Loss of Income Injury

The EDGE Loss of Income Injury Coverage Guaranteed To Issue1 Issue ages 18 - 69, coverage to age 75

$1,000 to $6,0002 per month

Injury only or Injury & Illness3 coverage, 24 hour or Non-Occupational available

Benefits payable to age 70

or for a 2 year* or 5 year benefit period. Benefit Period is reduced to 24 months upon attainment of age 68

Payable from the FIRST DAY

30 day or 120 day waiting period also available

Benefits based on Gross Business Revenue or Employment Income

Features Include

Partial Disability Benefit

50% benefits for up to 180 days

Waiver of Premium

after 30 days of Total Disability while benefits are payable

Return to Work Assistance Benefit

rehabilitation and financial assistance in returning you to work

Accident Medical Reimbursement Benefit

providing reimbursement up to $10,000 for medical expenses not covered by government health plans

 

HOW TO DETERMINE YOUR LOSS OF INCOME BENEFIT AMOUNT

How much income you make, and how you make it, will determine the benefit amount payable in the event of a claim, and will be determined by your Qualifying Insurable Monthly Earnings (QIME) at the time you become disabled. If your income changes after purchasing Loss of Income Coverage this could affect the benefit amount payable.

The benefit amount payable to you at claim time is the lesser of your QIME or the Benefit Amount purchased. (The benefit amount payable may be lower than this amount if you are receiving benefits from other sources.). The maximum Loss of Income Benefit amount available to purchase is based on your QIME, and must be within $250 of the QIME amount.

 

WHAT WILL HAPPEN AT CLAIM TIME?

At claim time you will be required to provide written evidence of your Qualifying Insurable Monthly Earnings. This may include information from third parties, a copy of income tax returns, audited income and expense statements or employer’s salary statements. Once a method of determining income has been selected that same method will be used throughout the entire period for that claim.

For the self employed, we offer a choice of income verification methods to provide you the most favourable benefit amount; either the average monthly income during the prior 6 month period, or the last taxation year, or the best consecutive 2 year period in the past 3 years immediately preceding the date of Disability (the 2 year period must commence after the effective date of coverage).

If the monthly benefit purchased, plus any other benefits received exceeds your QIME, benefits payable will be reduced by the excess amount. During the first 18 months of Total Disability but will not be less than 25% of the monthly benefit purchased.

 

KEY DEFINITIONS:

Total Disability means due directly to an injury or illness you are unable to perform the important duties of your Regular Occupation; you are not engaged in any gainful occupation, and you are receiving physician’s care. After Disability benefits have been payable for 36 months the definition of Total Disability changes to mean due directly to an injury or illness you are unable to engage in any Reasonable Occupation; and you are continuing to receive physician’s care. 

Partial Disability means you are not totally disabled; you are engaged in your regular or gainful occupation; but due directly to an injury or illness you are unable to perform either: i) one or more important duties of your Regular Occupation; or ii) the important duties of your Regular Occupation at least 1/2 of the time normally required. You must also be receiving physician’s care.

Regular Occupation means the occupation you are actively involved in for compensation on the date of Disability.

Reasonable Occupation means any occupation in which you could earn, or within a 12 month period, could expect to earn, an income equal to or greater than 80% for the first $4,350 of your QIME and 150% on the remainder of your QIME

Guaranteed Renewable means, Once issued, your policy cannot be cancelled by the Company, and its provisions may not be restricted or modified prior to your 75th birthday for Injury only coverage, and your 70th birthday for Illness coverage. (assuming premiums are paid when due and there were no misstatements, misrepresentations or omissions related to your insurability at time of application). Furthermore, your policy cannot be singled out for premium change, but, the insurer may at its discretion change premiums for all policies in any one class grouping.

Contract Personnel means an individual who, during the term of the contract, provides services to only one person, partnership, association, body corporate or entity, including a partnership or an unincorporated association or organization (each entity, a "Person"), where (a) the Person provides the tools, materials or equipment for the individual to perform the services, and (b) the individual is remunerated on a per unit (pound, square foot, kilometre, etc.) or hourly basis.

