Common use of Definition of Total Disability Clause in Contracts

Definition of Total Disability. to qualify for benefits for the first 12 months (excluding the six month qualification period), the employee must be unable, due to accident or sickness, to perform the duties of their "own occupation" • to continue to qualify for benefits beyond the "own occupation" period of disability, the employee must be unable to perform the duties of any gainful occupation ("any occupation") for which the employee has the education, training or experience and which pays at least 70% of the current rate of pay for the employee's job at the date of their disability Successive Disabilities • if the employee returns to work during the qualification period but stops working within 31 calendar days because of the same disability, the qualification period is extended by the number of days worked • if the employee returns to work after LTD benefits are approved, but stops working within six months because of the same disability, or within 31 days because of a new disability, the prior LTD claim is re-opened and the employee is not required to serve another qualification period Exclusions • any period of disability that is not supported by the regular and personal care of a physician • war, insurrection, rebellion, or service in the armed forces of any country • voluntary participation in a riot or civil commotion, except while performing regular occupational duties • intentionally self-inflicted injuries or illness Other Disability Income • LTD benefits will not be reduced by income from private or individual disability plans • LTD benefits will be reduced by 100% of any other disability income including but not limited to o any amounts payable under any Workers Compensation Act or law or any other legislation of similar purpose o any amount from any group insurance, wage continuation, or pension plan of the Employer that provides disability income o any amount of disability income provided by any compulsory Act or law o any periodic primary benefit payment from the Canada or Quebec Pension Plans or other similar social security plan of any country to which the disabled employee is entitled or would be entitled had the application for such a benefit been approved o any amount of disability income provided by a group or association disability plan to which the disabled employee might belong or subscribe • LTD benefits are reduced by the amount of other disability income to which the disabled employee is entitled upon first becoming eligible for the other income; future increases in the other income such as Consumer Price Indexing or similar indexing arrangements will not further reduce the disabled employee's LTD benefits until the disabled employee's LTD benefit is recalculated to reflect the weighted average wage rate in effect following review by the underwriter every four years Continuation of Coverage • the Employer will continue to pay the LTD contributions while the employee is receiving sick pay, is on maternity or parental leave, or during the first 20 work shifts in any calendar year of unpaid leave • coverage can continue while an employee is on an unpaid leave for up to 12 months (24 months if on an educational leave), if the employee pays 100% of the contributions • while an employee receives LTD benefits from the Plan, the employee's LTD, Group Life and AD&D coverage will continue at no cost to the employee or the Employer as long as the employee remains an employee • while an employee receives LTD benefits from the Plan, the employee can elect to continue Medical, Dental and Extended Health benefits as long as the employee remains an employee and pays 50% of the contributions to the Employer monthly in advance. Employees to be permitted to enrol in some or all of the above plans. Such an election must be made at the time the employee's LTD claim is accepted or at any time while in receipt of LTD benefits as long as proof of continuous alternate coverage can be provided by the employee • Employees are not to be terminated for non-culpable absenteeism while in receipt of long-term disability benefits. Termination of Coverage Coverage ceases on the date the employee: • terminates employment • retires • commences an unpaid leave beyond 20 work shifts in any calendar year and employee elects not to pay contributions or elects to pay contributions and then stops paying them until their return to work • transfers to an ineligible status • is laid off

Definition of Total Disability. to qualify for benefits for the first 12 months (excluding the six month qualification period), the employee must be unable, due to accident or sickness, to perform the duties of their "own occupation" • to continue to qualify for benefits beyond the "own occupation" period of disability, the employee must be unable to perform the duties of any gainful occupation ("any occupation") for which the employee has the education, training or experience and which pays at least 70% of the current rate of pay for the employee's job at the date of their disability Successive Disabilities • if the employee returns to work during the qualification period but stops working within 31 calendar days because of the same disability, the qualification period is extended by the number of days worked • if the employee returns to work after LTD benefits are approved, but stops working within six months because of the same disability, or within 31 days because of a new disability, the prior LTD claim is re-opened and the employee is not required to serve another qualification period Exclusions • any period of disability that is not supported by the regular and personal care of a physician • war, insurrection, rebellion, or service in the armed forces of any country • voluntary participation in a riot or civil commotion, except while performing regular occupational duties • intentionally self-inflicted injuries or illness Other Disability Income • LTD benefits will not be reduced by income from private or individual disability plans • LTD benefits will be reduced by 100% of any other disability income including but not limited to to: o any amounts payable under any Workers Compensation Act or law or any other legislation of similar purpose o any amount from any group insurance, wage continuation, or pension plan of the Employer that provides disability