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Total Disability or Totally Disabled • Completely unable to perform all of the material duties of the eligible employee's regular occupation at their customary place of work; and • Not actively working in any occupation for pay or profit; and • Under the regular care of a physician.
Partial Disability As a result of the sickness or injury which caused total disability: • Ability to perform one or more, but not all, of the material and substantial duties of the eligible employee's own or any other occupation on a full-time basis; or • Ability to perform all of the material and substantial duties of the eligible employee's own or any other occupation on a part-time basis. The eligible employee may receive up to 100% of pre-disability income if the following.
• Partial disability begins within 31 days of the date total disability ceases. • Earning less than 80% of pre-disability weekly earnings at the time the partial disability employment begins. The partial disability benefit is the lesser of: • The weekly benefit selected; or • 100% of pre-disability earnings, less partial disability earnings.
Pre-existing Condition A diagnosed sickness or injury for which the eligible employee received treatment within twelve (12) months prior to the effective date or the effective date of an increase in coverage. Treatment means consultation, care, or services provided by a physician, including diagnostic measures and taking prescribed drugs and medicine.
The plan does not pay for disabilities caused by or related to a pre--existing condition during the first year of coverage, or an increase in coverage. |