Accidental Disability Insurance Plus
Underwritten by Trisura Guarantee Insurance CompanyBenefits
The payment of any benefit provided for under Accidental Disability Insurance is subject to the terms and conditions of this Certificate and the Group policy.
|Accidental Disability Insurance Plus
|$750 per month up to 3 months||$750 per month up to 6 months|
Accidental Disability Insurance Plus
The Insurer shall pay a benefit to the Creditor equal to 1/30th of the Monthly Amount Insured for each day of continuous Total Disability upon receipt of proof satisfactory that an Applicant is Totally Disabled due to an Injury. This benefit shall be paid monthly.
"Accident" means a sudden, unforeseen and fortuitous event due exclusively to a violent external cause and resulting, directly and independently of any other cause, in bodily injury.
"Administrator" means Reinsurance Management Associates, Inc. at 170 University Avenue, Suite 500, Toronto, Ontario M5H 3B3, the administrator appointed by the Insurer to administer the Group Policy on their behalf.
"Applicant" means a customer(s) of the Policyholder who has enrolled for coverage under the Group Policy and who satisfies the Conditions of Eligibility.
"Creditor" means a lending institution or organization who has granted a Loan to an Applicant. For all purposes, a reference to Policyholder shall include the Creditor.
"Effective Date of Insurance" means the latest of:
a) the date the Loan funds are advanced;
b) the date the Application is signed, if no medical underwriting is required; or
c) the date the Application is approved by the Insurer, if medical underwriting is required.
"Group Policy" means the Group Accidental Death, Accidental Disability and Involuntary Unemployment Insurance Policy issued by the Insurer to the Policyholder.
"Indebtedness" means either the balance of the Loan or the remaining payments under a lease agreement, but will not include any Residual/Balloon Payment indicated on the Application. However, any amount in default is not part of the Indebtedness and is therefore not covered by the insurance.
"Indebtedness Insured" equals the least of the Indebtedness, the Principal Amount Insured, and the Maximum Benefit.
"Injury" means bodily injury which is caused solely by an Accident and which causes an Applicant to be Totally Disabled.
"Loan" means the loan or lease contract issued to the Applicant by the Creditor as specified on the Application.
"Maximum Benefit" means the maximum benefit payable as outlined below.
|Coverage||Conventional Benefit Maximum||Preferred Benefit Maximum|
|Accidental Disability Insurance Plus
|$750 per month up to 3 months||$750 per month up to 6 months|
"Non-Retroactive" means the benefit period begins after the (30) thirty day Waiting Period from the date of Total Disability or the date of involuntary unemployment, as applicable.
"Physician" means a person who is licensed and practicing in Canada within the scope of his license as a doctor of medicine (M.D.) and is not an Applicant or his legal/common law spouse, or a member of the family of the Applicant or his legal/common law spouse, or in a business relationship with an Applicant.
"Policyholder" means an organization that has been issued a Group Policy and is authorized by the Insurer to offer coverage to Applicants. For all purposes, a reference to Creditor shall include the Policyholder.
"Pre-Existing Condition" means any illness, disease, or physical condition for which medical advice, consultation, diagnosis or treatment was required or recommended during the twelve (12) months prior to the Effective Date of Insurance, and where such condition caused, directly or indirectly, death or Total Disability to occur within the twelve (12) months following the Effective Date of Insurance.
"Total Disability" or "Totally Disabled" means that condition resulting from Injury for which the Applicant is under care of a physician and is prevented from performing every duty of his/her own occupation.
"Waiting Period" means the number of days an Applicant must remain continuously Totally Disabled or involuntary unemployed in order to qualify for benefits.
CONDITIONS OF ELIGIBILITY
To be eligible for any insurance under the Group Policy, the Applicant, on the Effective Date of Insurance shown on the Application, must:
a) be a natural person (partnerships, corporations or other forms of business entities are not eligible for insurance);
b) be a Canadian resident;
c) be at least 18 years of age;
d) be under 76 years of age for Accidental Death Insurance; and
e) be under 66 years of age for Accidental Disability Insurance or Involuntary Unemployment Insurance.
In addition, to be eligible for Accidental Disability Insurance or Involuntary Unemployment Insurance provided under the Group Policy the Applicant must be gainfully employed and actively at work for wages or profit for at least 25 hours per week for 30 consecutive days immediately prior to the Effective Date of Insurance.
An Applicant who is self employed or whose normal employment is subject to seasonal conditions and layoff or work suspension is a regular and anticipated part of the work schedule is also eligible for Accidental Disability Insurance if this Applicant is so employed for 13 consecutive weeks during the 12 month period immediately preceding the Effective Date of Insurance.
The benefit period begins on the date following a 30 day Non-Retroactive Waiting Period.
The benefit period for an Applicant ends on the earliest of the following dates:
a) the date this Applicant is no longer Totally Disabled or returns to partial or full time work or is no longer available to work in Canada, whichever is earlier;
b) the date that three (3) benefit payments have been paid if the Conventional Plan was selected on the Application;
c) the date that six (6) benefit payments have been paid if the Preferred Plan was selected on the Application;
d) the date the Insurer requires the Applicant to submit proof of continued Total Disability or unemployment and such proof is not provided within thirty (30) days;
e) the date the Insurer requires the Applicant to be examined by a Physician or other practitioner named by the Insurer and the Applicant does not submit to such examination within thirty (30) days;
f) the date the Loan has been paid in full;
g) the date the Term of Insurance applicable to the Accidental Disability Insurance Plus for the Applicant is expired; or
h) the date on which the Applicant turns 66 years of age.
a) Recurrent Total Disability occurring within 180 days of a previous period of Total Disability for which an Applicant has received benefit payments and resulting from the same cause will be considered a continuation of the previous period and any benefits remaining unused from the first period will not be subject to a second Waiting Period.
b) A period of involuntary unemployment occurring within 180 days of a previous period of involuntary unemployment for which an Applicant has received benefit payments will be considered a continuation of the previous period and any benefits remaining unused from the first period will not be subject to a second Waiting Period.
c) If joint coverage was purchased and both Applicants are Totally Disabled or involuntarily unemployed at the same time, the Insurer shall pay benefits with respect to one Applicant only.
d) No Involuntary Unemployment Insurance benefit will be paid while benefits are being paid under Accidental Disability Insurance.
