Accidental Death & Dismemberment

AD&D is an additional insurance that employees may purchase for either themselves or their spouse. 

Amount of Insurance Available for Purchase:  
Multiples of units of $10,000, as elected, subject to a maximum benefit of $500,000.

Insurance Coverage:

• Spouse only Amount - 60% of the Employee's Optional Accidental Death and Dismemberment Insurance Amount.
• Spouse Amount with Children - 50% of the Employee's Optional Accidental Death and Dismemberment Insurance Amount.
• Child only Amount -20% of the Employee's Optional Accidental Death and Dismemberment Insurance Amount for each child.
• Child Amount with Spouse -15% of the Employee's Optional Accidental Death and Dismemberment Insurance Amount for each child

Termination of Insurance

The Optional Employee and Optional Dependent Accidental Death and Dismemberment Insurance ends on the earlier of:

1. the date the Employee retires, and
2. the date the Employee attains age 70.

Cost to you:

The monthly cost for single coverage is $0.15 per $10,000 per month. The cost for employee and spouse coverage is $0.24 per $10,000 per month (cost includes 8% PST).

Amount of Benefit for Employee and Spouse

The following percentage of the Amount Of Insurance for which the Employee and Spouse are insured on the date of drowning, disappearance or injury is paid:

**Subject to a maximum of $1,000,000 per person

If an Employee or Spouse has multiple losses as a result of one accident, the maximum amount payable shall not exceed 100% of the loss of life benefit amount with the exception of Loss of use of both arms, both legs or a combination of one arm and a leg, quadriplegia, paraplegia and hemiplegia. In no event will the maximum benefit amount exceed 200%.

Enhanced Child Benefit

Quadriplegia, paraplegia and hemiplegia will become payable after the elimination period of 365 days has been satisfied.

Loss of an arm means severance at or above the elbow. Loss of a leg means severance at or above the knee. Loss of a hand means severance at or above the wrist. Loss of a foot means severance at or above the ankle. Loss of a thumb, finger or toe means severance at or above the first phalange. Loss of sight, loss of speech or loss of hearing must be total and irrecoverable.

Loss of use must be total, continuous for 12 months, and then must be determined to be permanent and irrecoverable before the benefit is payable.

Repatriation benefit

When loss of life results in an amount of benefit becoming payable under this benefit, a Repatriation Benefit will also be payable, as follows:

1. payment is made if within 1 year of the accidental bodily injury, and
2. the loss of life must occur at least 50 kilometres away from the residence of the deceased Employee,

The maximum amount payable is $15,000.

Rehabilitation benefit

Rehabilitation/retraining means the R&C charges for treatment by a therapist licensed, registered or certified to provide such treatment or confinement in an institution which is licensed to provide such treatment; where treatment is intended to retrain the insured person for work in any gainful occupation including the Employee's regular occupation.

Must take place under the direction of a certified vocational rehabilitation specialist.

Benefit will be paid if an Accidental bodily injury prevents the Employee from performing the duties of the Employee's regular occupation and requires the Employee to obtain rehabilitation/retraining as determined by a physician approved by the company.

Benefits will be paid until one of the following occurs:

1. the total rehabilitation/retraining benefit has been paid; or
2. 2 years have elapsed from the date of the Accidental bodily injury; or
3. the Employee dies.

The maximum amount payable is $15,000.

Spouse Occupation Training Benefit

Spouse employment training expenses means the actual incurred costs for tuition, fees, and room and board billed by the institution of higher learning. Also means the costs for required books and required course supplies. These costs must be incurred for the Employee's spouse to attend an institution of higher learning for the purpose of obtaining or refreshing skills needed for employment. Benefit is payable only if the spouse incurs expenses within 3 years following the date of the Employee's loss of life. Participant must have elected spousal coverage under the policy.

The maximum amount payable is $15,000.

Child Education Benefit

Education means the actual incurred costs for tuition, fees, room and board billed by the institution of higher learning for the education of the Employee's dependent children. Also means costs for required books and required course supplies. Child must be enrolled as a full time student at an institution of higher learning on the date of the insured person's loss of life or subsequently enrol as a full time student at an institution of higher learning within 2 years following the date of the Employee's loss of life. Payments also limited to 4 consecutive years for each dependent child. Institution of higher learning means any public or private college, university or professional trade school beyond the 12th grade. Participant must have elected coverage for dependent children under the policy.

The maximum amount payable is $7,500 per year, $30,000 total benefit payment.

Family Transportation Benefit

Insured person must be confined to a hospital no less than 50km from his permanent city of residence and the attending physician recommends the personal attendance of a member of the immediate family. Sun Life standard rate of $0,20 per km applies. Member of the immediate family means the spouse, parents, grandparents, children age 18 and over, brother or sister of the insured person.

