Definition of Total Disability - A disability that completely and continuously prevents you from doing the material and substantial duties of your regular occupation during the Waiting Period and during the next 24 consecutive months. After which, you are considered to be totally disabled if you cannot perform any occupation for which you are or may become qualified by reason of education, training or experience.
Total Disability - If you become totally disabled as the result of an injury or sickness while covered under the policy, we will pay the monthly benefit amount due for the period of total disability. The period of total disability must require the regular care of a physician.
Successive Periods of Disability - Periods of disability due to the same or related medical causes and separated by less than 6 months during which you are actively-at-work will be considered one period of disability.
Period of Disability means a continuous length of time during which you are disabled under this plan.
Pre-existing Condition means an injury or sickness or any condition related to such injury or sickness for which a person consults a doctor, receives medical services or supplies or takes any medication during the 12 month period immediately before the insured member's insurance date. Pre-existing Condition does not include: (a) any such injury or sickness or condition after such person has been continuously insured under the Policy for 12 month; or (b) an injury or sickness or condition classified as an Impairment Restriction.
Maximum Payment Period: For total disability beginning before age 61: to age 62. Age 61 and over: 12 months.
If you are totally disabled due to mental or nervous disorders, alcoholism, or drug abuse, the maximum payment period will be reduced to 2 years during your lifetime unless you are confined in a hospital or other institution licensed to provide care and treatment for that disability.
Actively-at-work means you are performing the regular duties of your normal occupation for wage or profit on a full-time basis (at least 17.5 hours a week).
The plan has an offset provision which means benefits payable as a result of your total disability will be the lesser of the monthly benefit amount or the monthly benefit amount minus any other income benefits. However, if your monthly benefit amount would reduce to less than $200 per month due to other income benefits, then the minimum monthly benefit amount under this benefit will be $200 per month.
Other Income Benefits include, but are not limited to (See Certificate for details) 1. benefits for loss of time from employment which is provided for a disability under: (a) any plan arranged by any employer, union or association; (b) any fund or other arrangement pursuant to any compulsory disability benefit act or law; or (c) an individual disability income policy; 2. benefits in the form of periodic cash payments for a disability, excluding any benefits for a disability starting before the insured member's insurance date, which is provided: (a) under any group life insurance plan; (b) by any federal, state, provincial, municipal or other governmental agency, or pursuant to the Federal Railroad Retirement Act; or (c) under the Federal Social Security Act, Canada Pension Plan or Quebec Pension Plan on the basis of the insured member's record of wages and self-employment income and payable to the insured member or a spouse or child of the insured member, without regard to any deductions from such benefits which can be made: (1) on account of work; (2) because of the insured member's refusal to accept rehabilitation; or (3) because a spouse or child of the insured member has elected to be paid benefits under the Federal Social Security Act, Canada Pension Plan or Quebec Pension Plan on the basis of the spouse's or child's own record of wages and self-employment income. In determining the amount of such benefits, however, there will be excluded the amount of any increase therein which occurs after the waiting period 3. benefits under a Workers' Compensation Act or similar act.
The example in the table directly below is for purposes of illustrating the effect of benefit reductions and is not intended to reflect the situation of a particular claimant under the policy.
|Insured's monthly [Basic Monthly Insured Salary]
|Long term disability benefits percentage
|Unreduced maximum benefit
|Less Social Security disability benefit per month
|Less state disability income benefit per month
|The total amount of long term disability benefit per month