Group Benefits Plan Information

If an Employee becomes Totally Disabled while insured for this Benefit, Manulife Financial will pay a Disability Benefit as outlined in this section, provided the Employee meets Manulife Financial’s Entitlement Criteria.

Benefits are payable from the end of the Qualifying Period. Benefits are not payable for or during the Qualifying Period.

Restriction or lack of ability due to an illness or injury which prevents an Employee from performing the essential duties of:

a) his own occupation, during the Qualifying Period and the 2 years immediately following the Qualifying Period; and

b) any occupation for which the Employee is qualified, or may reasonably become qualified, by training, education or experience, after 2 years specified in part a) of this provision.

The availability of work will not be considered by Manulife Financial in assessing the Employee’s Disability.

An Employee who must hold a government permit or licence to perform his duties will not be considered Totally Disabled solely because such permit or licence has been withdrawn or not renewed.

Manulife Financial will apply the following criteria in determining an Employee’s entitlement to Disability Benefits:

a) the Employee has been continuously Totally Disabled throughout the Qualifying Period. If the Employee ceases to be Totally Disabled during this period and then becomes Totally Disabled again within 3 weeks due to the same  or related cause, the Qualifying Period will be extended by the number of days during which the Total Disability ceased;

b) Manulife Financial receives medical evidence documenting how the Employee’s illness or injury causes restrictions or lack of ability, such that the Employee is prevented from performing the essential duties of:

i) his own occupation, during the Qualifying Period and the 2 years immediately following the Qualifying Period; and

ii) any occupation for which the Employee is qualified, or may reasonably become qualified, by training, education or experience, after the 2 years specified in part i) of this provision.

c) the Employee is receiving from a Physician, regular, ongoing care and treatment appropriate for the disabling condition, as determined by Manulife Financial.

At any time, Manulife Financial may require the Employee to submit to a medical, psychiatric, psychological, functional, educational and/or vocational examination or evaluation by an examiner selected by Manulife Financial.

The Employee is not entitled to benefit payments for any period that he is:

a) not receiving from a Physician, regular, ongoing care and treatment appropriate for the disabling condition, as determined by Manulife Financial:

b) receiving Employment Insurance maternity or parental benefits;

c) on lay-off during which the Employee becomes Totally Disabled;

d) on leave of absence during which the Employee becomes Totally Disable, unless the Employee is required to pay benefits during this period as a result of legislation, regulation or case law (in some provinces, Employers with a benefit plan are required to provide benefits to an Employee during the health-related portion of a Maternity Leave of Absence);

e) receiving benefits under an employer-sponsored salary continuance or short term wage loss replacement plan;

f) working in any occupation, except as provided for under the Rehabilitation Assistance provision; or

g) incarcerated in a prison, correctional facility, or mental institution by order of authority of a criminal court.

The Amount of Disability Benefit payable is a monthly taxable benefit at 65% of the Employee’s Monthly Salary plus the pension contribution (see below) to a maximum Monthly Benefit of  $11,000 less any amount the Employee receives, or is entitled to receive, from the following sources for the same or related Disability:

a) Workers’ Compensation or similar coverage;

b) Canada or Quebec Pension Plans, excluding dependent benefits but including CPP/QPP Retirement benefits; and

c) any government motor vehicle automobile insurance plan or policy, unless prohibited by law.

With respect to Canada or Quebec Pension Plans, when requested by Manulife, reconsideration, appeal or reapplication following a decline of a benefit is to be made, as well as providing satisfactory evidence to Manulife that a reconsideration, appeal or reapplication of the benefit has been made.

The benefit amount payable will be further reduced so that the total amount from All Sources does not exceed 85% of the Employee’s pre-disability Earnings.

All Sources include those stated above and:

a) any amount the Employee receives, or is entitled to receive, from:

i) any group, association or franchise plan;

ii) any retirement or pension plan;

iii) earnings or payments from any employer, including severance payments and vacation pay;

iv) self-employment;

v) any government plan, excluding Employment Insurance Benefits.

Manulife Financial will apply the following rules in determining the Employee’s Disability Benefit:

a) benefits from other sources which began before the commencement of the Employee’s current Disability will not be taken into account;

b) benefits payable from other sources will not be adjusted to take into account any differences between the tax status of those benefits and the benefit payable by Manulife Financial;

c) benefits payable by Manulife Financial to an Employee’s pension, if stated as such above, will not be taken into account;

d) subsequent changes in benefits from other sources, other than cost of living increases, will be taken into consideration and a new benefit amount may be established;

e) benefits payable under individual disability income insurance will not be taken into account;

f) for benefits payable other than on a monthly basis, a monthly equivalent of such benefit will be estimated by Manulife Financial; and

g) if an Employee does not apply for a benefit for which he is eligible, the amount of such benefit will be estimated by Manulife Financial and assumed to be paid.

In order to continue a Total Disabled Employee’s participation in a public pension plan and/or the Employer’s pension plan, Manulife Financial will send the monthly pension plan contribution to the Employer or pension plan administrator. This contribution is payable only while the Employee is entitled to receive the Disability Benefit, as specified under The Benefit.

The amount of the monthly pension contribution is 15% of monthly Earnings.

The contribution will not be reduced by any income the Employee receives as part of Rehabilitative Assistance.

Conditional monthly payments shall be made to an Employee with a potential loss of income claim against a third party who caused or contributed to the Disability. Any such payments are subject to Manulife Financial’s subrogation right to reimbursement when the Employee is indemnified through a judgement or settlement.

Disability benefit payment will be made monthly in arrears. Any payment for a period of less than one month will be made at a daily rate of one-thirtieth of the Employee’s monthly benefit amount.