income o any amount of disability income provided by any compulsory Act or law o any periodic primary benefit payment from the Canada or Quebec Pension Plans or other similar social security plan of any country to which the disabled employee is entitled or would be entitled had the application for such a benefit been approved o any amount of disability income provided by a group or association disability plan to which the disabled employee might belong or subscribe • LTD benefits are reduced by the amount of other disability income to which the disabled employee is entitled upon first becoming eligible for the other income; future increases in the other income such as Consumer Price Indexing or similar indexing arrangements will not further reduce the disabled employee's LTD benefits until the disabled employee's LTD benefit is recalculated to reflect the weighted average wage rate in effect following review by the underwriter every four years years. Continuation of Coverage • the Employer will continue to pay the LTD contributions while the employee is receiving sick pay, is on maternity or parental leave, or during the first 20 work shifts in any calendar year of unpaid leave • coverage can continue while an employee is on an unpaid leave for up to 12 months (24 months if on an educational leave), if the employee pays 100% of the contributions • while an employee receives LTD benefits from the Plan, the employee's LTD, Group Life and AD&D coverage will continue at no cost to the employee or the Employer as long as the employee remains an employee • while While an employee receives LTD benefits from the Plan, the employee can elect to continue Medical, Dental and Extended Health benefits as long as the employee remains an employee and pays 50100% of the contributions to the Employer monthly in advance. Employees to be permitted to enrol in some or all of the above plans. Such an election must be made at the time the employee's LTD claim is accepted or at any time while in receipt of LTD benefits as long as proof of continuous alternate coverage can be provided by the employee employee. • Employees are not to be terminated for non-culpable absenteeism absenteeism, while in receipt of long-term disability benefits. Termination of Coverage Coverage ceases on the date the employee: • terminates employment • retires • commences an unpaid leave beyond 20 work shifts in any calendar year and employee elects not to pay contributions or elects to pay contributions and then stops paying them until their return to work • transfers to an ineligible status • is laid offoff • payment of premiums cease at 64 years and six months Rehabilitation Plan • while in receipt of benefits, employees are required to participate in a rehabilitation activity or program that is medically approved to prepare them to return to their job or other gainful work • employees returning to work through an Approved Rehabilitation Plan are eligible to receive all monthly rehabilitation earnings plus a monthly LTD benefit as defined under "Amount of Benefit" in this section, provided the total of such income does not exceed 100% of the current rate of pay for the regular occupation at the date of disability • upon successful completion of the Approved Rehabilitation Plan, the LTD benefit period may be extended for a period of six months for the purpose of job search Rehabilitation Review Committee • employees who do not agree with the recommended rehabilitation plan or feel they are medically unable to participate must demonstrate reasonable grounds for their lack of participation or appeal the dispute to the Rehabilitation Review Committee • the Rehabilitation Review Committee is composed of three qualified individuals who, by education, training and experience are recognized specialists in the rehabilitation of disabled employees • Committee members are composed of one employer nominee, one union nominee and a neutral chair appointed by the nominees. • if the employee does not accept the Committee's decision, LTD benefits are suspended until the employee is willing to participate Duration of Benefits • benefits stop on the date the employee recovers, reaches age 65, dies, elects early retirement, refuses to participate in an Approved Rehabilitation Plan approved by a Rehabilitation Review Committee, whichever occurs first • if the employee's employment terminates while receiving LTD benefits, only the payment of the LTD benefit will continue; all other health and welfare coverage will end Claims Review Committee • the Employer/provider will assume administrative responsibility for setting up the Claims Review Committee • an employee may request the carrier to coordinate a Claims Review Committee if their LTD claim is denied or terminated by the carrier • the Committee is comprised of three medical doctors: one designated by the employee; one by the Employer; and one (Chairperson) who has no relationship to the employee and agreed upon by the first two doctors • the Committee is responsible for reviewing the medical and vocational information with respect to the employee • the Committee may interview and/or examine the claimant and may establish medical procedures and tests to determine if the employee is disabled as defined in the collective agreement • the majority decision of the Committee is final and binding • the final report is signed by all members of the Committee and forwarded in writing to the carrier who is then responsible for forwarding a copy to the employee, Employer and the Union • expenses of the Chairperson are shared equally between the employee (or Union) and the carrier; expenses of the two nominees are the responsibility of each appointing party; expenses for medical procedures requested by the Committee, and travel expenses of the employee are the responsibility of the employee (or Union) INFORMATION APPENDIX “B” HARRASSMENT & BULLYING PROGRAM Introduction PHS Community Services Society (PHS) is committed to providing a safe work environment and maintaining a Workplace that is free of Workplace Harassment and Bullying as required by the Occupational Health and Safety Regulations (“Regulations”). This document supplements the PHS’s policy entitled “Workplace Harassment and Bullying” and outlines the responsibilities associated with this program. The program will be reviewed annually and revised as necessary.

