COVERAGE OPTIONS FOR DISABILITY AS A RESULT OF AN ACCIDENT OR SICKNESS
ELIGIBLE PERSONAL EXPENSES
- Natural gas
- Fuel oil
- Heating oil
- Support payments
- Public utilities
- Childcare expenses
- Auto and home insurance
- Casualty insurance
- Professional liability insurance
- Professional licences
- Professional bodies
- Personal and business debts
- Any fixed-term loan for which the insured is personally and legally responsible as a borrower or co-borrower with a recognized financial institution, including, but not limited to: any personal or business loan
- Leverage loan
- Car loan
- Boat loan
- Motorcycle loan
- Recreational vehicle (RV) loan
- Student loan
- Renovation loan
- Credit card
- Line of credit
- Mortgage loan and home equity line of credit
- Where the insured does not have a mortgage or a home equity line of credit, his or her monthly rent will be considered an eligible monthly expense, provided it is supported by a minimum one-year term, complies with the standards set by the Tribunal administratif du logement or any provincial regulator and is payable to an individual or entity with no family or business ties to the Insured or the Policyowner
- ELIGIBLE OVERHEAD EXPENSES
- Employees’ salaries, for a profession other than that of the insured, which generates no income and whose services are essential during the Insured’s Disability
- Interest on business debts
- Public utilities (electricity, heating, etc.) for the company
- Payments on machinery
- Rent or mortgage payment for the company
- Communication expenses
- Stationery and postage
- Maintenance costs
- Depreciation on office equipment
- Leasing of office equipment
- Professional fees for accounting services
- Other usual fixed expenses related to the proper operations of the office
The List of Types of Expenses is provided for information purposes only. In the event of a discrepancy between the List of Types of Expenses and the contract, the contract shall prevail.
Total Disability Benefits are paid based on the Waiting Period, the Benefit Period and the Regular Occupation Period.
During the Waiting Period and the Regular Occupation Period, you are unable to perform the main duties of your occupation and are not engaged in any other gainful activity;
Thereafter, for a Disability that lasts beyond the Regular Occupation Period, you are unable to perform any gainful occupation that you are reasonably qualified to perform based on your education, training or experience.
Refers to an Insured who, although not Totally Disabled, is unable to perform at least one of the main duties of his or her occupation at the onset of Disability, or who is unable to work at least fifty percent (50%) of the time usually devoted to this occupation, while under the continuous and appropriate treatment and care of a physician.
No Partial Disability benefit will be payable if the insured has been unemployed for more than ninety (90) days at the onset of Disability.
Waiver of premiums
While the insured is eligible to receive benefits as a result of a Disability, the insurer will waive the payment of premiums falling due according to the method of payment in effect at the onset of Disability. The waiver of premiums will end on the date the insured is no longer eligible to receive Disability benefits.
- First day of hospitalization:
- Benefits are payable on the first (1st) day of a hospitalization or day surgery
- From $500 up to $10,000 maximum. Non-integrated, non-coordinated
- PARTIAL DISABILITY BENEFIT COVERAGE
- REGULAR OCCUPATION COVERAGE
- 20-YEAR PREMIUM REFUND BENEFIT (50%, 75% AND 100%)
- ADDITIONAL INSURANCE OPTION
- You can maintain your policy up to age 100. As long as you pay your premiums, the insurer cannot modify or cancel your coverage.
- Your premium is based on the risk associated with your occupation. Once the policy has been in effect for five years, the insurer reserves the right to change the premium based on the experience of policies with similar features. In addition, the premium will be automatically adjusted when you turn 65.
No benefits shall be paid in the event of a disability resulting directly or indirectly from:
- Attempted suicide or intentionally self-inflicted injury or dismemberment, whether the insured is sane or insane;
- Participation by the insured in the commission or attempted commission of an assault or criminal offence, or driving a motor vehicle or piloting a boat while under the influence of narcotics or while his or her blood alcohol concentration exceeds the legal limit;
- Alcohol abuse, or the use of hallucinogens, drugs or narcotics;
- Service, whether or not as a combatant, with armed forces engaged in surveillance, training, peacekeeping, insurrection, war (whether or not declared) or any related act, or participation by the insured in a popular uprising;
- Injuries sustained during air travel unless as a passenger on an aircraft used by a common carrier;
- Cosmetic surgery or a surgical procedure not required by the health condition, and any complication resulting therefrom;
- Experimental treatments and treatments involving the use of new procedures or therapies that are not yet in mainstream use;
- Training for or participation in professional sports or motor vehicle speed contests;
- An injury obtained during the practice of any high-risk activity, including, but not limited to: bungee jumping, freestyle skiing or snowboarding, heliskiing or heliboarding, ski jumping, sky diving, hang gliding, sky surfing, street luge, skeleton, mountain or rock climbing with or without ropes, and participation in rodeos or ultimate fighting competitions;
- Pregnancy, childbirth or miscarriage, and any resulting condition, except in the case of a pathological complication;
- Refusal by the insured of any treatment or medication deemed necessary for his or her condition, or refusal to submit to a medical examination required by his or her condition;
- Refusal by the insured to submit to a rehabilitation program recommended by the attending physician or to actively participate in a rehabilitation program previously approved by the Insured and the Insurer;
- Organ donation(s), except where the donation is made after the coverage has been in effect for at least six (6) months.
NO DISABILITY BENEFIT WILL BE PAYABLE FOR:
- Any period during which the insured is receiving a salary, except as part of partial disability and/or a rehabilitation program approved by the insurer;
- Any period during which the insured is incarcerated in a penitentiary or a government detention facility;
- Any increase in Eligible Monthly Expenses and any Eligible Monthly Expenses incurred by an already disabled insured person;
- Any increase in Eligible Monthly Expenses and any Eligible Monthly Expenses incurred by an insured person in the ninety (90) days prior to the onset of Total Disability, unless the Eligible Monthly Expenses have been incurred within ninety (90) days following the effective date of the disability coverage;
- Any Eligible Monthly Expenses specifically covered by other debt or credit insurance.
If the Insured declares bankruptcy while Disabled, disability benefits cease as of the date of bankruptcy and no benefit will be paid.
No death benefit will be payable if the insured commits suicide within two (2) years of the effective date or reinstatement of coverage, whether he or she is sane or insane.
For full details, please refer to the specimen policy document. In the event of any discrepancy between the policies and this document, the policies will prevail.
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