You are eligible for Accident Insurance if you are a member of Doctors Manitoba or a clinic manager under age 75 or an eligible family member.

You can also purchase voluntary accident insurance for your spouse (if under age 75) and unmarried dependent children. This means your children who are:

• under 21 years of age, or
• under 25 years of age and attending university, college or trade school on a full-time basis, or
• any age if mentally or physically handicapped, provided they are incapable of self-sustaining employment and remain totally dependent upon you for support and maintenance.

Member Only Plan

With the member only plan:

• you purchase insurance in units of $10,000, to a maximum of 100 units ($1,000,000)
• premiums cost $3.00 per year (plus tax, where applicable) for each $10,000 unit of insurance*
• for example, if you want $250,000 (25 units) of coverage, the cost would be $75.00 per year (25 units X $3.00)
• the principal sum is the amount of insurance you choose to purchase.

Member and Family Plan

With the member and family plan:

• you can purchase insurance in units of $10,000 to a maximum of 10 units ($1,000,000)
• premiums cost $4.32 per year (plus tax, where applicable) for each $10,000 unit of insurance*
  • for example, if you want $250,000 (25 units) of coverage, the cost would be $108.00 per year (25 units X $4.32)
• the principal sum for you (the member) is the total amount of insurance you choose to purchase
• the principal sum for your spouse is equal to 50% of the member’s principal sum
• the principal sum for each dependent child is equal to 15% of the member’s principal sum, to a maximum of $50,000 per dependent child.
  • for example, if you purchased $100,000 of accident insurance under the Member and Family Plan, your spouse has coverage of $50,000 and your dependent children each have coverage of $15,000 (the maximum amount of coverage)
• if you and your spouse are both physicians paying dues to Doctors Manitoba:
  you they may both enrol, with one member electing the Member Only Plan and the other electing the Member and Family Plan with Dependent children only
  the member who does not enrol is considered the spouse to be insured under the Member and Family Plan.

*Retail sales taxes are calculated based on the premiums applicable to those members of Doctors Manitoba who reside in Manitoba, Ontario and Quebec. Taxes are not included in the above premiums

If, within one year from the date of the accident, injury results in any of the following specific losses, the Plan pays a sum for injury resulting from an accident. Each sum is calculated based on the amount of principle sum.

Percentage of Principle Sum

The following benefits are also included for Accident Insurance. Explanations of each benefit follow this table.

Common Disaster Benefit (Family Plan Members only)

• If both you and your spouse die as a result of the same accident and within 90 days after the date of the accident, your spouse’s insurance coverage will be doubled to match your coverage, to a maximum aggregate of $1,000,000.

Contagious Disease

• If you contract and/​or become infected by Hepatitis B, Tuberculosis or Meningococcal Meningitis to which you were exposed during the performance of your duties, the Plan pays the principal sum, to a maximum of $250,000, if loss of life occurs within 12 months following such exposure.

Conversion Option (Member Only)

• You may convert coverage to an individual plan within 31 days of the termination under this plan. The new plan maximum coverage will be $100,000, and will be subject to the terms and conditions of the new individual policy.

Day Care Benefit

• If an injury causes your death, the Plan will pay the reasonable and necessary expenses actually incurred for an eligible dependent child who is, at the time of the accident, enrolled in a day care centre, or enrolls in a day care centre within 90 days following the date of your death.
• The benefit is equal to 5% of the principal sum or $5,000, whichever is less, each year for up to four consecutive years for each eligible dependent child under age 13 if the dependent child remains enrolled in a legally licensed day care centre.

Education Benefit

• If an injury causes your death, the Plan will pay, in addition to all other benefits, an education benefit for any eligible dependent children.
• An eligible dependent child is one who, at the time of the accident, is enrolled as a full-time student in an institution for higher learning beyond the secondary school level, or is at the secondary school level and enrolls within 12 months following the date of your death.
• This benefit pays 5% of your principal sum to a maximum of $5,000 per year, for a maximum of four consecutive years.

Exposure and Disappearance

• If loss results from unavoidable exposure to the elements, benefits are payable under this policy.
• If the insured’s body is not found within one year after the date of the disappearance, sinking or wrecking of the vehicle in which he or she was an occupant at the time of the accident and under such circumstances as would otherwise be covered hereunder, it is presumed that the insured suffered loss of life resulting from bodily injury caused by an accident at the time of such disappearance, sinking or wrecking.

