In the event of your death, the amount of your Life Insurance will be paid to the beneficiary named by you. You may change your beneficiary whenever you like (subject to any legal restrictions), by giving written notice to the Administrator.
Premium Waiver
Should you become totally disabled while insured, and before reaching age sixty-five (65), and such disability continues without interruption for at least six (6) months, your Life benefit may remain in force as approved by the insurance company, without further payment, until you reach age sixty-five (65). You must maintain your coverage until the Waiver is approved.
In order to qualify for the Premium Waiver, you must notify the Administrator of your disability within one (1) year of your last active day at work and you must furnish proof of your disability satisfactory to the insurer. You will be required to submit continuing proof of your disability, from time to time, as requested by the insurance company.
NOTE: You will be considered totally disabled during the period you are entitled to receive Long Term Disability benefits.
Conversion of Insurance Coverage
(a) While The Plan Is In Force
If any, or all, of your insurance terminates while this Plan is in force, you may apply for an Individual Life Policy without taking a medical examination.
The individual policies available are:
(i) any of the policies other than Term Insurance customarily being issued by the insurance company; or
(ii) a non-renewable Term policy to age sixty-five (65); or
(iii) a one (1) year non-renewable Term policy which may, if desired, be converted to a policy described in (i) and (ii) above at any time during the one (1) year period.
(b) Upon Termination Of The Plan
In the unlikely event that the Asbestos Workers Local 95 Benefit Plan should terminate, or if the Board of Trustees should decide to change life insurance companies, the insurance policy provides a conversion privilege which allows you to apply for an individual policy, without taking a medical examination. This privilege is available provided you were continuously insured for at least five (5) years prior to the date of termination.
You are eligible to receive a Paid-Up Life Insurance policy provided you meet all of the following requirements:
(a) you are retired; and
(b) you are receiving pension benefits under the terms of the Asbestos Workers 95 Pension Plan; and
(c) immediately prior to the date of your retirement, you were covered by the Asbestos Workers Local 95 Benefit Fund.
Benefit Amount
If you retire on or after July 1, 1977, you are entitled to receive an amount of five hundred dollars ($500.00) for each year of your membership in the Pension Plan, to a maximum of five thousand dollars ($5,000.00).
The Paid-Up Life benefit is provided to you in full, as set out above, whether you retire prior to age sixty-three (63), early retirement; on attainment of age sixty-three (63), normal retirement; or after age sixty-three (63), postponed retirement.
Application
The Administrator will automatically arrange on your behalf for the purchase of a Paid-Up Life policy once you commence receiving pension benefits under the Pension Plan. However, should you retire before age sixty-three (63), and continue to self-pay your benefits, a Paid Up Life policy will be purchased upon your attainment of age sixty-three (63). If you are disabled and on an approved Life Waiver of Premium, a Paid Up Life policy will be purchased upon your attainment of age sixty-five (65).
Certificate of Insurance
Once a Paid Up Life policy is purchased, a Certificate of Insurance, "Certificate" will be issued to you. This Certificate should be kept with your other valuable documents. A lump sum payment, in the face amount set out on the Certificate, will be made to your named beneficiary upon your death.
The amount shown in the SUMMARY OF BENEFITS is payable if you are unable to work because of a non-occupational accident, sickness, or disability relating to pregnancy, provided you are under the continuing care of a doctor. The disability must commence while your insurance is in force. You do not need to be confined at home but your disability must be severe enough to prevent you from performing your regular work.
NOTE: IN NO EVENT WILL BENEFITS COMMENCE PRIOR TO THE DATE YOU SEE A DOCTOR.
The Weekly Disability Income benefit is co-ordinated with Unemployment Insurance Sickness benefits (U.I.C.). Benefits are payable provided you are totally disabled, under the continuous care of a doctor, and are unable to perform the duties of your regular occupation. Weekly Disability Income benefits will be paid for a total of not more than 52 weeks for each period of disability reduced by the number of full or partial weeks for which you are entitled to benefits under the Unemployment Insurance Act of Canada, whether you apply for them or not.
If you do not qualify for U.I.C. disability benefits, payments will be made under this Plan. However, you must submit proof of your disqualification by the Unemployment Insurance Commission.
If you are eligible for U.I.C. disability income, benefits under this Plan are payable from the eighteenth (18th) week of disability through the fifty-fourth (54th) week of disability. If you are not eligible for U.I.C. disability income, benefits under this Plan are payable from the third (3rd) week of disability through the fifty-fourth (54th) week of disability.
