Eligibility: Subject to eligibility guidelines, all NLTA members and employees under age 60 who have permanent or term contract positions are eligible to participate in the plan. Substitute teachers, private school teachers, and retirees are not eligible for the LTD coverage. Upon enrollment, the effective date of coverage is the first day of active employment or the date the application is approved by the underwriter, whichever date is later. Replacement and term contract teachers are eligible for participation in all options of the Group Insurance Plan for the period of their teaching contract. If LTD benefits are payable, the LTD benefit is payable only until the date contract ends.
NOTE: The member must be actively at work on the effective date of coverage or coverage will not take effect until return to active employment.
Any NLTA member/employee may choose to remove him/herself from this plan by contacting the Plan Administrator, Johnson Inc., to complete an Opting Out Form. Subsequent to opting out or allowing coverage to lapse or terminate, should a teacher wish to rejoin this plan, an application for coverage with evidence of medical insurability will be required.
Long Term Disability Insurance (formerly called Salary Continuance) is intended to protect the income of an insured member in the event that a disability prevents an insured member from performing the duties of their occupation beyond the expiry of paid sick leave. LTD insurance does not automatically “kick in” when an insured member’s sick leave runs out. An application must be made and detailed medical documentation provided. To avail of the LTD beneﬁt, a member must be totally disabled from performing their duties, and must have medical documentation, satisfying the underwriter, conﬁrming a continual disability from the onset of sick leave. The underwriter will perform a medical adjudication as to whether beneﬁts are, or are not, payable.
The period of beneﬁt payment can be short term or long term depending on the medical circumstances. This plan option provides the member with the ability to insure their income, thereby protecting themselves and their family against ﬁnancial disaster should the insured member become unable to earn a living due to disability.
DISABILITY INCOME BENEFIT
Application for beneﬁt is necessary. The application requires completion of forms by the insured member, the school principal (immediate supervisor), and the attending physician (usually a medical specialist). Medical proof of continuous total disability, satisfactory to the underwriter, must be submitted. The underwriter will determine eligibility for beneﬁt based on a medical adjudication of the medical evidence.
If approved, beneﬁt will commence after the expiration of paid sick leave, or a qualifying period of 30 calendar days, whichever is later, provided application and proof of disability is submitted within six (6) months of this qualifying period.
Waiver of Premium
Premiums must be paid during the qualifying period. However, a member does not pay premiums while receiving LTD beneﬁts.
The amount of monthly beneﬁt is 66 2/3% of gross monthly earnings on which the member was paying premium in effect on the date beneﬁt payments commence up to a maximum of $8,000 per month.
The amount of beneﬁt will be reduced so that the Long Term Disability payment plus the total income from all sources as outlined under integration of beneﬁts does not exceed 85% of net earnings on the date of expiration of sick leave.
This benefit is not taxable since the employer does not pay any portion of the premium.
Duration of Benefit (‘own occupation’ versus ‘any occupation’)
The maximum beneﬁt payable for an insured member who has been deemed totally disabled from performing the duties of their normal occupation is 24 months. Thereafter, beneﬁt can be maintained until age 60 if a medical adjudication by the underwriter conﬁrms a total disability from any occupation for which the insured is, or may become, ﬁtted by education, training, and/or experience.
Beneﬁt may be continued beyond 24 months if disabled from any occupation which will pay no less than 75% of the current monthly earnings for the insured’s normal occupation. The availability of such occupations, jobs, or work will not be considered in assessing the existence of an ‘any occupation’ disability.
Continuous medical treatment and documentation is required regularly throughout the time a member accesses Disability Insurance beneﬁts. The member must be under the regular care of a physician and receiving treatment deemed appropriate by the underwriter. The member must also be prepared to attempt rehabilitative employment, or participate in a rehabilitation program considered appropriate by the underwriter. If the member’s job requires a government permit or license, he/she will not be considered totally disabled solely because such permit or license has been withdrawn or not renewed.
Integration of Benefits
The LTD plan is designed to ensure a reasonable level of income, but is not designed as a “Stand Alone Plan”. The premium structure is based on the premise that the beneﬁt paid will be reduced by other sources of income which a member may be eligible to access. Therefore, the plan is said to be integrated with other sources of income to which the teacher may be eligible:
- Disability beneﬁts payable under the Canada/Quebec Pension Plan, not including CPP/QPP dependent beneﬁts.
- Beneﬁts payable under any Workers’ Compensation Act.
- Disability or retirement beneﬁts payable under the Teachers’ Pension Act or the Pension Plan for the Support Staff of the Newfoundland and Labrador Teachers’ Association.
- Disability or retirement beneﬁts under an employer sponsored retirement plan.
- Earnings recovered through a legally enforceable course of action against some other person or corporation.
The LTD beneﬁt can be used to top up the other sources of income to 85% of net income.
