To receive disability benefit payments, you must be under the care of a licensed physician.
There is no right to name a beneficiary under Your coverage.
The insurance company cannot cancel your insurance coverage provided the master policy remains in force and premiums are paid when due. If the master policy is terminated by Doctors Manitoba or the insurance company, and coverage is not continued under a new or replacing contract, you can convert the monthly income benefit to an individual guaranteed renewable policy, regardless of your health.
If a claim is denied in whole or in part, Doctors Manitoba can help you with any further discussions with the insurance carrier regarding the validity of the claim. Confidentiality is guaranteed.
Waiver of Premium
You are not required to pay premiums which become due while you are receiving benefits from the plan, provided you have been continuously disabled for at least 90 days.
Because recovery is the goal, this plan includes a provision for rehabilitative employment. With the approval of the insurance company, you may participate in a vocational or on-the-job training program while continuing to receive benefits.
Premiums paid by you for the disability income insurance program are not tax deductible. Any benefits you receive from this plan are not taxable as income to you.
If premiums are paid by a group or Corporation and deducted as a business expense, then any benefit received from this plan will be taxable as income to the individual. We recommend that premiums for disability be personally paid from a personal account.
Cessation of Benefit Payments
Your benefits terminate on the earliest of any of the following:
- the date you are no longer disabled,
- the date you do not comply, or fail to comply with the proof of claim provision,
- the date the you fail to undergo, when requested by the insurance company, medical, psychiatric, psychological examinations and evaluation selected by the insurance company,
- the date you refuse or fail to undergo medical, psychiatric or psychological treatment or participate in a rehabilitation program considered beneficial to you as recommended by the insurance company,
- the date you fail to furnish satisfactory evidence of continuance of disability or the date you are no longer receiving Regular Care and Attendance of a Physician satisfactory to the insurance company,
- the date you reach your maximum benefit period,
- the date you return to your Regular Occupation,
- the date you retire,
- any period of incarceration in a prison or mental institution following conviction by a criminal court, or
- the date of your death (with the exception of the survivor benefit, if applicable).
Termination of Coverage
Your coverage terminates on the earliest of any of the following occurrences:
- the Policy Anniversary Date coinciding with or following the date You have reached Age 70,
- subject to the grace period, the date any premium due has not been paid, unless premiums are being waived,
- the end of the period for which premiums have been paid, following receipt by Doctors Manitoba of written notice from You that one or more units of Your coverage are to be terminated,
- the date on which You no longer qualify as a duly qualified member of Doctors Manitoba in accordance with the membership requirements,
- the date on which the group policy is terminated,
- the date of Your retirement, or
- the date of Your death.
Note: If you are receiving disability benefits when your coverage would otherwise terminate, your benefits may continue. See the Payment of Benefits section for more details.
For Residents in the PARIM plan, if you withdraw from or are terminated from your program, coverage ends on the date of termination from your program.
Extension of Coverage
If on the date Your coverage terminates because the group policy terminates and You are disabled and either receiving benefits, eligible to receive benefits or fulfilling a required Elimination Period, the insurance company will pay You the monthly benefit while You remain disabled in accordance with the terms of this coverage.
Leave of Absence
The insurance of a duly qualified member of Doctors Manitoba will not terminate due to a leave of absence, sabbatical leave of a maximum duration of 4 years, or solely by reason of such member having moved from the province of Manitoba. You may continue the coverage in force as long as the premiums are paid by the Premium Due Date. The Premium Due Date for PARIM Members on a Leave of Absence is delayed until they return to work. However, You may not apply for a subsequent increase in coverage or change of coverage until such time as You again become a member in accordance with the membership requirements.
If You move outside of the province of Manitoba and maintain Your membership with Doctors Manitoba, You may continue the coverage in force as long as the premiums are paid by the Premium Due Date. You may also increase or change the coverage provided You are resident in Canada. Any increase in coverage is subject to evidence of good health and approval by the insurance company.
Premiums paid by You are not tax deductible and benefits received are not taxable.
Premiums paid by a group and deducted as a business expense means benefits received are taxable.