The Weekly Income benefit will be directly offset by Canada Pension Plan Disability benefits.
The waiting period is taken from the date of your first consultation with a doctor, who determines you are totally disabled and unable to work.
If the same disability recurs, it must be separated from the original disability by more than two (2) weeks of continuous active employment for it to be considered as a new period of disability. If a disability arises from a different and unrelated cause, it will be considered as a new disability, provided it commences after you return to one full day of work.
NOTE: Weekly Disability Income benefits are taxable.
Exceptions
Weekly Income benefits will not be paid for any:
disability due to injury sustained while working for pay or profit, or
disability due to illness for which you are covered under Workers' Compensation or similar program, or
disability due to or associated with treatment rendered for cosmetic purposes, or
disability during a period you are serving a prison sentence, or
disability during the scheduled duration of a leave of absence including maternity leave. Maternity leave is considered to begin on the earlier of the date agreed upon by you and your employer or the date of birth, or
disability resulting from self-inflicted injury, war, or engaging in a riot or insurrection, or
disabilities covered by "no-fault" insurance.
Subrogation of Disability Benefits
If you are entitled to recover damages for loss of income from a third party and you are entitled to receive benefits under the Weekly Disability Income benefit of this Plan, the Insurer will be entitled to all your rights of recovery for loss of income to the extent of the benefits paid, or payable to you.
The amount shown in the SUMMARY OF BENEFITS is payable after a waiting period of at least three hundred and seventy-eight (378) days, if you become totally disabled, as defined below. You will be paid for as long as you are totally disabled, but not beyond the attainment of your sixty-third (63) birthday.
Total Disability
You are considered totally disabled, during the first eighteen (18) months in which you receive benefits, provided you are wholly and continuously disabled due to illness or bodily injury and, as a result, are not physically or mentally fit to perform the essential duties of your normal occupation, and thereafter, any other occupation, job or work, whether available or not:
i) for which you are, or become, qualified by your education, training or experience, considered collectively or separately;
ii) and for which the net current monthly earnings are at least equal to the level of net monthly benefits payable under this policy; and
iii) which exists in the labour market within the province or territory where you worked at the time you became disabled or where you currently live.
Recurrent Disability
Successive periods of total disability from the same cause, separated by less than six (6) months of return to work, will be considered one (1) period of disability and the waiting period waived.
If a disability is due to causes unrelated to a prior disability, you may, in accordance with the terms of the insurance policy, be eligible again for a disability benefit, subject to the waiting period, if you have returned to active work for at least one (1) full month.
Rehabilitative Employment
If you are disabled, you will be encouraged to undergo some suitable rehabilitative training program which would take into account the nature and limitations of your disability. Benefits received from the Plan will only be reduced if the earnings received from your Rehabilitative Program, your income from this Plan, together with the income described under the Integration of Benefits provision exceeds one hundred percent (100%) of your monthly, pre-disability earnings. In this case, your income benefit is further reduced by the amount in excess of one hundred percent (100%).
Integration of Benefits
If you receive a disability income from any source, including U.S. Social Security (except from an individual insurance policy), benefits under this Plan will be reduced so that the total benefits received by you do not exceed eighty-five percent (85%) of your gross pre-disability earnings. Long Term Disability benefits are offset dollar for dollar by W.C.B. benefits.
Subrogation of Disability Benefits
If you are entitled to recover damages for loss of income from a third party and you are entitled to receive benefits under the Long Term Disability Benefit of this Plan, the Asbestos Workers Local 95 Benefit Fund will be entitled to all your rights of recovery for loss of income to the extent of the benefits paid, or payable to you.
Exceptions
Benefits are not payable for the following:
disabilities resulting from self-inflicted injuries or sickness;
disabilities covered by "no-fault" insurance, such as Ontario Bill No. 59, or similar provincial legislation;
disabilities as a result of participation in a war, whether declared or not;
any period of disability, or portion thereof, during which you are not under the care of a legally qualified physician or specialist;
disability during the scheduled duration of a leave of absence, including maternity leave. Maternity leave is considered to begin on the earlier of the date agreed upon by you and your employer or the date of birth;
an accidental bodily injury arising out of or in the course of any employment for remuneration or profit other than with the employer.
payment of benefits for any loss of income caused or contributed to by Alcoholism, any eating disorder, or any substance abuse will be covered provided the Member is under a program of regular care and rehabilitation deemed appropriate by current medical standards.
NOTE: Long Term Disability Income benefits are taxable.
