Definitions

“Accident” means a sudden and unexpected mishap or event in which an Insured Person is involved and which directly results in an Injury to the Insured Person.

“Accommodation” means lodging at a hotel, motel, inn, bed and breakfast or other like establishment as well as food reasonably required during the lodging, provided however that no indemnity will be paid for lodging at a private residence or for food not consumed as meals by the person seeking reimbursement of expenses.

“Assault” means an indictable offence, attempted indictable offence, felony, attempted felony, misdemeanour, attempted misdemeanour, summary conviction offence, attempted summary conviction offence, riot or attempted riot, including but not limited to robbery, theft, bombing, kidnapping, hijacking, larceny, sniping, and murder or any attempt to commit any of the aforementioned. The laws of the jurisdiction where the Injury occurs will govern as to whether an act constitutes an Assault as hereby defined.

“Brain Damage” means irreversible physical damage to the brain causing complete incapacity of performing all the substantial and material functions and activities normal to everyday life.

“Burn” means a condition which a Physician has determined to be a 3rd degree burn.

“Comatose” means being in a state of total unconsciousness from which the person cannot be aroused. A Comatose person is unresponsive to any external stimuli and continuously requires the use of life support systems.

“Commencement of Total Disability” means the date of commencement of the Insured Person’s Total Disability, as determined by a Physician, which date must be subject to the satisfaction of the Insurer that, on that date, the Insured Person has met all criteria for Total Disability.

“Common Accident” means a single Accident or multiple Accidents occurring within the same twenty-four (24) hour period.

“Daily Indemnity” means one-thirtieth of one percent (1/30 of 1%) of the Insured Person’s Principal Sum, subject to a maximum monthly indemnity of two thousand and five hundred dollars ($2,500).

“Day-Care Centre” means a facility, which is run according to the 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. A Day-Care Centre will not include a hospital, the child’s home or school if the only care at such school is provided during normal school hours while the Dependent Child is attending school from grades one (1) through twelve (12).

“Day of Hospitalization” means a necessary Period of Hospitalization in a Hospital as an inpatient for which a full day’s room and board is charged.

“Dentist” means a person who is duly licensed to practice dentistry.

“Denturist” means a person who is duly qualified to perform the services defined by the scope of his/her license. This includes any other practitioner practising under a similar license.

“Dependent Child” means a natural child, adopted child, stepchild or child who is in a parent-child relationship with you. The child must be dependant upon you for maintenance and support and:

  1. under 21 years of age; or
  2. under 25 years of age and in attendance at an Institution for Higher Learning on a full time basis; or
  3. by reason of mental or physical infirmity, is incapable of self-sustaining employment and is totally dependent upon the Insured Member for support within the terms of the Income Tax Act.

The Dependent Child will be covered from birth provided such child is born alive.

“Earnings” are defined as gross monthly earnings including bonuses, but excluding overtime.

“Education or Training or Experience” means the employee’s formal education, training or experience and the equivalent education, training or experience he/she has obtained from his/her past or present occupation, job or work experience; his/her hobbies, social, recreational and other activities; and all the knowledge and skills the employee has obtained from his/her total life experience.

“Evidence of Insurability” means any statement made on forms approved for such purpose by the underwriter concerning medical evidence of a person’s physical condition and/or other factual information which affects his/her acceptability for coverage. Job or work experience; his/her hobbies, social, recreational and other activities; and all the knowledge and skills the employee has obtained from his/her total life experience.

“Fare” means the regular fare charged for:

  1. an economy class seat on a regular flight by a domestic or international scheduled air carrier;
  2. a coach seat on a passenger train;
  3. a regular seat on a passenger bus;
  4. an economy class accommodation on a boat.

Each of those carriers must hold a current and valid certificate issued by Transport Canada or, if subject to regulation in another country by a similar governmental authority having jurisdiction in that country.

“Functional Disability” means an irreversible and serious limitation of a person’s physical or mental capacity or of their skills that prevents the person from living independently.

“Hemiplegia” means the permanent Paralysis and functional loss of use of upper and lower limbs on the same side of the body.

“Hospital” means an institution licensed as a hospital within the jurisdiction in which it operates. To qualify under this definition, a hospital must be an active treatment hospital open at all times for the care and treatment of sick and injured persons, have a staff of one (1) or more Physicians available at all times, provide twenty-four (24) hour nursing service by graduate registered nurses and have organized facilities for diagnostics and surgery. A facility which is primarily a clinic, rest home, nursing home, convalescent hospital or similar establishment is not a Hospital. For the purposes of this definition, a Hospital will include a facility or part of a facility used for rehabilitative care.

“Immediate Family Member” means a person at least eighteen (18) years of age, who is the son, daughter, father, mother, brother, sister, son-in-law, daughter-in-law, father-in-law, mother-in-law, brother-in-law, sister-in-law, uncle, aunt, nephew, niece, grandson, granddaughter, grandfather, grandmother (all of the above include natural, adopted or step relationships), or the spouse of an Insured Person.