The maximum amount payable is $15,000.

Child Care Expense

The actual incurred costs billed by the provider for the care and supervision of the insured person's dependent children under the age of 13. Expenses must be incurred within 365 days of the loss of life. If on the date of the insured person's loss of life the dependent children are not eligible for child care expenses, a one-time payment of $2,500 will be made in addition to the loss of life benefit. If this is paid, no additional claims can be made under the child care benefit.

Insured person must have elected coverage for dependent children under the policy.

The maximum amount payable is $5,000 per child per year to a maximum of$25,000.

Funeral Expenses

Funeral expenses means the reasonable costs associated with interment.

The maximum amount payable is $5,000.

Home/Vehicle Adaptation

Alterations to the Employee's residence that are necessary to make the residence accessible and habitable for the Employee I Modifications to a private passenger automobile that are necessary to make the automobile accessible and/or driveable by the Employee. Within 2 years of the accidental bodily injury a physician must certify that a home/vehicle adaptation is needed to accommodate the physical disability of the Employee and the home/vehicle adaptation is performed by individuals experienced in such adaption and the home/vehicle adaption is in compliance with any applicable laws or requirements for approval by appropriate government authorities. Private passenger automobile means a four-wheeled motor vehicle with a maximum capacity of 9, designed, manufactured and registered as a private passenger vehicle to travel on public roads.

The maximum amount payable is $15,000.

Identification Expenses

Identification expense means the actual costs for hotel accommodation for a maximum of 3 days and transportation by a member of the immediate family by the most direct route by a licensed common carrier. Loss of life must occur no less than 50km from the insured person's permanent city of residence and identification of the body by a member of the immediate family has been requested by the police or a similar government authority.

The maximum amount payable is $5,000.

Parent Care

Dependent parent: parents or grandparent of an Employee or Spouse who at the time of an accident is receiving support and care provided by such Employee or Spouse as evidenced by Canadian income tax returns showing parent as a dependent.

The maximum amount payable is $5,000 per eligible parent.

Psychological Therapy

Psychological therapy means the reasonable and customary charges for treatment or counselling by a therapist or counsellor, who is licensed, registered or certified to provide such treatment whether on an outpatient basis or while at a medical facility licensed to provide such treatment. Must be prescribed by a physician.

Payments will be made until on of the following occurs:

1. the total psychological therapy benefit has been paid, or
2. 2 years have elapsed from the date of the accidental bodily injury, or
3. the insured person dies.

The maximum amount payable is $5,000.

Seat Belt and Occupant Protection Device

Seat belt means a lap or lap and shoulder restraint device or a child restraint device, which meets the Canadian Motor Vehicle Standards administered by Transport Canada and has been installed in accordance with the manufacturer's instructions.

Occupant protection device means either an air bag, which inflates for added protection to the head and chest areas, or any other personal safety restraint system other than a seat belt.

Benefits will be paid if, at the time of the accident, the Employee suffers Accidental bodily injury resulting in a loss while:

- operating or riding in a private passenger automobile and utilising a seat belt.

The seat belt usage and proper operation of the occupant protection device must be verified by a licensed physician, a coroner, a police officer or other person of competent authority.

No benefit is payable if the Employee was driving or riding as a passenger in any race or contest of any type, or if intoxicated as defined by laws of the jurisdiction where the Accidental bodily injury occurred, or under the influence of a controlled substance unless taken on the advice of a physician and used in accordance with the prescription at the time of the accident.

The maximum amount payable is 10% of benefit amount for seat belt, 10% of benefit amount for occupant protection device to a combined maximum of $50,000.

Vocational Training

Vocational training expenses means the actual costs incurred for tuition, fees, room and board billed by an institution of higher learning that is intended to prepare an insured person for work in any gainful occupation. Includes costs for required books or course supplies.

Gainful occupation means an occupation including self-employment that is or can be expected to provide an Employee with an income equal to at least 60% of the Employee's monthly earnings within 12 months after the Employee's return to work.

Benefits are payable until the earlier of:

1. the total benefit has been paid; or
2. 2 years have elapsed from the date of the accidental bodily injury

The maximum amount payable is $15,000.

Common Accident

If a common accident causes the primary Employee's and Spouse's loss of life, the combined loss of Life benefit amount will be 2x the larger of the 2 loss of Life benefits amounts payable. This combined loss of Life benefit amount will not exceed 2x the Employee's benefit amount.

This extension of coverage is applicable only if the Employee has elected coverage under the policy for a Spouse, such coverage is in effect on the date of the accident, and the Employee and Spouse are survived by a dependent child or children to whom the common accident benefit amount can be paid.

Common accident means a single accident or separate accidents that occur within the same 24 hour period and result in accidental bodily injury to an insured person and the insured person's spouse.