No benefit shall be paid for a Total Disability that results directly or indirectly from:
a) a Pre-Existing Condition;
b) war or act of war, whether declared or undeclared;
c) attempted suicide or self-inflicted injury, while sane or insane;
d) flight in a non scheduled aircraft;
e) abuse of any alcohol or drug other than as legally prescribed by a Physician;
f) commission or attempted commission of a criminal offence; or
g) childbirth, abortion, pregnancy, complication of pregnancy, or miscarriage.
To claim benefits under the Group Policy, the Applicant, his/her agent or the Creditor must request a claim form from the Administrator within ninety (90) days of the happening of the event giving rise to the claim. Notice of claim may be given in writing or by telephone. Claim forms will be furnished within fifteen (15) days of receipt of notice of claim.
Within one (1) year of the death, for an accidental death claim, and ninety (90) days of the onset of any accidental disability or involuntary unemployment, for an accidental disability or involuntary unemployment claim, the Applicant or the Creditor must furnish the Administrator with proof of the death, accidental disability or involuntary unemployment satisfactory to the Insurer.
Failure to give notice of claim within the time set out above will not invalidate a claim if the notice is given as soon as reasonably possible and no later than one year from the date of the event giving rise to the claim if it is shown that it was not reasonably possible to give notice within such time.
Failure by an Applicant to perform any actions required by the Insurer, or to provide the Insurer with such information or documentation as may be required, shall release the Insurer from making any payment for benefits. In the case of such a failure the Creditor may, to the extent it is able, perform any actions or provide any information to the Insurer that the Applicant is required to do. Until such failure has been remedied by the Applicant or the Creditor, the Applicant shall be solely responsible for making the required payments for the Indebtedness.
When an Application does not need to be underwritten, failure by the Policyholder to submit the Application and/or the Premium to the Insurer will not prejudice or abrogate the Applicant's rights provided that:
a) the failure results from an inadvertent error or omission;
b) the Policyholder is in possession of a completed and signed Application; and
c) upon becoming aware of the error or omission, the Policyholder promptly forwards to the Insurer the Application and/or the Premium, as the case may be.
Insurance in respect of an Applicant shall automatically terminate on the earliest of the following dates:
a) the date the Loan is paid in full or discharged;
b) the date of repossession by the Creditor of the property which constitutes security for the Loan;
c) the date the Administrator receives the Applicant's written request to terminate insurance;
d) the date the Loan is renegotiated, transferred to another creditor or assumed by another debtor;
e) in the case of Accidental Disability Insurance or Involuntary Unemployment Insurance, the date this Applicant retires;
f) the date an Accidental Death Insurance benefit is paid;
g) the date on which this Applicant turns 76 years of age for Accidental Death Insurance or 66 years of age for Accidental Disability Insurance or Involuntary Unemployment Insurance; or
h) for a specific coverage: the date the Term of Insurance applicable to this coverage for this Applicant is expired.
If insurance terminates for any of the reasons specified from a) to e) above, any unearned premium less any benefits already paid will be refunded to the Creditor. Such refund will be calculated using the Rule of 78 formula and will be subject to a processing fee of $75.00, which will be deducted from the refund. Refunds of less than $10.00 shall not be made.
The rule of 78 takes into account the initial term of the loan or lease as well as the period of time that has elapsed between the beginning and termination of coverage. The formula is as follows:
(U x (U + 1) x P) / (T x (T + 1)) = Premium Refund.
U = Term of Insurance – Number of months Insurance was in force
T = Term of Insurance
P = Premium Paid for Coverage
For example: The term of coverage is 24 months and the premium was $200. If the coverage is cancelled or terminated after 6 months, the refund would be calculated as follows:
(18 x (18 + 1) x 200) / (24 x (24 + 1)) = $114
Claims submitted for any event that occurred prior to the termination date as determined above will be processed in accordance with the terms of the insurance even if the termination date has passed.
The Application, Certificate and Group Policy constitute the contract between the Insurer, the Applicant and the Policyholder. Each Applicant's rights and obligations are governed by this contract. Any statement, other than a fraudulent statement, made by an Applicant relating to his/her insurability under the Group Policy may be used to contest the validity of the Applicant's insurance for the first two (2) years that the initial insurance, or any increase in insurance, is in force during the Applicant's lifetime. Any fraudulent statement may be used to contest the validity of insurance at any time.
Where Alberta law applies, "Every Action or proceeding against an Insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act".
Upon request, we will provide the Applicant with a copy of the Application for Insurance, and on reasonable notice will provide the Applicant or a claimant under this Certificate with a copy of the Group Policy. A claimant's access to the Group Policy may be limited to those portions that are relevant to the claim being made.
The Insurer has the right to conduct necessary investigations relating to applications or claims, and to obtain independent medical or vocational assessments if required.
Only the Creditor may assign or transfer any rights or benefits provided by the insurance to another person. No assignment or transfer will be effective until such written notice is received by the Administrator.