Optional accidental death and dismemberment insurance

Premiums payable under Optional Accidental Death and Dismemberment Insurance can be waived in the event you become totally and permanently disabled, and you are eligible for a waiver of premium under the University’s Long Term Disability Plan.

Premiums will be waived from the same date your claim is accepted and approved by the Long Term Disability Plan until one of the following occurs:

• The date you reach age 65,
• The date of your death or recovery,
• The date you are no longer eligible for waiver of premium under the Long Term Disability Plan, or
• The date you are no longer eligible for waiver of premium, or
• The date this plan is cancelled.

If death, dismemberment or loss of sight occurs within one year after the date of the accident, the following benefits will be paid, as a percentage of the principal sum:

• Loss of life or brain death: 100%

• Loss of both hands or both hands: 100%

• Loss of both legs or both feet: 100%

• Loss of entire sight of both eyes: 100%

• Loss of one hand and one foot: 100%

• Loss of either hand or foot and the entire sight of one eye: 100%

• Loss of speech and hearing: 100%

• Loss of one arm or one leg: 80%

• Loss of one hand or one foot: 75%

• Loss of the entire sight of one eye: 75%

• Loss of speech or hearing: 75%

• Loss of hearing in one ear: 67%

• Loss of thumb and index finger of the samme hand: 40%

• Loss of four fingers of one hand: 40%

• Loss of all toes of one foot: 33%

Loss of use

• Loss of use of both arms or both hands: 100%

• Loss of use of both legs or both feet: 100%

• Loss of use of one hand and one foot: 100%

• Loss of use of either hand or foot and the entire sight of one eye: 100%

• Loss of use of one arm or one leg: 80%

• Loss of use of one hand or one foot: 75%

• Loss of use of thumb and index finger of the same hand: 40%

• Loss of use of four fingers on any one hand: 40%

Paralysis

• Quadriplegia (total paralysis of both upper and lower limbs): 200%

• Paraplegia (total paralysis of both lower limbs): 200%

• Hemiplegia (total paralysis of upper and lower limbs of one side of the body): 200%

If an insured employee suffers a covered injury causing permanent and total disability, Sutton will pay the employee’s principal sum less any amounts payable under the table of losses.

If an insured person suffers loss of life, Sutton will pay the reasonable and necessary expenses incurred by the spouse and dependent children for up to six sessions of grief counselling, by a professional counsellor, to a maximum of $1,500.

If an insured employee requires special training, due to a covered injury, Sutton will pay the reasonable and necessary expenses incurred, to a maximum of $15,000, provided:

• Training is required due to the injuries suffered, and is necessary for the insured person to be qualified to engage in an occupation for which he/she would not have been engaged except for having suffered such injuries,

• Expenses are incurred within three years from the date of the accident, and

• Expenses are not related to ordinary living, travelling or clothing.

If an insured employee requires rehabilitative physical therapy, Sutton Special Risk will pay the reasonable and necessary expenses incurred, to a maximum of $10,000, provided:

• Rehabilitative physical therapy is prescribed and recommended by the attending physician,

• Expenses are incurred within three years from the date of the accident, and

• Expenses are not related to ordinary living, travelling or clothing.

If an insured person suffers a covered injury and is subsequently required to use a wheelchair to be ambulatory, Sutton will pay the reasonable and necessary expenses incurred, a maximum of $15,000 or 10% of the insured's principal sum but not exceeding $25,000 for:

• The one-time cost of alterations to the insured injured person's residence to make it wheelchair accessible and habitable, and the lesser of:
  • The one-time cost of modifications necessary to a motor vehicle, owned by the insured injured person, to make the vehicle accessible or drivable for the insured person, or
  • The one-time cost to purchase a specially modified wheelchair accessible vehicle, with prior approval from Sutton.

This benefit is payable, provided:

• Home alterations are made on behalf of the insured person and carried out by an experienced individual in such alterations and recommended by a recognized organization, providing support and assistance to wheelchair users, and
• Vehicle modifications are made on behalf of the insured person and carried out by an experienced individual in such matters and modifications are approved by the provincial vehicle licensing authorities in the insured person’s province of residence.

If an insured employee suffers a covered injury for which special adaptive equipment and/or workplace modification is required for an employee’s return to active full-time work with the University, Sutton will reimburse the University for the modifications up to $7,000.

If the insured person suffers a covered injury and is disfigured due to a third degree burn, Sutton will pay an amount determined by multiplying the percentage of body surface actually burned, as presented in the table below, times the principal sum, up to a maximum of $25,000.

Body Part - Maximum percentage of benefit amount payable:

• Face, neck, head - 100%

• One arm and forearm - 25%

• One upper arm - 10%

• Front or back torso - 35%

• One thigh or one lower leg (below the knee) - 10%

The attending physician will determine the actual percentage applicable to each burn.

If an insured person suffers a covered injury and as a result of the injury requires psychological therapy as prescribed by a physician, Sutton will pay a maximum of $5,000 for the reasonable and customary expenses related to the therapy provided:

• Therapy is required, within two years of the date of the injury, and

• Treatment is provided by a licensed, registered or certified counsellor or therapist.

If an insured person, prior to age 65, is diagnosed by a qualified physician with any of the following specifically listed diseases, Sutton Special Risk will pay 10% of the insured’s principal sum up to the maximum of $5,000.