Family Transportation

• When, as a result of loss covered by this policy, an insured person is confined as an in-patient in a hospital located not less than 100 kilometres from his/​her normal place of residence, the Plan will pay the reasonable expenses actually incurred by any member of the immediate family of the insured person for hotel accommodation and transportation by the most direct route to the insured person, not to exceed an aggregate amount of $10,000 for all such expenses.

HIV Adjustment

• If, during the performance of your duties, you sustain an Injury which results in your acquiring and testing positive for the Human Immunodeficiency Virus (HIV) within 12 months following the date of the accident, the Plan pays a lump sum amount equal to your principal sum, subject to a maximum of $25,000.

Home Alteration and Vehicle Modification

• When an injury does not cause loss of life but results in the Plan making a payment under the Schedule of Loss, and requires you to use a wheelchair to be ambulatory, the Plan will pay for:
  • the cost of alterations to make your home wheelchair accessible and habitable, and
  • the cost of modifications necessary to make your vehicle accessible or drivable. Vehicle modifications must be approved by licensing authorities.
• The total maximum amount payable is $10,000.

Identification Benefit

• If injury results in loss of life for you, your insured spouse or insured dependent child and indemnity becomes payable under the policy, and provided identification of the body is required by the policy or similar law enforcement agency, the Plan will pay the reasonable and necessary expenses actually incurred by a member of the immediate family for lodging and board (not to exceed a maximum duration of three consecutive nights) and transportation by the most direct route to and from the location of the body, subject to a maximum of $5,000. The body’s location must not be less than 150 kilometers from the family member’s normal place of residence.

Rehabilitation

• If injury requires that you undergo special training to qualify you for employment in an occupation for which you would not otherwise have engaged except for your injury, the Plan will pay the reasonable and necessary expense incurred for such training within 3 years of the date of the accident, subject to a maximum amount of $10,000 as the result of any one accident.

Repatriation Benefit

• If death of an insured person from accidental injury occurs at least 50 kilometers away from the normal residence, expenses of up to $10,000 will be paid for preparation and transportation of the body of the insured person to his/​her city of residence.

Seat Belt

• If an insured person sustains an injury in a vehicular accident which results in a payment under this policy, the Plan increases the benefit amount payable by 5% if, at the time of the accident, the insured person was driving or riding in a vehicle and wearing a properly fastened seat belt.

Spousal Retraining Benefit

• If an injury causes your death, the Plan will pay the reasonable and necessary expenses actually incurred by your spouse within 3 years from the date of the accident for a formal occupational training program up to $10,000.
• Payment is made for expenses actually incurred for an approved formal program, specifically qualifying your spouse for employment in an occupation for which he or she would otherwise not have had sufficient qualifications.

Waiver of Premium

• If you become totally disabled from an accident or sickness for at least six consecutive months, your premiums (and those of your insured spouse and/​or insured dependent children, if applicable) are waived.
• The waiver is in effect until the earlier of the date you cease to be totally disabled, you reach age 65, your eligibility terminates, the policy is terminated, or failure to provide the Plan with proof of your continued total disability.

Aggregate Limit of Indemnity

• The policy is subject to an Aggregate Limit of Indemnity of $2,500,000 for all losses resulting from any one accident. This means that in the event of an accident that results in an accumulation of losses exceeding $2,500,000, the amount payable with respect to each Insured Person will be reduced proportionately.

Benefit for Accident Insurance is not paid for losses due to:

• suicide or any suicide attempt while sane or insane
• self-inflicted injuries while sane or insane
• war, declared or undeclared, or any act thereof
• full-time active service in the armed forces of any country
• traveling as a pilot or crew member of any aircraft, or travel in the policyholder’s owned or leased aircraft

• Spouse whenever used in this policy means a person who is under the age of 75 and:
  • to whom the Participant is legally married, or
  • to whom the Participant is married by a marriage that is voidable and has not been declared null and void, or
  • with whom the Participant has continuously cohabited and who has been publicly represented as the Participant’s spouse for a minimum of 12 months immediately before a Loss is incurred under the policy.

If more than one person meets this definition, the Company will pay only one benefit, which will be paid in equal shares to the persons meeting the definition. The Participant must file written designation of a common-law spouse with the Policyholder.