Facility of Payment
If for any reason, You are not competent to give a valid release for payments to which You are entitled, the insurance company may in its discretion make payment, to the extent permitted by law, to any person related to You, or to any other individual appearing to the insurance company to be equitably entitled to such payment. Any payment made by the insurance company in good faith pursuant to this provision fully discharges the insurance company to the extent of such payment.
Rights of the Insurance Company
If benefit payments made are later determined to be in excess of the amounts You are qualified for, the insurance company and Doctors Manitoba reserve the right to recover the excess. If the excess amount cannot be recovered, the insurance company has the right to reduce benefit payments until the excess amount is fully recovered.
Right of Examination
On request, Doctors Manitoba will make the group policy available to You for inspection at a reasonably accessible place.
Your rights and interests with respect to the group policy may not be assigned.
This contract will be subject to the laws of the province of Manitoba.
Your coverage will be subject to the laws of the Canadian province or territory in which You resided at the time of application.
The insurance company will not contest the validity of Your coverage, or any Unit of Your coverage, after it has been in effect for 2 years from the effective date of insurance, or the date of reinstatement, except for fraud.
No statement will be used by the insurance company to void Your coverage or to deny a claim during this
2 year period unless the statement is:
- part of the Your application, and
- material to the insurance.
In issuing each coverage, the insurance company has relied on statements made in the applications of Doctors Manitoba and each applicant. These are representations and not warranties. If Your coverage is voided for fraud, the insurance company will not refund the premiums paid under Your coverage.
Limitation of Action
Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Insurance Act, or other applicable legislation, or the Limitations Act, 2002, in Ontario.
Your coverage may be reinstated at any time within 6 months from the date of the lapse, on the following conditions:
- receipt by the insurance company of satisfactory evidence of good health and insurability determined on the same basis as when the coverage was issued,
- receipt by the insurance company of all overdue premiums with interest, and
- written confirmation by the insurance company of Your coverage’s reinstatement.
HIV/Hepatitis B and C Provision
If for the first time ever You test positive for Human Immunodeficiency Virus (HIV) or are determined to be a carrier of the Hepatitis B or Hepatitis C Virus (acute viral hepatitis) and are in an asymptomatic infectious state, You are eligible for Partial Disability benefits, notwithstanding the fact that You are neither Totally Disabled nor Partially Disabled. You are considered eligible if, prior to Age 65, You suffer from either or both of the following conditions:
- the condition is required to be disclosed to Your patients by regulations approved by an appropriate government authority or hospital board or an applicable medical regulatory body or licensing authority, and/or
- the condition results in a limitation of Your practice of medicine as a consequence of regulations approved by an appropriate governmental authority or hospital board or an applicable medical regulatory body or licensing authority, and
as a consequence of either or both of the situations described in paragraphs (a) or (b), You suffer a loss of 20% or more of Your Pre-Disability Average Net Monthly Earned Income for the period before: the date the condition was disclosed as provided in paragraph (a) and/or Your practice of medicine was limited as provided in paragraph (b).
If these circumstances apply, the insurance company will pay benefits in accordance with the terms governing the calculation of the Partial Disability benefit.
Your Partial Disability benefits under this provision terminate on the earliest of any of the following occurrences:
- the date You are determined to have recovered from the infectious state,
- the date You no longer suffer a loss of Pre-Disability Average Net Monthly Earned Income of at least 20%,
- the date You become entitled to Total Disability or Partial Disability benefits,
- the date You reach Age 65,
- the date of Your death, or
- the date You fail to furnish satisfactory medical or financial evidence as requested by the insurance company.
Actively at Work means You work at Your Regular Occupation for a minimum of 20 hours per week and perform all of the usual and customary job duties, at the time of application for insurance and during any period You are not disabled.
Age means the Age as of the Policy Anniversary Date of each year.
Earned Income means income resulting from Your performance of personal services in any and all occupations, including bonuses, overtime pay and all other extra compensation, after deduction of the usual and customary business expenses incurred in earning such income and before the deduction of any income taxes. Earned Income does not include interest, dividends, rents, royalties, annuities, pensions, wage continuation plans, or any other payments which do not depend on Your ability to earn an income.