Definition of Total Disability. to qualify for benefits for the first 12 months (excluding the six month qualification period), the employee must be unable, due to accident or sickness, to perform the duties of their "own occupation" • to continue to qualify for benefits beyond the "own occupation" period of disability, the employee must be unable to perform the duties of any gainful occupation ("any occupation") for which the employee has the education, training or experience and which pays at least 70% of the current rate of pay for the employee's job at the date of their disability Successive Disabilities • if the employee returns to work during the qualification period but stops working within 31 calendar days because of the same disability, the qualification period is extended by the number of days worked • if the employee returns to work after LTD benefits are approved, but stops working within six months because of the same disability, or within 31 days because of a new disability, the prior LTD claim is re-opened and the employee is not required to serve another qualification period Exclusions • any period of disability that is not supported by the regular and personal care of a physician • war, insurrection, rebellion, or service in the armed forces of any country • voluntary participation in a riot or civil commotion, except while performing regular occupational duties • intentionally self-inflicted injuries or illness Other Disability Income • LTD benefits will not be reduced by income from private or individual disability plans • LTD benefits will be reduced by 100% of any other disability income including but not limited to o any amounts payable under any Workers Compensation Act or law or any other legislation of similar purpose o any amount from any group insurance, wage continuation, or pension plan of the Employer that provides disability income o any amount of disability income provided by any compulsory Act or law o any periodic primary benefit payment from the Canada or Quebec Pension Plans or other similar social security plan of any country to which the disabled employee is entitled or would be entitled had the application for such a benefit been approved o any amount of disability income provided by a group or association disability plan to which the disabled employee might belong or subscribe • LTD benefits are reduced by the amount of other disability income to which the disabled employee is entitled upon first becoming eligible for the other income; future increases in the other income such as Consumer Price Indexing or similar indexing arrangements will not further reduce the disabled employee's LTD benefits until the disabled employee's LTD benefit is recalculated to reflect the weighted average wage rate in effect following review by the underwriter every four years Continuation of Coverage • the Employer will continue to pay the LTD contributions while the employee is receiving sick pay, is on maternity or parental leave, or during the first 20 work shifts in any calendar year of unpaid leave • coverage can continue while an employee is on an unpaid leave for up to 12 months (24 months if on an educational leave), if the employee pays 100% of the contributions • while an employee receives LTD benefits from the Plan, the employee's LTD, Group Life and AD&D coverage will continue at no cost to the employee or the Employer as long as the employee remains an employee • while an employee receives LTD benefits from the Plan, the employee can elect to continue Medical, Dental and Extended Health benefits as long as the employee remains an employee and pays 50% of the contributions to the Employer monthly in advance. Employees to be permitted to enrol in some or all of the above plans. Such an election must be made at the time the employee's LTD claim is accepted or at any time while in receipt of LTD benefits as long as proof of continuous alternate coverage can be provided by the employee • Employees are not to be terminated for non-culpable absenteeism absenteeism, while in receipt of long-term disability benefits. Termination of Coverage Coverage ceases on the date the employee: • terminates employment • retires • commences an unpaid leave beyond 20 work shifts in any calendar year and employee elects not to pay contributions or elects to pay contributions and then stops paying them until their return to work • transfers to an ineligible status • is laid offoff • payment of premiums cease at 64 years and six months Rehabilitation Plan • while in receipt of benefits, employees are required to participate in a rehabilitation activity or program that is medically approved to prepare them to return to their job or other gainful work • employees returning to work through an Approved Rehabilitation Plan are eligible to receive all monthly rehabilitation earnings plus a monthly LTD benefit as defined under "Amount of Benefit" in this section, provided the total of such income does not exceed 100% of the current rate of pay for the regular occupation at the date of disability • upon successful completion of the Approved Rehabilitation Plan, the LTD benefit period may be extended for a period of six months for the purpose of job search Rehabilitation Review Committee