In applying for the LTD beneﬁt, the insured member will also be asked to sign an agreement to apply for TPP/CPP beneﬁts or other employer sponsored disability beneﬁts, if required by the insurance underwriter. If an insured member is approved for TPP/CPP or other employer sponsored disability beneﬁts, the LTD monthly beneﬁt will be adjusted accordingly. If the Pension beneﬁts are received retroactively, then the LTD beneﬁts will be recalculated retroactively, and the insured will be required by the underwriter to remit in full any overpayment that may occur due to this retroactive adjustment. Members should be aware that the LTD beneﬁts are nontaxable, while the TPP/CPP employer sponsored beneﬁts are taxable.
In the event that the insured member fails to apply for CPP or TPP or other employer sponsored disability beneﬁts; or a disability decision from these plans has not been rendered within six (6) months from the application date, the underwriter reserves the right to commence deducting an estimate of CPP/TPP or other employer sponsored beneﬁts from the LTD beneﬁts.
Long Term Disability beneﬁts are designed to be paid during periods when a member is disabled and cannot work. Often however, there will be a time when, although not yet fully recovered, a member can work at some type of job and possibly earn an income. Therefore, the insured will be encouraged to participate in a rehabilitation program developed by the underwriter’s rehabilitation counsellors in consultation with the physician, employer and rehabilitation specialists. In order to participate in a rehabilitation program not developed by the underwriter, the program must be approved by the underwriter. In the case of rehabilitation, only half of these earnings will be used to reduce the monthly beneﬁts. Rehabilitation beneﬁts will be paid for a maximum of 24 months. If at any time the income received from rehabilitative employment equals 75% or more of the current monthly earnings for the normal occupation, beneﬁt payments will cease.
If a member recovers during the qualifying period and becomes disabled again within two weeks due to the same cause, the qualifying period will be extended by the number of days during which the member ceased to be disabled. Once the member has been disabled and received beneﬁts under this Plan, and has returned to work, a later disability will be deﬁned as recurrent when it occurs within six (6) months after returning to active employment. A disability will be considered to be recurrent if it results from an injury or sickness which is directly related to the causes of the immediately preceding disability. Once receiving Long Term Disability beneﬁts, any period of disability which is classiﬁed as “recurrent” will be treated as a continuation of the previous disability. An insured member will not have to re-satisfy the qualifying period, and beneﬁts will begin again immediately based upon the same earnings level as at the original date of disability.
EXCEPTIONS AND LIMITATIONS
Disability income is not payable for the following:
- A disability caused by self-inﬂicted injuries or illness.
- A disability resulting from insurrection, war, service in the armed forces of any country, or participation in a riot.
- When an insured member is not under continuing medical supervision and treatment considered satisfactory to the underwriter.
- Pregnancy, childbirth, or miscarriage, either as a cause or effect, except complications thereof. Complications due to pregnancy are covered. However, a member will not be able to receive beneﬁts for any cause during the time on maternity/parental leave, or placed on such leave by the employer in accordance with relevant government legislation, or the leave agreed upon by the teacher and the employer.
CESSATION OF BENEFIT PAYMENTS
Monthly payments will cease on the earliest of the following events:
- The date a member is no longer totally disabled, as deﬁned in the policy.
- The date a member reaches age 60. However, should the qualifying period be completed after the 59th birthday but prior to the 60th birthday, the monthly payments will continue beyond age 60 until a total of twelve (12) monthly payments have been made.
- The date a member fails to undergo, when requested by the underwriter, medical, psychiatric, psychological, educational and/or vocational examinations by examiners selected by the underwriter.
- The date a member fails to undergo medical, psychiatric or psychological treatment or participate in a rehabilitation program for alcoholism, drug addiction or substance abuse treatment program when recommended by the underwriter.
- The date a member is incarcerated in a prison or mental institution by authority of a criminal court.
- The date a member refuses to complete and return a Reimbursement Agreement form or comply with the terms of a signed Reimbursement Agreement form, when requested, with respect to disability beneﬁts payable under a public pension plan or the Teachers’ Pension Act or the Pension Plan for the Support Staff of the Newfoundland and Labrador Teachers’ Association, or other employer sponsored disability pension plan.
- The date a member dies.
- For insured members in term contract/replacement positions, the date the contract terminates.
Claim forms are available from the Plan Administrator, Johnson Inc. The insured member will be required to complete the member portion. The immediate supervisor (i.e., principal or assistant director) must also complete a portion. The doctor must complete the Attending Physician’s statement. The family physician or medical specialist must understand the necessity of providing all and complete medical documentation, even if it means adding details for which there is no room on the form. Copies of medical history, consultation reports, chart notes and test results should also be sent. Should the medical documentation be incomplete, unnecessary delays will occur. Expenses incurred in compiling this information are the insured member’s responsibility. It is the member’s responsibility to ensure that all reports are completed and sent to the Plan Administrator, Johnson Inc. Claims must be submitted no later than six (6) months following the qualifying period (i.e. the expiration of sick leave or thirty (30) calendar days, whichever is later).
It is recommended that application for benefits be made at least twelve (12) weeks prior to the end of the qualifying period (i.e., before sick leave expires).