The common accident extension of coverage is subject to a maximum amount of 2 times the Employee's loss of Life benefits amount.

Aggregate Limit

An Employee or Dependent who has multiple losses as a result of one accident, the maximum amount payable shall not exceed 100% of the loss of life benefit amount with the exception of Loss of use of both arms, both legs or a combination of one arm and a leg, quadriplegia, paraplegia and hemiplegia.

In no event will the maximum benefit amount exceed 200%.

Disability Benefit

Upon receipt of proof of claim that an employee, while insured and before age 65 or earlier retirement, became totally disabled, insurance continues from the date of onset of total disability without further payment of the employee's premiums for this benefit.

The amount of Employee Accidental Death and Dismemberment Insurance is subject to the terms and conditions of this policy in effect on the date of onset of total disability, including reductions or terminations.

The amount of Employee Accidental Death and Dismemberment insurance is reduced by the amount of any Accidental Death Benefit Provision issued to the employee under the conversion unless the Accidental Death Benefit Provision and the policy to which it is attached are exchanged for a full refund of premiums, or in the event of the employee's accidental death, by the amount of any benefit paid under the 31 day free cover of the Conditions Of Conversion.

This disability benefit ends on the earlier of:

1. the date on which the employee ceases to be totally disabled, and
2. the date on which the employee fails to furnish proof to Sun Life that he continues to be totally disabled.

Conversion

If an Employee's Optional Accidental Death and Dismemberment Insurance terminates or reduces for any reason other than solely as a result of the Employee's request, and if he applies for an individual life insurance policy under the terms of the Conversion of the Employee Life Insurance Benefit Provision, the Employee is entitled at that time to have an Accidental Death Benefit provision attached to that individual life insurance policy without evidence of insurability, subject to Conditions Of Conversion.

The amount of the Accidental Death Benefit Provision will not be more than $100,000.

Exclusions

A benefit is not paid for a loss which is due to or results from

1. self-inflicted injuries by firearm or otherwise, attempted suicide or suicide (while sane or insane).
2. drug overdose.
3. carbon monoxide inhalation.
4. flying in, entering, or exiting any aircraft owned, leased or operated by the employer or any aircraft owed, leased or operated by an employee of the employer on behalf of the employer. This exclusion does not apply to aircraft chartered with pilot or crew on a one time charter basis.
5. flying in, entering, or exiting any aircraft while acting or training as a pilot or crew member. This exclusion does not apply to passengers who temporarily perform pilot or crew functions in a life threatening emergency.
6. the hostile action of any armed forces, insurrection or participation in a riot or civil commotion.
7. full-time service in the armed forces of any country.
8. commission or attempted commission of a criminal offence.
9. disease or illness.
10. loss caused by or resulting from an insured person's emotional trauma, mental or physical illness, disease, pregnancy, childbirth or miscarriage, bacterial or viral infection or bodily malfunction.

This exclusion does not apply to loss resulting from an insured person's bacterial infection caused by an accident or from accidental consumption of a substance contaminated by bacteria.

Changes of Insurance

Unless otherwise provided in a benefit provision, any increase in the amount of an employee's insurance will take effect as follows:

• if evidence of insurability is not required, on the date of the increase.
• if evidence of insurability is required, on the date of approval by Sun Life.

Unless otherwise provided in a benefit provision, any decrease in the amount of an employee's insurance will take effect on the date of the decrease.

If an insured employee is not actively at work on the date an increase would otherwise take effect, or on the date the policy is amended to provide increased benefits, the employee will be insured for the increased benefits only when he is again actively at work.

A Dependent who is confined in a hospital on a date when his insurance under this policy would otherwise increase is not insured for such increase, until the day following the last day of confinement.

Individual Terminations

An employee will cease to be insured on the earliest of the following dates:

1. the date of termination of employment,
2. the end of the period for which the last premium is paid to Sun Life for the employee's insurance,
3. the date of termination of the policy.

An employee's dependent will cease to be insured on the earliest of the following dates:

1. the date the employee ceases to be insured, otherwise than by death,
2. the date the dependent ceases to qualify under the definition of dependent,
3. the last day of the third month following the month in which the employee died,
4. the end of the period for which the last premium is paid to Sun Life for insurance on the dependent.

Surviving Dependent Insurance (Applicable to Optional Dependent Accidental Death & Dismemberment Insurance)

A Dependent, whose insurance under this policy would otherwise end because of the Employee's death, continues to be insured without further payment of premiums, subject to all other terms of this policy. Such insurance ends on the earliest of:

1. 6 months after the date of the Employee's death,
2. the date a person ceases to be a Dependent other than as a result of the Employee's death,
3. the date the benefit provision for which the Dependent is insured terminates, and
4. the date of termination of the policy.