We tend to think of accidents as things that happen to other people. But it can happen to anyone, and even accident survivors may be left with devastating injuries which have significant financial implications.
Coverage provided by Manulife Financial (effective March 1, 2021)
If an Employee sustains an injury as a result of an Accident while insured under this benefit and suffers a Loss specified in the Table of Covered Losses, Manulife Financial will pay the amount specified in that table, provided the Loss:
a) is a direct result of the accidental injury:
b) occurs within 365 days from the date of the accidental injury; and
c) is total and irreversible or irrecoverable.
In the case of loss of speech or hearing, or loss of use of an arm, hand, or leg, the loss much be continuous for 12 months and determined to be permanent, after which time the benefit is payable.
In the following table, the amount payable is a percentage of the Benefit Amount for which the Employee was insured at the time the accidental injury occurred.
Only one percentage, the largest, will be paid for multiple losses to the same limb due to any one accidental injury.
No more than 100% will be paid for all losses due to any one accidental injury, except in the case of hemiplegia, paraplegia or quadriplegia, where the total amount paid will not exceed 200% (provided such benefit is paid while the Employee is living).
Loss Percent of Benefit Amount
loss of life 100%
loss of or loss of use of both hands or of both feet 100%
loss of sight of both eyes 100%
loss of one hand and one foot 100%
loss of use of one hand or arm and one leg 100%
loss of one hand and sight of one eye 100%
loss of one foot and sight of one eye 100%
loss of hearing in both ears and speech 100%
loss of or loss of use of one arm or one leg 75%
loss of use of both arms 200%
loss of both arms 100%
loss of use of both legs 200%
loss of both legs 100%
loss of use of one arm and one leg on the same side of the body 200%
loss of or loss of use of one hand or one foot 66 2/3%
loss of sight in one eye 66 2/3%
loss of speech or hearing in both ears 66 2/3%
loss of or loss of use of thumb and index finger or at least four fingers of one hand 33 1/3%
loss of all toes of one foot 25%
loss of hearing in one ear 33 1/3%
hemiplegia, paraplegia or quadriplegia 200%
Loss of hand means complete severance at or above the wrist joint, but below the elbow.
Loss of foot means complete severance at or above the ankle joint, but below the knee joint.
Loss of arm means complete severance at or above the elbow.
Loss of leg means complete severance at or above the knee joint.
Loss of sight means the entire and irrevocable loss of sight of the eye.
Loss of speech means the entire and irrevocable loss of speech which does not allow audible communication of any degree.
Loss of thumb and index finger means the complete severance between the wrist and the interphalangeal and proximal interphalangeal joints of one hand, respectively.
Loss of finger means the complete severance at or above the knuckles joining the finger to the hand.
Loss of toe means the complete severance at or above the knuckle joining the toe to the foot.
Hemiplegia means paralysis of one side of the body.
Paraplegia means paralysis of the lower portion of the body (including the bowel and bladder) and both lower limbs due to injury of the spinal cord.
Quadriplegia means paralysis of four limbs.
The AD&D Policy also provides the following benefits:
If an Employee suffers a Loss specified in the Table of Covered Losses due to unavoidable exposure to the elements of nature after a conveyance in which the Employee was travelling, sinks, makes a forced landing or is lost, wrecked or stranded, such loss will be deemed to have occurred as a result of an accidental injury.
An Employee is deemed to suffered death by accidental injury if his body is not found within 365 days after a conveyance in which the Employee was travelling, sinks, makes a forced landing or is lost, wrecked or stranded.
Coverage: A maximum of $10,000 within three years of the Accident
If, as a direct result of an accidental injury, an Employee suffers a Covered Loss and requires participation in a formal rehabilitation program in order to return to gainful employment, Manulife Financial will pay expenses incurred by the Employee, provided the expenses are reasonable and necessary, as determined by Manulife Financial.
No payment will be made for room and board expenses, or other living, travelling or clothing expenses.
