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

health
benefits

        
 
 
 
 
 
 
 
 
 
 
 
   
   
   
 
 
 
 
   
 
 
 
 
 
   
 

Long Term Disability

 


General

If a Member becomes Totally Disabled while insured for the Long Term Disability Benefit, the Plan will pay the benefits for which that Member is eligible in accordance with the provisions of this policy.

 

 
Classification: Amount
All eligible persons under age 65: $1,400 no CPP offset

2 year own occupation

Integration provision: 85% from all sources

Waiting Period: 26 weeks of Total Disability

Benefit Duration: up to five years or to age 60, (for LTD claims incurred on or after January 01, 2010, the maximum age for collecting LTD benefits will be increased to age 65) whichever occurs first.

Please note: The all source maximum benefit entitlement will be determined in accordance with the following formula: 

1,000 hours times the basic hourly rate exclusive of overtime or any additional allowances as outlined in the Collective Agreement in force at the onset of disability times 85 percent. 

 


Benefit Payment Waiting Period
A Member must be Totally Disabled for a period of 26 weeks or for the duration of the Weekly Indemnity benefit period, whichever is greater. 

If a Member, who has satisfied some but not all of the Benefit Payment Waiting Period, returns to work for a continuous period of 30 days or less and again becomes Disabled as a result of the same sickness or injury, such later Period of Disability will be deemed by the Plan to be a continuation of the previous Period of Disability, however, the Benefit Payment Waiting Period will be extended by the number of days worked by the Member during that period.

 


Waiver of Premiums
No premium will be charged for this benefit for a Member while Long Term Disability Benefits are payable under this policy.

 


Calculation of the Monthly Integrated Benefit
The Monthly Integrated Benefit shall be the Monthly Benefit reduced by an amount equal to the sum of any disability or retirement benefits for which the Member is eligible under: 
  1.  
    1. the Canada Pension Plan or Quebec Pension Plan; and
    2. any worker's compensation legislation in Canada; and
  2. any government disability or retirement benefit plans in any other jurisdiction.
However, no Benefit reduction shall be applied until income from all disability related sources exceeds 85% of the Member's gross predisability earnings at onset of disability and only to the extent that the total income exceeds the 85% threshold. 

In no event, however, shall the Monthly Integrated Benefit be less than the Minimum Monthly Benefit shown in the Benefit Schedule. 

For the purpose of the calculation of the Monthly Integrated Benefit, any lump sum payment received from any source specified in the definition of "Income from All Sources" shall be converted to equivalent monthly amounts for the period to which such payments relate. 

Government Source Income Integration Freeze 
During any one Period of Disability, any Cost-of-Living increase in disability benefits under a Government Plan will not reduce the amount of the Monthly Integrated Benefit otherwise payable under this policy if the increase is effective after the due date of the first payment to a Member under this benefit.  

 


Time of Payment 
Subject to the terms and conditions of this policy, the Long Term Disability Benefit shall be payable one month following the expiration of the Benefit Payment Waiting Period and at the end of each monthly period thereafter. 

Taxability Status 
The Plan will administer any payments made under this benefit on the basis of the Taxability Status set out in the Benefit Schedule. However, the Plan shall not be responsible for any taxes or penalties levied by any government in connection with such benefit payments and shall not be liable to the Policyholder or any Member or Employer for any such taxes or penalties. 

Termination of Monthly Disability Benefit Payments
Monthly Disability benefit payments payable to a Disabled Member shall terminate on the earliest of the date the Member:

  1. engages in any occupation for wage or profit, except as allowed by the provisions of this policy;
  2. fails to provide written proof satisfactory to the Plan of continuance of Disability;
  3. fails to submit to any medical examination by Physicians of the Plan's choice;
  4. refuses to follow the treatment recommended for his or her disabling condition by a Physician whose specialty encompasses such disabling condition;
  5. is no longer receiving regular and ongoing care of a Physician;
  6. refuses to enter into any Rehabilitation Program that is considered to be appropriate by the Plan;
  7. fails to agree in writing to reimburse the Plan, following written request to do so, for any amounts owed to the Plan;
  8. ceases to be Disabled;
  9. dies;
  10. starts to draw a Union Pension; or
  11. has received benefits for the Maximum Benefit Payment Period as shown in the Policy.

