Description of Benefits

Long Term Disability benefits are wage replacement benefits, which provide you a monthly income if you become so totally disabled by a Non-Occupational accidental bodily injury or disease while covered under this plan and under the age of 60 that you can no longer work for your living. Long Term Disability coverage covers you for those total disabilities that last beyond the period covered by the Short Term Weekly Wage Replacement Plan. This benefit applies to active Members under age 60 provided they have worked a minimum of 4,000 hours for a contributing employer(s). It does not apply to Dependents, working Members age 60 or older, or Retirees.

Definition of Total Disability: After the qualifying period you will be considered Totally Disabled for Long Term Disability Benefit only if you are incapacitated to the extent that solely because of a non-occupational disease or accidental bodily injury, you are unable to work at any occupation or employment for which you are, or may reasonably become, qualified by education, training or experience. Such disability must result from a medically determinable physical or mental impairment.

Maximum Period of Payment

You will be eligible for your first income payment from the plan after you have completed the qualifying period, which is the first 106 weeks of a period of total disability, or the duration of the Weekly Wage Replacement benefit, whichever is greater. However, you will not receive an income payment if you reach age 60 before you complete the qualifying period.

After completing the qualifying period, you will be eligible for income payments during the continuance of a period of total disability to age 60, however at age 60 you you are entitled to apply for your pension under the Insulators Local 95 Pension Plan.

A period of total disability is considered to cease:

• when you commence work at a reasonable occupation;
• when you fail to furnish proof of the continuance of total disability or refuse to be examined by a Physician;
• when you cease to be under the care of a Physician;
• the date of your death.

Amount of Monthly Income

The Long Term Disability benefit will be payable monthly to a maximum of $1,600, less any income received from any employer or from any occupation for compensation or profit, except as allowed under the Rehabilitation Provision.

Your Long Term Disability benefit will not be reduced by Canada Disability Pension Plan or Quebec Pension Plan benefits, or by any benefits received from the Insulators Local 95 Pension Plan, unless your total monthly income exceeds 85% of your Earnings prior to disability.

Your total monthly income from all sources cannot exceed 85% of gross monthly Earnings as of the date disability commences, except as allowed under the Rehabilitation Provision. If your monthly payments under the Long Term Disability benefit together with any other income, disability benefits or pension to which you may be entitled under any other group disability program or pension plan, total more than 85% of your normal Earnings; payments under this LTD benefit will be reduced so that your monthly payments together with all other compensations as described above, will not exceed 85% of your normal gross monthly Earnings.

Benefits are paid monthly at the end of the month.

Your normal gross monthly Earnings will be determined from the hourly rate in effect for your normal workweek as determined from the Collective Agreement in effect when your disability commenced.

Normal gross monthly Earnings do not include overtime pay, bonuses, or any other extra compensation. A retroactive change in the rate of Earnings shall be deemed to be effective on the date of the determination of the change in the rate of Earnings.

Rehabilitation Provision

If considered justified by the Claims Adjudicator, you will be required to participate in an approved rehabilitation program designed to favour your return to work. The rehabilitation program may be modified or interrupted if the Claims Adjudicator deems it necessary and justified.

The Claims Adjudicator will review your case file to determine what kind of rehabilitation program, if any, would be best for you. If your case file indicates rehabilitation would be beneficial, the Trust Fund will provide the necessary resources and support to help you recover your health and functional autonomy to a level enabling you to return to work.

The rehabilitation program resources may include, among others:

• Psychological consultation;
• Employment counselling;
• Changes to your workstation, job description or work schedule.

Your Long Term Disability (LTD) benefit will not be reduced by any remuneration you receive under an approved rehabilitation program unless your total income from all sources exceeds 100% of your monthly pre-disability Earnings. In that event, your LTD benefit will be reduced by the amount in excess of 100%.

Failure to participate in the rehabilitation program will result in suspension or termination of your LTD benefit payments.

Tax Status

The Long Term Disability benefit is taxable however no tax will be withheld from your monthly payments. You will receive a T4A for all paid amounts by the end of February of the following year.

Continuous Period of Disability

If you become disabled from the same or related causes within 6 months after return to active work, it will be considered one continuous period of disability and the qualifying period will not be reapplied.

If you have returned to active work for one full month and become disabled from different and unrelated causes, it will be considered a new period of disability, subject to a new qualifying period.

Exclusions and Limitations

No benefits are payable:

• for any day for which you are entitled to benefits under the Weekly Wage Replacement plan.
• for the portion of a period of disability during which you are not under treatment by a legally qualified Physician or specialist.
• for a disability resulting from injury or disease which occurred while the Member is on active duty in the armed forces of any country, or while participating in a riot, insurrection, rebellion or civil commotion.
• for a disability resulting from participation in the commission of a criminal offence.
• for the portion of disability during which you are imprisoned in a penal institution or confined in a Hospital or similar institution as a result of criminal proceedings.
• for a disability resulting from intentionally self-inflicted injuries or illness while sane or insane.
• for a disability resulting from an accident which occurs while you are operating a motor vehicle and your blood contains more than 80 milligrams of alcohol in 100 milliliters of blood (.08%).
• for any portion of a period of disability resulting from an eating disorder, or substance abuse, including alcoholism and drug addiction, unless you are participating in a recognized substance withdrawal program.
• an illness or injury caused or contributed to by a Motor Vehicle Accident that occurs in Ontario or Quebec.
• during any leave of absence (including Maternity/Paternity Leave).
• for a disability which commences on or after the date a strike begins, subject to any provincial Employment or Labour Standards Act. However, you can fulfill your Qualifying Disability Period during a strike.

Extended Insurance

If your Long Term Disability coverage terminates during a period of total disability, the Plan continues to be liable as though the coverage provision remained in force. The Plan shall not be liable for disabilities occurring after the Long Term Disability coverage provision terminates.

Termination of Coverage

Your eligibility for Long Term Disability terminates at attainment of age 60.