Once Manulife Financial determines that an Employee is Totally Disabled, where appropriate and at Manulife Financial discretion, the Employee may be offered rehabilitation to assist him in returning to gainful employment, either to his pre-disability occupation or to another occupation.

In partnership with the Employer and the Employee, Manulife Financial will provide the Employee with a structured Vocational Plan that will prepare the Employee for a return to work:

a) with the Employer;

b) with an alternate employer; or

c) in a self-employed capacity.

In considering whether Rehabilitation Assistance is appropriate for an Employee, Manulife Financial will take into account:

a) the nature, extent and expected duration of the Employee’s Disability;

b) the Employee’s level of education, training or experience; and

c) the nature, scope, objectives and cost of the Vocational Plan.

An Employee will continue to be entitled to Disability Benefits while participating in the Vocational Plan. The Employee’s Disability Benefit will be reduced by earnings received from any employment only if the Employee’s total income from all sources exceeds 100% of his pre-disability Earnings as this Benefit is taxable.

If an Employee ceases to participate in a Vocational Plan because of a change in his medical status, Manulife Financial will require medical evidence documenting how the Employee’s medical condition has deteriorated such that the Employee’s inability to continue with the Vocational Plan is due to an increase in restrictions or lack of ability.

If the Employee is not available or does not co-operate or participate in the Vocational Plan, the Employee will no longer be entitled to Disability Benefits.

Disability benefit payments will cease on the earliest of:

a) the date the Employee ceases to meet this Benefit’s definition of Totally Disabled.

b) the date the Employee does not supply Manulife Financial with appropriate medical evidence documenting how the Employee’s illness or injury causes restrictions or lack of ability, such that the Employee is prevented from performing the essential duties of:

i) his own occupation, during the Qualifying Period and the 2 years immediately following the Qualifying Period; and

ii) any occupation for which the Employee is qualified, or may reasonably become qualified, by training, education or experience, after the 2 years specified in part i) of this provision.

c) the date the Employee does not attend a medical, psychiatric, psychological, education and/or vocational examination or evaluation by an examiner selected by Manulife Financial.

d) the date on which benefits have been paid up to the Maximum Benefit Period.

e) the date the Employee refuses to perform work offered by the Employer, as approved by Manulife, that accommodates the Employees’ medical restrictions and limitations and provides an income comparable to the Employee’s pre-disability Earnings.

f) the date the Employee dies.

Where an Employee becomes becomes Totally Disabled again from the same or related causes as those for which Long Term Disability benefits have been paid under this Policy and such Disability recurs within 6 months from the end of the period for which benefits were paid under this Policy, Manulife Financial will waive the Qualifying Period.

All such recurrences will be considered a continuation of the same Disability. The benefit payable will be based on the Employee’s Earnings as at the original date of Disability. Benefits for all recurrences will not be paid for a combined period longer than the Maximum Benefit Period.

If the same Disability recurs within 6 months after the end of the period for which benefits were paid, and the member has attained the age of 65, no further disability benefits are payable for that same Disability.

If the same Disability recurs more than 6 months after the end of the period for which benefits were paid, such Disability will be considered a separate Disability.

Two Disabilities which are due to unrelated causes are considered separate Disabilities if they are separated by a return to work of at least one day.

If the insured has been diagnosed as having a chronic disease that is progressive and degenerative in nature and the unusual course of the disease is such that is will lead to the member becoming totally disabled, and the disease has progressed to a stage where the member is unable to perform the duties of the members occupation. The employee mush be actively at work for an employer on a part-time or reduced work load basis. Where mutually agree, the employees may accept alternate employment.

A Pre-Existing Condition is any injury or illness (whether diagnosed or not) for which an Employee was treated or attended by a Physician, or for which Drugs were prescribed, within 90 days prior to the date the Employee’s insurance under this Benefits became effective.

For Rostered Employees whose employment has terminated and who return to work within 12 months from the date last Actively at Work with the Employer, the original date of employment will be used to determine the effective date for any Pre-Existing Condition.

A Pre-Existing Condition which causes Disability with in the first 12 months of insurance under this Benefit will not be covered.

Premiums required on behalf of an Employee for the Benefit will be waived during any period for which Long Term Disability Benefits are payable.

If an Employee’s insurance terminates for reasons other than reaching the Termination Age for the Benefit, Manulife Financial will continue insurance under this Benefit if the Employee is Totally Disabled and:

a) entitled to receive benefits; or

b) fulfilling the Qualifying Period.

The Employee must satisfy Manulife Financial’s Entitlement Criteria in order for the Disability Benefit to be payable.

The insurance continued is subject to all the provisions of this Policy.

No benefits are payable for any Disability directly or indirectly related to:

a) self-inflicted injuries, unless medical evidence establishes that the injuries are related to a mental health illness.

b) war, insurrection, the hostile actions of any armed forces or participation in a riot or civil commotion.

c) medical or surgical care which is not Medically Necessary.

d) the committing of or the attempt to commit an assault or criminal offence.

injuries sustained while operating a motor vehicle, either while under the influence of any intoxicant or if the Employee’s blood contained more than 80 milligrams of alcohol per 100 millilitres of blood at the time of injury.

f) abuse of addictive substances, including Drugs and alcohol, unless the Employee is actively participating and co-operating in an in-patient medical treatment program for substance abuse which has been approved by Manulife Financial.

g) a Pre-Existing Condition which causes Disability with in the first 12 months of insurance under this Benefit. A Pre-Existing Condition is any injury or illness (whether diagnosed or not) for which an Employee was treated or attended by a Physician, or for which Drugs were prescribed, within 90 days prior to the date the Employee’s insurance under this Benefits became effective.