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!

Weekly Wage Replacement Benefits

Weekly Wage Replacement Benefit

The plan pays you 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 that commence while you are covered.  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.  This benefit does not apply to dependents.

Period of Payment

This short-term disability wage replacement benefit is subject to a waiting period before payments commence.  The waiting period is 7 days for a sickness, 0 days for an accident, and 0 days if hospitalized.   The plan pays benefits to the end of Employment Insurance Sickness Benefit’s 2-week waiting period.  Benefits will then be suspended for the next 15 weeks, during which time you should be eligible to receive Employment Insurance Sickness Benefits. Should you not qualify for Employment Insurance Sickness Benefits and submit due proof of your disqualification to the Claims Department, benefits under this plan will be reinstated.   If you continue to be totally disabled after the 15-week E.I. period, you may apply to receive a further benefit from this plan. 
The maximum payment period considered by this wage replacement plan is 26 weeks, including any Employment Sickness Benefit payment period.  It is your responsibility to apply for E.I. and to supply due proof of your disqualification if applicable.

Benefit Amount

  • For Example:SicknessAccident or Hospitalization
  • Waiting Period7 days0 days
  • Payment1 week2 weeks
  • E.I.15 weeks15 weeks
  • Payment14 weeks13 weeks

The amount of your weekly benefit is specified in the “SUMMARY OF BENEFITS” at the beginning of this website.  Benefits are calculated based on a five day workweek.  This benefit is taxable and 15% will be withheld from your cheques for Income Tax.  You will receive a T4A for all benefits paid, and tax amounts withheld, by the end of February of the following year.
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.

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.

Termination of Coverage

Your eligibility for Weekly Wage Replacement benefits terminates upon your retirement.

Loss of Licence (DOT)

If a member who requires a Driver’s Licence for their regular duties, becomes disabled and is approved for Short Term Disability Benefits, but subsequently has his licence suspended for medical reasons by the Department of Transportation (DOT) may be eligible for a continuation of Short Term Disability Benefits. This applies even though his attending physician indicates that the member can return to work. A licence suspension by the DOT for drug addiction or alcohol abuse is excluded. This applies to the Loss of Licence after June 1, 2014.

Certain conditions would apply as follows:

  • The Member must be eligible to work according to the employer
  • The request for the Loss of Licence Benefit must be approved by the Local
  • The Member must not be receiving other income
  • The member must immediately appeal the decision of the DOT
  • A copy of the appeal must be provided to the administrator
  • If the member fails to regain his licence (the appeal process is declined), the “Continuous Period of Disability” provision would apply
  • If the member is successful in his appeal, the Loss of Licence Benefit would terminate
  • The benefit period will not exceed 52 weeks including the initial STD Benefit

 

Claim Forms

Brochures:

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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