 


Recurrent Disability
If a Member who has received benefits under the Long Term Disability Benefit of this policy returns to work for a period of 180 days or less and again becomes Disabled as a result of the same sickness or injury, such later Period of Disability will be deemed by the Plan to be a continuation of the previous Period of Disability. No new Benefit Payment Waiting Period will be required, however, no benefits are payable for any period of such employment. 

 


Extension of Benefit Payments 

If a Member's insurance terminates while Disabled, the Plan will continue to pay benefits, provided:
  1. the Member is receiving benefits under the Long Term Disability Benefit of this policy, or is completing the Benefit Payment Waiting Period on the date the insurance terminated;
  2. the Member was Disabled on the date the insurance terminated;
  3. the Member has remained Disabled since the date the insurance terminated; and
  4. notice of Disability is given by the Member to the Plan within six months from:
    1. the commencement date of Disability with respect to a Member who resides in the province of Quebec,
    2. the termination date of insurance with respect to a Member who resides in a province other than Quebec.
In no event will benefit payments continue beyond any date specified for the termination of benefit payments.

 


Limitations
  1. The Plan will not pay benefits for any Period of Disability which directly or indirectly results from or is contributed to by a disability due to:
    1. a self-inflicted sickness or injury caused while sane or insane,
    2. any act related to insurrection or war or participation in a riot, or
    3. the Member's commission or attempted commission of any criminal offense (including an offense related to driving a vehicle while under the influence of alcohol).
  2. No amount will be paid for any period:
    1. during which the Member is imprisoned, or
    2. on formal leave of absence taken by the Member
    3. a Member collects Union Pension benefits.
  3. The Plan will not pay benefits for a Period of Disability due to:
    1. the chronic use of alcohol or drugs (prescribed or otherwise), or
    2. the use of any hallucinogen,
    unless the Member is under active treatment and is participating in a medically supervised rehabilitation program. All substance abuse claims will be paid a maximum WI benefit of 6 weeks, provided they are in a rehabilitation centre and remain there for the full course of treatment.
  4. No amount will be payable for any Period of Disability which results from or is caused by a condition: 
    for which the Member was treated or attended by a Physician, or for which prescription drugs were taken, during the 3 month period prior to the effective date of insurance, 
    until the Member has performed all the duties of his or her regular occupation (on a Full-Time and Full-Pay Basis) for a 12 month period after the effective date of his or her insurance.

 


Policyholder Subsidy

The Plan will pay an amount equal to 50% of the remuneration of a Member who is actively participating in an approved Rehabilitation Program provided by the Policyholder for the first 3 months of participation in such Program. 

The amount paid to the Member by the Plan will be made as Additional Monthly Income, thus reducing the Policyholder's income payments by 50%. 

The Plan's subsidy shall apply only once during any period of Disability.

 


Eligibility for Total Disability Benefits
A Disabled Member will be eligible for Total Disability Benefit payments if:

  1. the Member became Totally Disabled while insured for the Total Disability Benefit,
  2. the Member's Total Disability has continued for a period in excess of the Benefit Payment Waiting Period shown in the policy, and
  3. as a result of the Disability, the Member
    1. is absent from work,
    2. incurs a loss of Earnings, and
    3. is not engaged in any occupation for wage or profit, except as specified under the subsection "Rehabilitation Program".
The Member must submit proof of loss satisfactory to the Plan.

Please Note: Members returning to work, must be cleared in writing to do so by their physician.

Rehabilitation Program
If a Member receiving Total Disability Benefits under this policy, participates in a Rehabilitation Program approved by the Plan, he or she shall be eligible for Disability benefits while participating in the program for a period of up to 24 months, or a longer period if deemed advisable by the Plan. The Rehabilitation Program must be supervised by a Physician, and is subject to the continued approval of the Plan.

 


Amount of Benefit
For purposes of the calculation of the Monthly Integrated Benefit, the Monthly Benefit shall be the Insured Amount shown in the Policy.

