General Information

Beneficiary Designations

There is no right to name a beneficiary under Your coverage.

Cancellation of Coverage

The insurance company cannot cancel Your coverage provided the policy remains in force and premiums are paid when due.

Termination of Coverage

Your coverage terminates on the earliest of any of the following occurrences:

  1. the Policy Anniversary Date coinciding with or following the date You have reached Age 70,
  2. subject to the grace period, the date any premium due has not been paid, unless premiums are being waived,
  3. 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,
  4. the date on which You no longer qualify as a duly qualified member of Doctors Manitoba in accordance with the membership requirements,
  5. the date on which the policy is terminated,
  6. the date of Your retirement, or
  7. the date of Your death

Extension of Coverage

If on the date Your coverage terminates because the 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.

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. 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.

Portability

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 when due. 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.

Tax Issues

Premiums are tax deductible as business expenses and 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, the insurance company will furnish to You or the claimant a copy of the application and any written document provided to the insurance company as evidence of good health, to the extent required by law.

Assignment

Your rights and interests with respect to the policy may not be assigned.

Governing Law

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.

Incontestability

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:

  1. false
  2. part of the Your application, and
  3. material to the insuranc

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.

Reinstatement

Your coverage may be reinstated at any time within 6 months from the date of the lapse, on the following conditions:

  1. receipt by the insurance company of satisfactory evidence of good health and insurability determined on the same basis as when the coverage was issued,
  2. receipt by the insurance company of all overdue premiums with interest, and
  3. written confirmation by the insurance company of Your coverage’s reinstatemen

Definitions

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 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.

Eligible Office Expenses mean expenses that are incurred monthly in the conduct and operation of Your practice by You either directly or through a personal service corporation (or Your share of such expenses if You share the cost of these expenses with any other person) that are normally deemed to be recoverable by You from the billable services performed by You, but not exceeding the aggregate amount of such expenses incurred by You or Your practice divided by the total number of persons whose billable services normally contribute to the defrayment of such expenses.

The following expenses are eligible for coverage:

  1. rent, electricity, heat, water and other utilities,
  2. accountants fees or charges for services,
  3. salaries and the cost of benefits of employees,
  4. taxes (other than personal income tax),
  5. equipment depreciation,
  6. auto depreciation or rental entered into prior to disability,
  7. telephone, postage, delivery services,
  8. stationery and normal office supplies,
  9. laundry,
  10. lease or instalment purchase agreement payments for equipment, or property (entered into prior to disability) limited however to the portion therefore that relates to business use,
  11. any other expenses as are normal and customary in the conduct and operation of Your office plus the monthly pro-rata amount of annual fees, or subscriptions, and
  12. cost of internet provider services, web page hosting, cost of email service, if not included with the internet provider services.

The following expenses are not eligible for coverage:

  1. Your salary or salaries of other doctors,
  2. cost of wares, goods, pharmaceutical products,
  3. professionals books, and
  4. equipment or supplies.

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.

Non-Smoker means You have not used any form of tobacco, tobacco cessation products or marijuana, in the 12 consecutive months preceding the date of application for:

  1. Office Overhead Expense insurance; or
  2. Non-Smoker rates;

and You also meet the insurance company’s health standards.

Partial Disability or Partially Disabled means that, after being Totally Disabled during Your Elimination Period and while under Age 60, You are unable to perform one or more of the usual and customary duties of Your Regular Occupation for more than 4 hours per day and You are suffering 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.

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 and treatment requiring the personal attendance of 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 the disability.

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 and You are suffering a loss of Earned Income. There must be documented evidence of Your Total Disability.

You or Your means a physician, under Age 70, whose application for the Office Overhead Expense insurance has been accepted by the insurance company and whose insurance is in force.