable under this policy are waived as of the same date the claim is accepted and approved by the Group Life Plan Underwriter until one of the following occurs, whichever is earlier.
  1. The date the Insured Person attains age 65.
  2. The date of the death or recovery of the Insured Person.
  3. The date the Master Policy is terminated.

 


Beneficiary Designation
In the event of Accidental Loss of Life, benefits shall be payable as designated in writing by the Insured Person under the Policyholder’s current basic group Life Insurance policy. In the absence of such designation, benefits shall be payable to the Estate of the Insured Person. 

All other benefits shall be payable to the Insured Person.

 


Exclusions
The accident insurance plan does not cover any loss resulting from:
  • Suicide or self-inflicted injuries;
  • Full-time service in the Armed Forces;
  • Declared or undeclared war or any act thereof;
  • Injuries received during aircraft travel except for the purposes of transportation where the Member is traveling as a passenger.


Related Links
Printable Version of the Health & Welfare Plan Booklet

 
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