Elimination Period means the number of days that must elapse following the date on which Your disability is deemed to have commenced, during which time no benefits will be payable.
Injury means accidental bodily injury sustained while Your coverage is in force and which directly and independently of all other causes, results in limitation, impairments and/or restrictions preventing You from performing all of the usual and customary duties of Your Regular Occupation.
An injury resulting in disability or loss which is caused directly or indirectly by any form of Sickness, disease, hernia, or degenerative condition, or any infection, other than infection of a visible external accidental cut or wound, will be deemed to be a Sickness for the purposes of this insurance. Any such Injury resulting in disability where such disability commences more than 60 days after the Injury will be considered a Sickness for the purpose of determining the maximum benefits period.
Insured Member means a Member, under the age of 70, whose application for insurance under this policy has been accepted by the insurance company and for whom insurance is in force.
Non-Smoker means You have not used any form of tobacco or tobacco cessation products in the 12 consecutive months preceding the date of application for:
- Disability Income insurance, any applicable rider; or
- Non-Smoker rates;
and You also meet the insurance company’s health standards. Marijuana use is excluded.
PARIM Member means a person who is a resident member of the Professional Association of Residents and Interns of Manitoba.
Partial Disability or Partially Disabled means that, if under Age 65, You have a loss of Earned Income of at least 20%, or You are engaged in another occupation and have a loss of Earned Income of at least 20%. Your Partial Disability must be a result of Sickness or Injury for which You are under the Regular Care and Attendance of a Physician. If a disability commences on or after Age 65, You will be considered Partially Disabled after being Totally Disabled during Your Elimination Period. You will not be entitled to receive Partial Disability Benefits while in receipt of Total Disability Benefits.
Physician means a physician or surgeon who is licensed as such in Canada or United States of America or any such other region as the insurance company may approve, and who is practicing within the scope of the Physician’s licensed authority. A Physician must be someone other than You, or Your immediate family member, or anyone who resides with You.
Policy Anniversary Date means June 1st of each year.
Policy Year means the period commencing on the effective date of insurance and terminating on May 31st of the following year and beginning on any Policy Anniversary Date thereafter.
Pre-Disability Average Net Monthly Earned Income means Your Earned Income averaged using the highest consecutive 12 months in the 24 months immediately preceding the disability date.
Premium Due Date means the first day of the month coinciding with or following Your effective date of insurance, and on each Policy Anniversary Date thereafter.
Regular Care and Attendance means a planned program of observation, care, and treatment requiring the personal attendance of You by a Physician, which, once initiated, is continued in accordance with existing standards of medical practice for the Sickness or Injury which is the cause of Disability.
If a Disability is as a result of or is contributed to by an addiction disorder You must, at the Company’s discretion, participate in a therapeutic program, recognized as such by the Company and be under continuous medical supervision by a licensed specialist in this field.
If a Disability is the result of or is contributed to by a psychiatric disorder as recognized by the American Psychiatric Association (APA), You must be under the care of a licensed Physician and licensed psychiatrist or licensed clinical psychologist as deemed necessary and appropriate by the Company. You must also be following the Regular Care and Attendance recommended.
Regular Occupation means the occupation You are engaged in immediately preceding the disability date.
Sickness means a disease or illness which first manifests itself while coverage is in force, and/or restrictions preventing You from performing the usual and customary duties of Your Regular Occupation.
Complications of pregnancy are considered a Sickness. Sickness does not include an ineligible disease or illness resulting directly or indirectly from any risk covered under the Exclusions.
Total Disability or Totally Disabled means that, as a result of Sickness or Injury for which You are under the Regular Care and Attendance of a Physician, You are unable to perform the usual and customary duties of Your Regular Occupation, You are suffering a loss of Earned Income and are not engaged in any other gainful occupation. There must be documented evidence of medical impairments, restrictions and limitation precluding You from performing the normal duties of Your Regular Occupation. The availability of employment will not be considered in the assessment of Disability.
You or Your means an Insured Member, under Age 70, whose application for the Disability Income Insurance has been accepted by the insurance company and whose insurance is in force.