The Total Disability Benefit amount shall be the Monthly Integrated Benefit reduced by:
  1. 50% of the Member's monthly Net (After-Tax) Earnings under an approved Rehabilitation Program; and
  2. an amount equal to the amount by which the Member's
    1. Income from All Sources, plus
    2. 100% of the Member's monthly Net (After-Tax) Earnings under the Rehabilitation Program
    exceeds 100% of the Member's monthly Inflation-Indexed, Pre-Disability Net (After-Tax) Earnings.

 


Definitions
When used in the provisions of the Long Term Disability Benefit, each of the following terms is limited in meaning to the definition shown.

Claim Anniversary Date
The date 12 months after the first day for which benefits are payable, and each date 12 months thereafter during the same Period of Disability.

Consumer Price Index
The Consumer Price Index published by Statistics Canada. 

If the Consumer Price Index is:
  1. no longer available,
  2. no longer published, or
  3. changed so that it no longer reasonably reflects the rate of change in the cost of living,
then the Plan will determine some other appropriate index to use for these calculations and the CPI Factor will be based on such index.

CPI Factor
A ration calculated annually at the Claim Anniversary Date by dividing the Consumer Price Index at Claim Anniversary Date* by the Consumer Price Index at commencement date* of Disability, but in no event will the CPI Factor be less than 1.

*The Consumer Price Index is published monthly for a period several months in the past. For calculations based on the Consumer Price Index, the index used will be that published for the month four months prior to the date used for calculation. For example, for any date in January, the index used will be that published for the preceding September.

Disability or Disabled 
Respectively, Total Disability or Totally Disabled.

Income from All Sources
The sum of any amounts for which the Member is eligible as:
  1. disability or retirement benefits provided under the Canada Pension Plan or Quebec Pension Plan (Primary and Secondary Income benefits);
  2. any salary continuation from the Employer;
  3. any indemnity for loss of time provided under any other group disability plan, including any professional association plan;
  4. any retirement income provided under any retirement or pension plan of any other employer if the income commenced after the commencement date of Disability;
  5. any indemnity for which the Member is eligible under any Employment Insurance Act, Worker's Compensation Law or similar legislation;
  6. any amount paid or payable under any no-fault automobile insurance policy for disability, loss of income, or wage replacement, if permitted by law;
  7. Disability benefits paid by the Plan under this policy.

Inflation-Indexed, Pre-Disability Net (After-Tax) Earnings
Net (After-Tax) Earnings at commencement of Disability times CPI Factor

Net (After-Tax) Earnings
A Member's Earnings, excluding any Federal and Provincial Income Taxes deducted, and non-voluntary pension plan contributions.

Period of Disability
The period of time from and including the date on which a Member becomes disabled until the Member ceases to be Disabled due to the same sickness or injury.

Primary Income Benefits
Disability income benefits for which a Member is eligible under the Canada Pension Plan or Quebec Pension Plan, whether or not the Member has dependent children.

Rehabilitation Program
A program of job training or work-related activity approved by the Plan designed to facilitate a Disabled Member's return to employment or any other gainful employment for which the Member is or may become qualified.

Secondary Income Benefits
Disability income benefits for which a Member is eligible under the Canada Pension Plan or Quebec Pension Plan, which are in addition to Primary Income Benefits and are provided in respect of the Member's dependent children.

Total Disability or Totally Disabled
A condition due to sickness or accidental bodily injury which requires the regular and ongoing care of a legally qualified Physician appropriate to the sickness or injury and as a result of which the Member is not engaged in any occupation for wage or profit and
  1. during the Own Occupation Disability Period, is prevented from performing the substantial duties of his or her own occupation;
  2. after the Own Occupation Disability Period, is prevented from performing any gainful occupation
    1. for which the Member is or may become reasonably qualified by training, education, or experience, and
    2. which will enable the Member to earn at least 67% of his or her Inflation-Indexed, Pre-Disability Earnings.


Related Links
Filing a Long Term Disability Claim
Printable Version of the Health & Welfare Plan Booklet

 
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