• Acute Poliomyelitis

• Acute Rheumatic Fever

• Amyotrophic Lateral Sclerosis (ALS)

• Encephalitis

• Huntington’s Disease

• Meningoccal Meningitis

• Necrotizing Fasciitis

• Parkinson’s Disease

• Tuberculosis

• Typhoid Fever

• Yersinia Pestis

This benefit is only payable if investigations leading to the diagnosis of the covered disease(s) are initiated more than ninety days following the effective date of insurance coverage and if the insured person is totally disabled from the covered disease(s) for at least nine months following the date of the diagnosis.

If an insured person is on a trip and is confined as an inpatient in a hospital because of injuries sustained due to an accident and subsequently requires the personal attendance of an immediate family member or an authorized family representative as recommended by the attending physician, Sutton Special Risk will pay a maximum of $15,000 for the expense for accommodation and transportation by the most direct route by a licensed common carrier.

"Immediate family member" means a person who is related to the insured person in any of the following ways: a spouse, parent, grandparent, child, brother or sister.

If an insured person suffers a covered injury causing loss of life, more than 50 km from his/her permanent city of residence, within 365 days from the date of the accident, Sutton will pay a maximum of $15,000 for actual expenses incurred relating to:

• The preparation of the deceased for burial, and

• Shipment of the body to the deceased’s city of residence.

If an insured person suffers loss of life and a law enforcement agency requests identification of the body, Sutton will pay a maximum of $15,000 for transportation and lodging for an immediate family member to travel at least 150 km from their place of residence to identify the body.

If an insured person suffers a covered injury while he/she is a passenger or driver of a private passenger type automobile and his/her seat belt is properly fastened, Sutton will pay an additional benefit of 10% of the insured person’s principal sum. Verification of proper use of the seat belt must be part of the official accident report or certified by the investigating officer.

If an insured employee or insured Spouse suffers a covered injury causing loss of life, Sutton will pay the legal guardian of the insured person’s Dependent child an amount equal to the lesser of the following:

• The annual cost charged by a commercial and licensed day care center,

• 5% of the insured's principal sum, or

• $5,000 per year.

This benefit is payable annually for a maximum of four consecutive payments, provided the dependent child is:

• Under age 13 at the time of the loss,

• Enrolled in a commercial and licensed day care center no later than 90 days following the date of loss, and

• Continues his/her enrollment in a commercial and licensed day care center.

If an insured employee or insured Spouse suffers a covered injury causing loss of life, Sutton will reimburse the annual tuition, excluding room and board, of an institution of higher learning per school year, for each Dependent child, up to the lesser of the following amounts:

• $10,000 per school year, or
• 5% of the insured person’s principal sum.

This benefit is payable annually for a maximum of four consecutive payments per dependent child, provided:

• The dependent child was, at the time of accident, enrolled as a full-time student in an institution of higher learning beyond the 12^th grade level, and
• Continues enrollment at an institution of higher learning.

If at the time of the accident, you have employee and family coverage but do not have any dependent children who qualify for this benefit, the Sutton will pay an additional benefit of $2,500 to the designated beneficiary.

"Institution of higher learning" includes, but is not limited to, any university, private post secondary college or trade school, and any College of General and Vocational Education/Collège d’enseignement général et professionnel (CÉGEP).

If an insured employee suffers a covered injury causing loss of life, Sutton will reimburse the insured Spouse for expenses relating to a professional or trades training program, to a maximum of $15,000, provided:

• The spouse enrolls for the purpose of obtaining an independent source of support and maintenance, and

• Expenses are incurred no later than 30 months after the date of loss.

If an insured person suffers a covered injury causing loss of life, Sutton will reimburse the person who incurred the expenses for cremation, burial, or other funeral expenses of the insured person. The maximum amount payable for this benefit is $5,000 per insured person.

If an insured employee suffers a covered injury as a result of a deliberate felonious assault from another person, excluding a co-worker or family member, Sutton will pay an additional benefit of 10% of the principal sum up to a maximum of $25,000.

If an insured person suffers a covered injury causing loss of life, Sutton Special Risk will pay 10% of the principal sum, up to the maximum of $10,000, to or on behalf of any dependent parents of the insured person.

Dependent parent(s) means the insured person’s parents, parents-in-law, grandparents, grandparents-in-law, great-grandparents or great-grandparents-in-law (whether natural, step or adoptive), who are:

• Not regularly employed on a full-time basis,

• Primarily dependent upon the insured person for support and maintenance due to a proven mental disability or physical handicap, and

• Residing in the insured person’s home.

Only one parental care benefit will be payable regardless of the number of dependent parents and will be payable in equal shares to the dependent parents.

If an insured person’s dependent child sustains an injury that results in a covered loss other than accidental loss of life, within 52 weeks of the date of accident, Sutton Special Risk shall pay two times the schedule amount up to the maximum amount shown payable.

If the body of an insured person has not been found within one year of his/her disappearance, due to a forced landing, stranding, sinking or wrecking of a conveyance in which the insured person was an occupant, then it will be deemed, in the absence of any evidence to the contrary, that the insured person has suffered loss of life. Benefits will be payable based on the table of losses.

If an insured employee and his/her insured Spouse both die from a covered injury in the same accident, the principal sum payable for loss of life of the spouse will be increased to equal that payable for loss of life of the employee.

If an insured employee suffers a loss of life, coverage may be extended to the insured Spouse and Dependent child for a maximum of 12 months without premium.