Contract Personnel Income means the greater of: (a) The monthly average of the Insured Person’s gross remuneration from the Contract in the six month period immediately preceding the commencement of disability less any applicable Contract expenses that are deductible from the gross remuneration under the Income Tax Act of Canada (the "Tax Act"); (b) The monthly average of the Insured Person’s gross remuneration from the Contract in the last completed taxation year preceding the commencement of disability less any applicable Contract expenses that are deductible from the gross remuneration under the Tax Act; and (c) The monthly average of the Insured Person’s gross remuneration from the Contract in any consecutive 24 month period within the 36 months immediately preceding the commencement of disability less any applicable Contract expenses that are deductible from the gross remuneration under the Tax Act.

Please note that benefits will not be payable for a disability that occurs while you are travelling outside Canada, US, United Kingdom or Australia for more than 60 days

NOTE: Key definitions apply to the Coverages provided by Co-operators Life Insurance Company only

 

 

KEY EXCLUSIONS:

It's important that you understand under what circumstances a claim may not be paid. Here is a brief summary of some exclusions and limitations under the coverages provided by Co-operators Life Insurance Company. Please ensure you review your policy contracts in their entirety for complete details of the exclusions and limitations under these and any other coverages. 

Benefits are not payable for Disability or other losses covered, that results, directly or indirectly, from an Injury which occurs while you:

  • fly in an aircraft that is not a certified passenger aircraft operated by a properly certified pilot, flying between
  • duly established and maintained commercial airports
  • participate in professional athletics or underwater activities, including scuba diving engage in mountaineering, rock climbing, caving, parachuting, sky diving, hang gliding, bungee jumping, racing (for example; automobile, motorcycle, or horse) or racing any water device (e.g. seadoo)
  • operate a motor vehicle while under the influence of any intoxicant or while you have a blood alcohol concentration in excess of 80 mg of alcohol per 100 ml of blood.

Benefits are also not payable for Disability, or other losses covered, that results, directly or indirectly, from:

  • disease or sickness (if you purchased injury only coverage)
  • intentionally self-inflicted harm, or attempted suicide, including inhaling gas or absorbing fumes, while sane or insane
  • committing or attempting to commit a criminal offense inside or outside Canada
  • the use of any drug, poisonous substance, intoxicant or narcotic
  • engaging in an illegal occupation, a riot or insurrection or any form of public disturbance or an act of declared or undeclared war
  • normal pregnancy and childbirth
  • any type of opportunistic infection or sickness if you have Acquired Immune Deficiency Syndrome (AIDS) and/or have tested positive for Human Immunodeficiency Virus (HIV or any subtypes) or had symptoms which were diagnosed or manifested themselves prior to your effective date of coverage
  • Subjective Conditions: including, but not limited to, chronic fatigue syndrome, chronic pain syndrome, fibromyalgia, Epstein Barr syndrome or any other subjective syndrome or condition; mental disorders and substance use disorders: any psychiatric, psychological or emotional disorder including but not limited to, depression, anxiety, stress, burnout, or any mental disorder or substance use disorder. Such disorders include psychotic, emotional or behavioural disorders and disorders related to substance abuse or dependency.
  • service in the Armed Forces or other military organization

Limitations

Back and neck injuries are required to be substantiated by diagnostic medical tests to qualify for Benefits.
Soft Tissue Injuries are limited for each period of Disability based on your occupational class. 

Soft Tissue Injury means a contusion, a Sprain or a Strain and also includes tendonitis, carpal tunnel syndrome, bursitis and plantar fasciitis, as well as some others, (please see policy booklet for complete list).
Degenerative disc disease is deemed a disease or sickness. If you purchased illness coverage, benefits will be limited to 20 days per period, up to a lifetime maximum of 120 days, for disability that results directly or indirectly from degenerative disc disease.

 



1Provided you satisfy 2 qualifying questions 2Benefits over $5,000 only available to classes AA and Exec 3Illness issue ages 18-64, coverage to age 70 4Subject to additional premium 5Certain exclusions apply, please see policy booklet for complete details before you travel. * Injury only with a 2 year Benefit Period is available to non-residents residing in Canada with a valid work permit. A valid work permit must be submitted with the application.

This is a brief overview of the Benefits, providing some key definitions, exclusions and limitations only. A complete policy booklet will be issued once coverage is purchased, and we suggest you review for details on all policy provisions when received.