Description of Benefits

The plan pays an Eligible Active Member a weekly benefit for disability absences during which you are prevented from performing your usual job duties solely as a result of a Non-Occupational accidental bodily injury or disease, including pregnancy related conditions. Your disability absence must commence while you are covered under the plan. If you are laid off at the time your disability commences, the benefit period will not start until you are recalled to work. You do not need to be confined at home. You must be under the continuous care of a Physician throughout the entire period of your disability. Eligibility for this benefit terminates at the earlier of Retirement or age 70. This benefit does not apply to Dependents.

Weekly Wage Replacement Benefit

IN NO EVENT WILL BENEFITS COMMENCE PRIOR TO THE DATE YOU ARE SEEN BY A PHYSICIAN.

You will be considered Totally Disabled if you are unable to work at your own occupation, solely as a result of a non-occupational injury or disease. Your own occupation means the type of work in which you were engaged and is not limited to the actual job you were performing prior to the start of a period of Total Disability.

Period of Payment

The Weekly Wage Replacement Benefit is integrated with Employment Insurance Sickness Benefits (E.I.). Your benefits under this Trust Fund will be reduced by the number of full or partial weeks for which you are entitled to E.I. benefits, whether you apply for them or not. If you do not qualify for E.I. Sickness Benefits, payments will be made under this Trust Fund; however you must submit proof of your disqualification by E.I. The maximum benefit period provided by the wage replacement plan is 104 weeks, inclusive of E.I. benefits.

This short-term disability wage replacement benefit is subject to a 1-week waiting period before payments commence. The waiting period is taken from the date of your first consultation with a Physician who determines you are totally disabled and unable to perform your usual job duties. No benefits are payable for the next 26 weeks, unless you prove your disqualification for E.I. benefits. If your disability continues beyond the 1 week waiting period and the 26 week E.I. period, you may claim benefits from this Trust Fund.

Benefit Amount

The amount of your weekly benefit is specified above. Please note that all benefits are subject to Income Tax, which will be deducted from your weekly income replacement benefits. You will receive a T4 for all paid amounts by the end of February of the following year.

In addition to the benefit reduction for CPP/QPP, your benefit under this coverage will also be directly reduced by any income or benefit payable under:

• any other plan or program provided to you by your employer;
• any plan or program of any government or of any subdivision or agency of the government.

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

Rehabilitation Provision

If considered justified by the BPA Health Management Services Case Manager, 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 BPA Health Management Services Case Manager 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 Weekly Wage Replacement 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 weekly pre-disability Earnings. In that event, your Wage Replacement 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 Weekly Wage Replacement benefit payments.

Successive Disabilities

Successive disabilities separated by less than two weeks of active, full-time work will be considered one disability, unless the subsequent disability is due to an entirely different and unrelated cause. Disabilities arising from different and unrelated causes will be considered as a new disability providing they commence after you return to full-time work, for at least one full day. Disabilities arising from the same or a related cause will be considered as a new disability provided you returned to regular, full-time work for a period of at least two weeks.

Exclusions and Limitations

No benefits are payable for:

• any day on which you are not under the care of a legally qualified Physician or surgeon; no period of care shall be considered to have started until you have been seen and treated personally by a Physician or surgeon;
• any day you are performing work of any kind, anywhere, for compensation or profit;
• during any leave of absence (including Maternity/Paternity Leave);
• any day you are receiving Disability Benefits, Early Retirement, or Retirement benefits under any Employer or Union sponsored pension plan;
• any day you are entitled to receive Employment Insurance Sickness Benefits;
• any day you are entitled to receive reimbursement under any Workplace Safety and Insurance law or similar legislation;
• any disability due to or associated with treatment rendered for cosmetic purposes;
• any portion of a period of disability resulting from substance abuse, including alcoholism and drug addiction, unless you are participating in a recognized substance withdrawal program;
• any injury caused or contributed to by a Motor Vehicle Accident which occurs in Ontario or Quebec;
• for any disability resulting from intentionally self-inflicted injuries, whether you are sane or insane;
• for any disability resulting from voluntary participation in war, riot or insurrection;
• for the portion of a period 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;

Termination of Coverage

Your eligibility for Weekly Wage Replacement benefits terminates at the earlier of Retirement or age 70.

Subrogation

If you are entitled to recover compensation for loss of income from a third party as a result of the incident that caused or contributed to the disability for which you have received these benefits, the Trust Fund will be subrogated to all the rights of your recovery for loss of income, to the extent of the sum of benefits paid or payable by the Trust Fund. You shall execute such documents as required by the Trust Fund.

In the event that you can provide proof to the Trust Fund that you have not recovered full compensation for loss of income, the Trust Fund shall determine the proportion of damages actually recovered and share proportionately in that amount.

Should you choose to settle the matter prior to judicial determination, you should understand that the sum reached in settlement would be deemed to be full compensation for loss of income, and the Trust Fund’s right of subrogation will apply.

The term compensation shall include any lump sum or periodic payments which you receive or are entitled to receive on account of past, present or future loss of income.

Proof of Loss

Written proof stating the occurrence, character and extent of loss must be submitted to the BPA Health Management Services Office within 90 days after the termination of the period for which the Insurer is liable. Failure to provide such proof within the time required shall not invalidate nor reduce the claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.

The Trust Fund shall have the right and opportunity to independently examine any person whose injury or illness is the basis of claim, when and as often as it may reasonably require during the pending and payment period, if any, of such claim.