Effective April 1, 2019, OHIP+ will no longer provide drug coverage for individuals under the age of 25 who have access to private insurance. Therefore, prescription drug claims for children and youth 24 years of age and younger with private plan coverage will have to be submitted directly to their private plan. Click here for details!

Long Term Disability Extended

All Source Maximum

If your monthly payments under the Long Term Disability benefit together with any other income to which you may be entitled under:

  1. Long Term Disability benefits under this plan;
  2. Income payable to you under a pension or retirement plan of your employer, or any plan or arrangement resulting in the payment of any salary, wage, or other payment by your employer to you during disability;
  3. Any income or benefit payable under any other plan or program provided to you by or through your employer. Such plan or program includes any permanent and total disability benefit of group life insurance for which you could have elected not to apply;
  4. Any income or benefit under any other plan or program of any government or any subdivision or agency of the government, including any plan or program established pursuant to a provincial automobile insurance act. The insurer shall not reduce the monthly benefit in respect of benefits payable by the Employment Insurance Commission;
  5. Income or benefit from a different or less paid occupation, not related to the Program of Rehabilitation;
  6. Any Canada Pension Plan or Quebec Pension Plan (primary benefits);
  7. When you are disabled and participating in a Program of Rehabilitation, income from the Program of Rehabilitation. See Direct Offsets and Rehabilitation Provision sections of this website;

exceed, in the aggregate, 85% of your normal earnings; payments under this benefit will be reduced so that your monthly payments together with all other disability payments or compensations as described above will not exceed 85% of your normal gross monthly earnings.  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 you recover sufficiently to work again at any occupation, you may be able to do so without jeopardizing your total disability status.  However, in order to remain eligible for income benefits from the plan, the Insurance Company must approve such work as a rehabilitation program, in writing.   This approval may be withdrawn if it is determined by the insurance company that you are not participating in the program to the extent previously agreed to.

Any of the following may be eligible for consideration as a rehabilitation program:

  1. your regular occupation on a part-time basis;
  2. a formal vocational training program;
  3. any other training program deemed suitable by the Insurer.

If you commence work under an approved rehabilitation program, you will regain a portion of the income you lost when you became totally disabled.  Working under an Approved Rehabilitative Program is to your advantage as you will receive a greater total income than if you had not made the effort to rehabilitate yourself.  Your gross benefit will be reduced by 50% of any earnings under the rehabilitation program, subject to the All Source Maximum.

A rehabilitation program may be in effect for up to 24 months.  After 24 months, benefits may be extended upon written approval of the insurance company for up to an additional 24 months, but in no event beyond 48 months during any one period of total disability.

Your involvement in a rehabilitation program will cease on the earliest of the following:

  1. the date you cease to be Totally Disabled
  2. the date you complete the rehabilitation program; or,
  3. the date that is determined by the Insurer that you are not participating in the rehabilitation program to the extent previously agreed upon between you and the Insurer.

Subrogation

If you are entitled to recover compensation for loss of income from a third party as a result of the incident which caused or contributed to the disability, for which benefits are paid or payable, the Insurer 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 Insurer.  You shall execute such documents as required by the Insurer.
In the event that you can provide proof to the Insurer that you have not recovered full compensation for loss of income, the Insurer shall determine the proportion of damages actually recovered and share pro rata 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 Insurer’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.

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


 

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Teamster Local Union 230 Members' Benefit Fund c/o Benefit Plan Administrators
90 Burnhamthorpe Road West, Suite 300 Mississauga, Ontario L5B 3C3