No benefits are payable:
- for any total disability commencing within twelve months of the insured Member’s effective date of insurance if the disability is caused or contributed to by a sickness or accidental injury for which the member has received medical treatment services or has sickness or accidental injury for which the Member has received medical treatment services or has taken a prescribed drug at any time within ninety days before his or her effective date of insurance.
- for any portion of a period of disability during which you are not under treatment by a legally qualified physician or specialist. You will not be paid for any portion of a period of disability during which you do not participate in the treatment program recommended by the doctor.
- for a disability resulting from injury or disease which occurred while the Member is on active duty in the armed forces of any country, or while participating in a riot, insurrection, rebellion or civil commotion.
- for a disability resulting from participation in the commission of a criminal offence.
- for a disability resulting from intentionally self-inflicted injuries or illness while sane or insane.
- for a disability resulting from an accident which occurs while you are operating a motor vehicle and your blood contains more than 80 milligrams of alcohol in 100 milliliters of blood (.08%).
- for any portion of a period of disability resulting from substance abuse, including alcoholism and drug addiction, unless you are participating in a recognized substance withdrawal program.
- an illness or injury caused or contributed to by a Motor Vehicle Accident that occurs in Ontario or Quebec.
- if you are receiving disability benefits, early retirement benefits or retirement benefits under any Employer or Union sponsored pension plan.
- for the portion of disability during which you are imprisoned in a penal institution or confined in a hospital or similar institution as a result of criminal proceedings.
- for a disability which commences on or after the date a strike begins, subject to any provincial Employment or Labour Standards Act. However, you can fulfill your Qualifying Disability Period during a strike.
- during any leave of absence, including maternity/paternity leave
- for any portion of a period of disability during which you are receiving treatment by a therapist unless such treatment is recommended by a physician deemed appropriate by the Insurer.
- if you refuse to participate in a rehabilitation program which is deemed appropriate by the Insurer.
Canadian Residency Required
No benefits are payable if the member resides outside Canada for any period exceeding 90 consecutive days or a total of 180 days in any 365-day period unless the member:
- has previously notified and received approval in writing from the Insurer, or
- remains under the regular care of a licensed physician deemed appropriate by the Insurer, and
- provides proof of the ongoing disability can be determined on evidence satisfactory to the