“Injury” means bodily injury caused by an Accident occurring while the Policy is in force as to the Insured Person whose loss is the basis of claim and resulting directly and independently of all other causes in loss covered under the Policy, twenty-four (24) hours a day, anywhere in the world but in no event shall Injury mean Sickness or Disease howsoever caused unless caused by an Accident.

“Institution for Higher Learning” means and is limited to universities, colleges, CEGEPs, and professional or vocational schools.

“Insurable Earnings” means that portion of the employee’s earnings that is used to determine the amount of benefit for which he/she is covered, those earnings on which premiums are being paid.

“Insurer”, “We”, “Us” means Insurance Company Inc.

“Insured Person” means you or your insured Spouse or your insured Dependant Children, while meeting the Spouse and Dependent Child definition criteria presented in this section, and before the date of individual coverage termination.

“Intoxicated” and “Under the Influence of Drugs” means that the driver has a blood alcohol content and/or is impaired due to the use of alcohol, narcotics or other drugs such that he could be subject to proceedings under provincial, state or federal law, even if he has not been subject to such proceedings.

“Loss of Life” means the death of the Insured Person.

“Loss” means:

  1. as used with reference to a hand or foot, the complete and irrecoverable severance through or above the wrist or ankle joint, but below the elbow or knee joint;
  2. as used with reference to an arm or leg, the complete and irrecoverable severance through or above the elbow or knee joint;
  3. as used with reference to a thumb, the complete and irrecoverable severance of one (1) entire phalanx of the thumb;
  4. as used with reference to a finger, the complete and irrecoverable severance of two (2) entire phalanges of the finger;
  5. as used with reference to toes, the complete and irrecoverable severance of one (1) entire phalanx of the big toe and irrecoverable severance of all phalanges of the other toes;
  6. as used with reference to an eye, the irrecoverable loss of the entire sight thereof, and determined by a Physician to be irrecoverable;
  7. as used with reference to speech, the complete and irrecoverable loss of the ability to utter intelligible sounds, and determined by a Physician to be irrecoverable;
  8. as used with reference to hearing, the complete and irrecoverable loss of hearing, and determined by a Physician to be irrecoverable.

“Loss of Use” means a total incapacity to use part of the body, which incapacity has been continuous for twelve (12) consecutive months and was determined by a Physician to be permanent at the end of such period.

“Member Only Plan” means a plan which provides insurance to the Member only.

“Member and Family Plan” means a plan which provides insurance to the Member and his/her Spouse and/or Dependent Children.

“Medically Necessary” means broadly accepted and recognized by the Canadian medical profession as effective, appropriate and essential in the treatment of a sickness or injury, in accordance with Canadian medical standards.

“Motorized Vehicle” means a passenger car, van, jeep-type automobile, sports utility vehicle (SUV), any truck-type automobile, truck, ambulance, or any type of motorized vehicle used by municipal, provincial or federal police forces.

“Net Earnings” means your gross monthly salary less income tax.

“Normal Occupation” means the regular occupation, job or work (apart from any temporary assignment) an employee was performing at the time he/ she became totally disabled by the condition which prevented him/her from working and led to a claim made under a policy.

“Nurse” means a graduate registered nurse (R.N.) or nurse who is licensed to practise nursing service by a governmental agency having jurisdiction over such licensing. For the purpose of this definition, nurse is neither the insured nor a member of the immediate family.

“Orthodontic Treatment” means dental treatment which has as its objective the correction or malocclusion of the teeth.

“Paralysis” means the loss of ability to move all or part of the body. “Paraplegia” means the permanent Paralysis and functional loss of use of both lower limbs of the body.

“Period of Hospitalization” means a single uninterrupted confinement in a Hospital or several successive confinements in a Hospital as a result of the same Accident, provided each such confinement is separated by a period of less than ninety (90) consecutive days and all such confinements occur within seven hundred and thirty (730) days of the date of the Accident.

“Physician” means an individual who is legally licensed to practice medicine and provide treatment within the scope of his licence by:

  1. a recognized medical licensing organization in the jurisdiction where the treatment is rendered, provided he is a member in good standing of such licensing body, or
  2. a governmental agency having jurisdiction over such licensing where the treatment was rendered.

The Physician must not ordinarily reside in the Insured Person’s residence. The Physician must not be an Insured Person, an Immediate Family Member or business associate of an Insured Person.

“Policy” means Policy as well as the Master Application, any endorsements and attached papers.

“Policyholder” means NEWFOUNDLAND AND LABRADOR TEACHERS’ ASSOCIATION.

“Principal Sum” means the amount indicated in the Master Application as being applicable to the Insured Person and stated on the Insured Person’s most recently signed individual enrollment card on file with the Policyholder, if any.

“Private School Teacher” means a certified teacher approved by the Department of Education, and teaching in a private school system (K-12) recognized and approved by the Government of Newfoundland and Labrador.

