Exposure and Disappearance
Benefits are payable if, due to an accident, you are exposed to the elements and suffer an insured loss under the policy within 365 days of the accident.
The plan also will pay for a loss of life benefit if due to accidental wrecking, sinking or disappearance of a conveyance in which the insured is riding and the body is not found within 365 days of the accident and will be presumed dead after one year.
Air Travel Accidents
If you are traveling as a passenger or as a crew member in an aircraft properly licensed and flown by a pilot properly certified to fly such aircraft, you are entitled to the benefits described herein.
When injury results in your loss of life more than 50 kilometers from your normal place of residence and the death benefit becomes payable under the policy, the actual expenses incurred for the preparation and transportation of the body to the place of burial, in proximity to the normal place of residence, will be paid to a maximum of $20,000 (excluding the cost of a coffin).
In the event you sustain an injury which results in a loss payable under the policy and such injury requires that you undergo special training in order to engage in an occupation in which you would not have engaged except for such injury, the reasonable and necessary expenses actually incurred by you for such training will be paid to a maximum of $20,000 as a result of any one accident. No payment will be made for any expense incurred more than three years after the date of the accident, nor for room, board or other living, traveling or clothing expenses.
In the event of your accidental death, the insurer will pay an education benefit for each dependent child enrolled in a school for a higher learning, or who enrolls in a school for higher learning within 365 days after your death. The benefit is equal to the reasonable and necessary expenses actually incurred, subject to the lesser of a maximum of 5% of your principal sum or $5,000 for each year the dependent child continues their education on a full-time basis, not to exceed five consecutive years per child. Payment will not be made for room, board or other living, traveling or clothing expenses.
If you have no dependents eligible for the education benefit, the insurer shall pay an additional amount of $1,000 to the designated beneficiary.
Spousal Retraining Benefit
In the event of your accidental death, the insurer will pay the reasonable and necessary expenses to a maximum of $20,000 actually incurred by your spouse who engages in a formal occupational training program in order to become qualified for employment in an occupation for which they would not otherwise have sufficient qualifications. Payments will not be made for room, board or other living, traveling or clothing expenses.
Seat Belt Benefit
Benefits will be increased by 25% to a maximum of $25,000 if your injury or death results while you were a passenger or driver of an automobile and your seat belt was properly fastened. Seat belt use must be certified by the investigating officer or verified on the official accident report.
The plan 1% of the benefit payable, up to $2,500 per month, if you are hospitalized for at least four days as a result of injury occurring in a covered accident. The benefit is payable for a maximum of 12 months for confinement due to any one accident. This benefit is reduced by the amount by which this benefit, plus benefits payable under the Government of Newfoundland and Labrador optional long term disability insurance plan, exceed 100% of pre-disability net monthly earnings.
Benefit in the Event of Coma
In the event that you suffer an accidental injury which directly results in a state of coma, the benefit payable will be equal to the amount for which you are insured on the date of the accident.
If an insured Employee suffers a loss covered under the accidental death and dismemberment provision and is hospital confined, or suffers from an illness or injury other than as specified in the schedule of losses which requires hospital confinement of at least four days, and such confinement occurs more than 100 kilometers from his normal place of residence, the plan will pay for the reasonable and necessary traveling expenses or one or more family members to the insured Employee's place of confinement. The total amount will be $10,000 for hotel accommodation and transportation cost combined. If personal transportation is used in lieu of public conveyance, a rate of $0.20 per kilometer will apply.
In the event accidental Loss of Life is sustained by an insured person and indemnity for such Loss becomes payable, the plan will pay the Day-Care Benefit below for each of the insured person's dependent children who:
- are enrolled in a day-care centre on the date of such Loss; or
- enroll in a legally licensed day-care centre within 365 days after the date of death of the insured Employee; and
- is age 12 or younger
The benefit will be paid each year immediately upon receipt of satisfactory proof that the child is enrolled in a legally license day-care centre, but payment will not be made for expenses incurred prior to the death of the insured person, nor for room, board or other ordinary living, traveling or clothing expenses.
In the event the insured person's dependent child does satisfy the requirement indicated above, the Day-Care Benefit will be payable to the surviving spouse if the spouse has custody of the child. If there is no surviving spouse or the child does not reside with the spouse, benefits payable under this provision will then be paid to the child's legally appointed guardian. If none of the insured person's dependent children satisfy the above requirements, the insurer will pay an amount of $2,500 under one of the policies issued to the Policyholder by the insurer to the insured person's beneficiary.
"Day-Care Center" means a facility which is run according to law, including laws and regulations applicable to day-care facilities and which provides care and supervision for children in a group setting on a regular basis. Day-Care Centre will not include a hospital, the child's home or care provided during normal school hours while a child is attending grades one through 12.
Home Alteration and Vehicle Modification Benefit
In the event an insured person sustains the Loss of or Loss of Use of Both Feet or Legs or becomes Quadriplegic, Paraplegic of Hemiplegic, for which indemnity is payable in accordance with the terms of the policy, and he/she subsequently requires the use of a wheelchair to be ambulatory, the plan will pay the reasonable and necessary expenses actually incurred within three years of the date of the accident causing such loss for:
- the cost of alterations to the insured person's principal residence and/or
- the cost of modifications to one motor vehicle utilized by the insured person, when such modifications are approved by licensing authorities where required, for the purpose of making them wheelchair accessible.
Waiver of Premium
While insured under the plan, should you become disabled from engaging in your own occupation, your accidental death and dismemberment insurance may be continued in force following four (4) months of continuous disability.
For the duration of such disability without further premium payment up to your attainment of age 65, recovery or death. Application must be made in accordance with the group insurance policy.
Termination of Coverage
Your accidental death and dismemberment insurance coverage terminates on the earlier of termination of employment or on the attainment of age 75. Coverage may be continued during early retirement provided you are in receipt of a pension from either the Public Service Pension Plan, the Uniformed Services Pension Plan or the Members of the House of Assembly Pension Plan, or the Provincial Court Judges' Pension Plan but not beyond your 65th Birthday.
If your insurance reduces and /or terminates on or prior to age 65, you may be entitled to convert up to $100,000 of basic accidental death and dismemberment insurance to an individual policy of the type then being offered by the insurer to conversion applicants. Application for conversion must be made within 31 days of the termination or reduction date, and no medical evidence of insurability will be required. The premium rate will be based on your age and class of risk at that time. For further information, please contact your Administrator.
Benefits are not payable if loss results from or was associated with:
- suicide or self-destruction or any attempt thereat while sane or insane;
- declared or undeclared war, insurrection or participation in a riot;
- active full-time service in the armed forces of any country; and
- air travel in any aircraft not properly licensed or flown by a pilot not properly certified.
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