Coverage: A maximum of $10,000
If an Employee dies as a direct result of an accidental injury which occurs while travelling 150 kilometres or more from the Employee’s normal place of residence, Manulife Financial will pay for expenses incurred for the repatriation of the deceased’s body, provided the expenses are:
a) reasonable and necessary, as determined by Manulife Financial; and
b) for preparation and transportation of the body to the deceased’s place of residence.
Coverage: A maximum of $5,000 per Accident
If, as a direct result of an accidental injury, an Employee suffers a Covered Loss and is confined in a Hospital located at least 150 kilometres or more from his normal place of residence, Manulife Financial will pay the hotel and travel expenses incurred by an Immediate Family, provided the expenses are:
a) reasonable and necessary, as determined by Manulife Financial;
b) for hotel accommodations in the vicinity of the Hospital; and
c) for transportation by the most direct route to the Hospital, including return fare.
If transportation is by means other than a conveyance which is licensed to transport fare-paying passengers, expenses incurred will be reimbursed at a rate of $0.20 per kilometre travelled.
Coverage: The lesser of $5,000 or 5% of the Benefit Amount for the Employee’s Basic Life Insurance Amount per Child per year, for a maximum of 4 years
If an Employee dies as a direct result of an accidental injury, Manulife Financial will pay the benefit described below for each Child who is enrolled as a full-time student:
a) in a school for higher learning above the secondary school level; or
b) at the secondary school level, but who enrolls as full-time student in a school for higher learning within 365 days after the date of the Employee’s death.
A school for higher learning means any accredited university, private college, colleges d’enseignement general et professionel (CEGEP), community college or trade school.
The benefit paid for each Child will be equal to the actual tuition expenses incurred, subject to the Dependent Education Expenses maximum.
No payment will be made for:
a) tuition expenses incurred prior to the Employee’s death; or
b) room and board expenses, or other living, travelling, or clothing expenses.
Coverage: A lifetime maximum of $10,000
If an Employee dies as a direct result of an accidental injury and the Spouse must participate in a formal occupational training program to become qualified for active employment in an occupation for which the Spouse would not otherwise sufficient qualifications, Manulife Financial will pay for expenses incurred by the Spouse for the program, provided the expenses are:
a) reasonable and necessary, as determined by Manulife Financial; and
b) incurred within a period of 3 years from the date of the accidental injury.
No payment will be made for room and board, or other living, travelling or clothing expenses.
Coverage: 10% of the AD&D Benefit Amount
If an Employee dies as a direct result of an accidental injury sustained while driving or riding in an Automobile, Manulife Financial will pay the Seat Belt Benefit shown in the Benefit Schedule, provided:
a) the Automobile was equipped with seat belts;
b) the seat belt was in use and properly fastened at the time of the accidental injury; and
c) the position of the seat belt is certified in the official report of the accident or by the investigating police officer.
An Automobile means a motorized land vehicle which does not operate on rails or crawler treads, not including a two-wheeled vehicle, farm-type tractor, or any equipment which is primarily designed for off-road use.
Coverage: The lesser of $5,000 or 5% of the AD&D Benefit Amount per Child per year, for a maximum of 4 years
If an Employee dies as a direct result of an accidental injury, Manulife Financial will pay the benefit described below for each Child under 13 years of age who is enrolled in a legally licensed day-care centre on the date of the accidental injury, or who is subsequently enrolled with in 365 days from the date of the Employee’s death.
The benefit paid for each Child will be:
a) the reasonable and necessary expenses incurred, as determined by Manulife Financial; and
b) subject to the Day-Care Expenses maximum.
No payment will be made for:
a) expenses incurred prior to the Employee’s death; or
b) room and board expenses, or other living, travelling, or clothing expenses.
Coverage: A lifetime maximum of $10,000
If, as a direct result of an accidental injury, an Employee:
a) suffers a loss of, or loss of use of, both feet or both legs; or
b) becomes a hemiplegic, a paraplegic, or quadriplegic.
and subsequently requires the use of a wheelchair to be ambulatory, Manulife Financial will pay for expenses incurred by the Employee, provided the expenses are:
a) reasonable and necessary, as determined by Manulife Financial;
b) incurred within 3 years from the date of the accidental injury;
c) for alterations to the Employee’s principal residence for the purpose of making it wheelchair accessible; and
d) for modifications to one motor vehicle utilized by the Employee for the purpose of making it wheel chair accessible (subject to approval by licensing authorities, where necessary).