• Dependent children are your unmarried natural-born children, legally adopted children, step-children, common-law children for whom you have legal custody or any other children dependent upon you for support and maintenance in a parent-child relationship as defined under the Income Tax Act; who are:
  • one day old but under 21 years of age, or
  • under 25 years of age and attending an institution for higher learning on a full-time basis, or
  • any age if mentally or physically handicapped, provided they are incapable of self-sustaining employment and remain totally dependent upon you for support and maintenance

• Injury is bodily injury caused by an accident occurring while coverage is in force, where such injury is the basis of claim and results directly and independently of all other causes in loss
• Insured means you, your insured spouse or your insured dependent children
• Principle sum is the amount of insurance you select and which is stated on your most recently signed enrollment card on file with the policyholder
• Member of the Immediate family is a person at least 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 (all of the previous include natural, adopted and step relationships), spouse, grandson, granddaughter, grandfather or grandmother of the insured
• Physician is a doctor of medicine (other than the insured or a member of the immediate family) licensed to practice medicine by:
  • a recognized medical licensing organization in the locale where the treatment is rendered, provided he or she is a member in good standing of such licensing body, or
  • a governmental agency having jurisdiction over such licensing in the locale where the treatment is rendered
    
• Residence is the primary dwelling of which the insured is an occupant and the premises on which it is situated
• School for Higher Learning whenever used in this policy includes any university, college, CEGEP (College d’Enseignement General et Professionel [community colleges in Quebec]) or trade school.
• Hospital is an institution licensed as a hospital, which:
  • is open at all times for the care and treatment of sick and injured persons, has a staff of one or more physicians available at all times and which continuously provides 24-hour nursing service by graduate registered nurses,
  • provides organized facilities for diagnostics and surgery, and
  • is an active treatment hospital and not primarily a clinic, rest home, nursing home, convalescent hospital or similar establishment.
  For the purpose of this definition, physicians and nurses do not exclude a member of the immediate family.
• Nurse is a graduate registered nurse (R.N.) or nurse who is licensed to practice nursing service by a governmental agency having jurisdiction over such licensing (the nurse can not be yourself nor a member of the immediate family)
• Regular care and attendance means medical treatment to the extent necessary under existing standards of medical practice for the condition causing Hospital confinement
• Accommodation is lodging in the vicinity of the Hospital where you are confined
• Seat belt means the belts that form a restraint system and includes infant and child restraint systems when properly used with a seat belt
• Vehicle is a passenger car, station wagon, van, Jeep-type automobile or truck.

Effective date

Accident insurance is effective on the date your application form and premiums are received by Doctors Manitoba.

Increase, Decrease or Cancellation of Insurance

You may:

• Increase or decrease your coverage at any time by contacting Doctors Manitoba and completing the appropriate application form.
• Cancel your coverage at any time. Cancellations are effective at the end of the month in which a written request is received, or a future specified date on that request.

Termination of Coverage

Your coverage terminates immediately on the earliest of the date:

• The policy terminates,
• A premium due is unpaid,
• of the Policy Anniversary coinciding with or immediately following the date you reach age 75, or
• The Policy Anniversary date following the date that you cease to be associated with Doctors Manitoba in a capacity making you eligible for insurance under the policy, unless stated otherwise.

Your spouse and/​or dependent children’s coverage terminates immediately on the earliest of the date:

• They cease to be eligible, or
• Your insurance is terminated, unless stated otherwise.

Upon termination of eligibility for any reason, the insurance coverage is continued until the end of the period for which the premium is paid.

Payment of Benefits

Your accidental death benefit is paid to the beneficiary designated on your application form, or to your estate if no such designation is made. Any other benefits payable (which include those payable for your insured spouse and/​or insured dependent children) are paid to you, with the exception of indemnities payable under the Day Care Benefit, Education Benefit, and Spousal Retraining Benefit.

To make a claim, written notice of the accident must be provided to the insurer within 30 days of the date of the accident and written proof must be submitted within 90 days of the date of the accident. If the required notice and proof of loss is not received, the claim may not be considered after the 90-day period has expired, unless there is good reason for the delay. In no event is a claim considered after one year from the date of the accident if notification was not provided to the insurer and the necessary forms not completed and submitted.