“Professional Counsellor” means a therapist or counsellor who is licensed or registered within the jurisdiction in which he practices to provide psychological treatment or counselling.

The Professional Counsellor must not ordinarily reside in the Insured Person’s residence. The Professional Counsellor must not be an Insured Person, an Immediate Family Member or business associate of an Insured Person.

“Quadriplegia” means the permanent Paralysis and functional loss of use of both upper and lower limbs of the body.

“Qualifying Period” means an initial period of total disability before benefits become payable, as specified in the BENEFIT PLAN SUMMARY. If an employee ceases to be totally disabled during this period and then becomes totally disabled again within two (2) weeks due to the same cause, the qualifying period will be extended by the number of days during which total disability ceased.

“Regular Care and Attendance” means observation and treatment to the extent necessary under existing and recognized standards of medical practice.

“Rehabilitation Income” means income which the employee receives for work performed under a rehabilitation program, including self-employed activity.

“Residence” means the primary dwelling of which the insured is an occupant and the premises on which it is situated.

“Seat Belt” means a belt that forms a restraint system in a Motorized Vehicle.

For the purposes of this definition, a Seat Belt includes infant and child restraint systems used in Motorized Vehicles and the restraining belts which are part of a stretcher used in the transportation of sick or injured persons by ambulance.

“Sickness or Disease” means the alteration of a person’s state of health resulting from internal or external cause(s), creating objectively verifiable symptoms and/or signs, and revealing itself by the impairment of physiological or mental functions.

“Specific Loss” means Loss of Life, Loss, Loss of Use, Quadraplegia, Paraplegia or Hemiplegia, all as defined in the present section of this website.

“Spouse” means an individual:

  1. to whom you are legally married or in a civil union with; or
  2. although not legally married to the insured member, cohabits with the insured member in a conjugal relationship for a minimum of 12 continuous months. The term “conjugal relationship” shall be deemed to include a conjugal relationship between partners of the same sex.

However, when the individual is the biological or adoptive mother or father of at least one (1) of your children and is cohabitating with you, the individual shall be deemed a Spouse from the date of birth or adoption of that child, if that date precedes the end of the period of one year of cohabitation.

Only one (1) individual will qualify as your Spouse. If you are legally married or in a civil union but are also cohabiting with an individual as described under Item (b) above, you may elect in writing which one of the individuals will qualify as a Spouse under the Policy. This election must be filed with the Policyholder. The Insurer will not be bound by an election not filed before the occurrence of the event insured against. If an election is not filed, the Spouse will be the individual to whom you are legally married or in a civil union with.

“Stable” means any medical condition or related condition (including any heart condition and/or lung condition), other than a minor ailment, for which all of the following statements are true:

  • there has been no new diagnosis, new treatment or new prescribed medication;
  • there has been no change in treatment or change in prescribed medication (including the amount of medication to be taken, how often it is to be taken, the type of medication or changes in treatment frequency or type); Exception: i) the routine adjustment of Coumadin or Warfarin, insulin or oral medications to control diabetes, (as long as it is not newly prescribed or stopped); or ii) a change from a brand name medication to a generic brand medication (provided the dosage is not modified);
  • there has been no new symptom, more frequent symptom or more severe symptom experienced;
  • there has been no test result showing a deterioration;
  • there has been no hospitalization or referral to a specialist (made or recommended) and there is no further investigation for which results are pending.

“Totally Disabled Retired Employee” means wholly and continuously disabled by sickness or an accidental bodily injury which prevents one from engaging in duties or activities (household or otherwise) which could be considered to be normal for a person of the same age and sex.

“Totally Disabled Employee” means during the Qualifying Period and the succeeding 24 months, an employee is totally disabled when he/she is wholly and continuously disabled due to illness or bodily injury and, as a result, is not physically or mentally fit to perform the essential duties of his/her normal occupation.

“Total Disability” or “Totally Disabled”, as referenced in A3 and A4 Accidental Death and Dismemberment Policies means or directly refers to a continuous state of incapacity preventing the Insured Person from performing all of the usual and customary duties of his occupation.

An Insured Person will be deemed Totally Disabled only if he does not receive any income from any occupation after the Commencement of Total Disability, directly or indirectly, except in the context of a rehabilitation program approved by the Insurer.

For a Total Disability to be recognized, the state of the Insured Person must require Regular Care and Attendance by a Physician or an appropriate specialist. Proof of Regular Care and Attendance must be satisfactory to the Insurer.

“Transportation” means conveyance from one place to another by private or public motorized vehicle, bus, train, boat, ferry, airplane or helicopter.

“Travelling on Company Business” means any travel undertaken as part of the normal duties of the Insured Person’s occupation with the Policyholder, but excluding commuting to or from the Insured Person’s workplace.

“Waiting Period”, means a thirty-one (31) day period from the date the Insured Spouse and/or Dependent Child(ren) becomes comatose for which no benefits are payable.