The amount payable is subject to the Home Alteration and Vehicle Modification Expenses maximum.
Coverage: 1% of the Benefit Amount for AD&D, up to a maximum of $2,500 per month for a maximum of 12 months
If, as a direct result of an accidental injury, an Employee suffers a Covered Loss and is confined in a Hospital, Manulife Financial will pay the Hospitalization Allowance provided:
a) the Hospital confinement begins while the Employee is covered under this Benefit; and
b) the Employee has been confined to the Hospital for longer than the Qualifying Period of 7 consecutive days and remains confined at the end of such period.
Payments will be made monthly in arrears. Any payments for a period less than one month will be prorated according to the formula then used by Manulife Financial.
Payments will cease on the earlier of:
a) the date on which benefits have been paid up to the Maximum Benefit Period; or
b) the date the Employee is no longer confined in a Hospital (for which a full day charge is not made by the Hospital).
Recurrent Hospitalization
If an Employee becomes confined to a Hospital again following a period for which benefits were payable under this provision, such subsequent periods of confinement will be considered a continuation of the previous period of hospital confinement, provided:
a) the subsequent period of hospitalization is directly related to the same accidental injury which caused the previous period of hospitalization; and
b) the subsequent period of hospitalization occurs within 183 days after the previous period of hospitalization.
For an Employee who is in a recurrent period of hospitalization:
a) the Qualifying Period of 7 days will be waived; and
b) the benefit which was payable during the previous period of hospitalization will be re-instated.
Benefits for all such recurrences will not be paid for a combined period longer than the Maximum Benefit Period shown.
Coverage: an amount equal to the Benefit Amount for AD&D, less any amount payable under this Benefit for a Covered Loss which results from the same accidental injury that caused the Permanent and Total Disability
If, as a direct result of an accidental injury, an Employee becomes Permanently and Totally Disabled while insured for this Benefit, Manulife Financial will pay the Permanent and Total Disability benefit shown, provided:
a) the Employee becomes Permanently and Totally Disabled within 365 days after the date of the accidental injury; and
b) the Employee has been Permanently and Totally Disabled for a continuous period of 12 months and remains so disabled at the end of such period.
The benefit is payable to the Employee in a single sum.
Definition of Permanent and Total Disability
The Employee is wholly and continuously disabled due to an accidental injury which is severe enough, in Manulife Financial’s opinion, to permanently prevent the Employee from working for remuneration or profit.
Expenses which are eligible under this Benefit and which are also payable in part or in full under any other benefit, policy or plan providing similar coverage issued to the Policyholder, will be paid first under such other benefit, policy or plan. any expenses not paid will then be considered under this Benefit, subject to any stated maximum.
The total amount of payments from all coverages combined will not exceed 100% of the eligible expenses incurred.
If an Employee’s Life Insurance premiums are being waived while this Benefit is in force, the premiums for the Benefits will also be waived.
Waiver of Premiums for the Benefits will be effective on the same date as the Waiver of Premiums for the Life Insurance Benefit.
The amount of insurance continued under this provision will be subject to the same terms described under the Life Insurance Benefit, except that:
a) the Conversion Privilege is not available for this Benefit (unless required by legislation or regulation); and
b) Waiver of Premiums for the Benefit terminates when this Benefit terminates.
No benefit is payable for any loss directly or indirectly related to:
a) suicide or self-inflicted injury;
b) war, insurrection, the hostile action of any armed forces, or participation in a riot or civil commotion;
c) an infection (except pyogenic infections from an accidental cut or wound), illness or disease or the medical treatment of any illness or disease, or bodily or mental infirmity;
d) riding in, boarding or leaving, or descending from, any aircraft as a pilot, operator or member of the crew;
e) riding in, boarding or leaving, or descending from, any aircraft which is owned, operated or leased by or on behalf of the Employer;
f) the committing of or attempt to commit an assault or criminal offence; or
g) injuries sustained while operating a motor vehicle, either while under 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.
