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AD & D

 

Accidental Death & Specific Loss Schedule:
Member Principal Sum $100,000
Spouse Principal Sum $ 50,000
Dependant Child Principal Sum $ 15,000

When an insured Member or eligible Spouse receives Injuries resulting in any of the following Losses within 365 days of the accident, benefits will be payable for:

For Loss of:% of Principal
Life 100%
Brain Death 200%
Both Hands, or Both Feet, or One Hand and One Foot 100%
Entire Sight of Both Eyes 100%
One Hand and Entire Sight of One Eye, or One Foot and Entire Sight of One Eye 100%
Speech and Hearing in Both Ears 100%
Use of Both Arms or Both Hands or Both legs or Both Feet 100%
Quadriplegia, Paraplegia, Hemiplegia 200%
One Arm, or One Leg, or Use of One Arm, or One Leg 80%
One Hand, or One Foot, or Use of One Hand, or One Foot 75%
Entire Sight of One Eye 75%
Speech or Hearing in Both Ears 75%
Thumb and Index Finger of the Same Hand 33 1/3%
Loss of Use of Thumb and Index Finger of the Same Hand 33 1/3%
Four Fingers of the Same Hand 33 1/3%
Hearing in One Ear 66 2/3%
Thumb of Either Hand 25%
All Toes of the Same Foot 25%
One to Three Fingers of Either Hand 16 2/3%

When an eligible Child receives Injuries resulting in any of the following Losses within 365 days of the accident, benefits will be payable for:

For Loss of:% of Principal
Life 100%
Brain Death 1,000%
Both Hands, or Both Feet, or One Hand and One Foot 1,000%
Entire Sight of Both Eyes 1,000%
One Hand and Entire Sight of One Eye, or One Foot and Entire Sight of One Eye 1,000%
Speech and Hearing in Both Ears 1,000%
Use of Both Arms or Both Hands or Both legs or Both Feet 1,000%
Quadriplegia, Paraplegia, Hemiplegia 1,000%
One Arm, or One Leg, or Use of One Arm, or One Leg 80%
One Hand, or One Foot, or Use of One Hand, or One Foot 75%
Entire Sight of One Eye 75%
Speech or Hearing in Both Ears 75%
Thumb and Index Finger of the Same Hand 33 1/3%
Loss of Use of Thumb and Index Finger of the Same Hand 33 1/3%
Four Fingers of the Same Hand 33 1/3%
Hearing in One Ear 66 2/3%
Thumb of Either Hand 25%
All Toes of the Same Foot 25%
One to Three Fingers of Either Hand 16 2/3%

If more than one Loss is sustained as the result of any one accident, only one benefit shall be payable, the largest.

The amount specified for losses of

  • both hands, both feet or both eyes
  • one hand and one foot
  • one hand and one eye
  • one foot and one eye
  • use of both arms, both hands, both legs or both feet
  • speech and hearing
  • thumb and index finger or at least four fingers of one hand
  • all toes of one foot

is payable only when such double loss occurs as a result of the same accident.

The maximum payable for all losses sustained by an Insured Person as a result of the same accident shall not exceed the Principal Sum, except as noted for Brain Death, Paraplegia, Hemiplegia, or Quadriplegia.

Waiver of Premium

In the event a Member becomes totally and permanently disabled and his/her waiver of premium claim is accepted and approved under the Trust Fund’s current Group Life policy, then the Accidental Death & Dismemberment premiums payable under this policy are waived as of the same date the claim is accepted and approved by the Group Life Insurer until one of the following occurs, whichever is earlier:

  • the date the Member attains age 65;
  • the date of the death or recovery of the Member;
  • the date the Member is no longer eligible for total disability waiver of premium under the Trust Fund’s group life policy; or
  • the date the Master Policy is terminated.

Exclusions

No coverage shall be provided under the Accidental Death and Dismemberment Benefit and no payment shall be made for any Loss or claim resulting from, or contributed to, in whole or in part by, or as a natural and probable consequence of any of the following excluded risks even if the proximate or precipitating cause of the Loss or claim is an accidental Injury:

  • suicide or any attempt thereat by the Insured Person while sane;
  • self inflicted Injury or any attempt thereat by the Insured Person while sane or insane;
  • declared or undeclared war or any act thereof;
  • sickness, disease, or bodily infirmity whether the Loss or claim results directly or indirectly from any of these;
  • mental incapacity whether the Loss or claim results directly or indirectly from any mental incapacity;
  • sustained while the Insured Person is undergoing the medical or surgical treatment of sickness, disease, or bodily or mental infirmity;
  • stroke or cerebrovascular accident or event, cardiovascular accident or event, myocardial infarction or heart attack, coronary thrombosis, aneurysm;
  • travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if the Insured Person is:
    • (i) riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; or
    • (ii) performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft; or
    • (iii) riding as a passenger in an Owned Aircraft or Leased Aircraft operated by the Policyholder.
  • infections of any kind regardless of how contracted, except bacterial infections that are directly caused by botulism, ptomaine poisoning or an accidental cut or wound independent and in the absence of any underlying sickness, disease or condition including but not limited to diabetes;
  • injury or Loss sustained while the Insured Person is on full-time active duty in the armed forces or organized reserve corps of any country or international authority. (Unearned premium for any period for which the Insured Person is on full-time active duty shall, upon application to the Company by the Policyholder, be refunded);
  • the commission or attempted commission by an Insured Person or Injury incurred while an Insured Person is in the course of committing or attempting to commit any act which if adjudicated by a court would be an indictable offence under the laws of the jurisdiction where the act was committed;
  • an act, attempted act or omission taken or made by the Insured Person, or an act, attempted act or omission taken or made with the Insured Person’s consent, for the purposes of interrupting the blood flow to the Insured Person’s brain or to cause asphyxiation to the Insured Person whether with intent to cause harm or not;
  • natural causes.

Insulators Local 95 Benefit Trust Fund c/o Benefit Plan Administrators 
90 Burnhamthorpe Road West, Suite 300 Mississauga, Ontario L5B 3C3