Benefits and Contract Summary

View the complete contract on the OTIP Website (password required).

LTD Plan Provisions & Features

Termination of benefits

Benefits will terminate at the earliest of:
a) the end of the month the member turns age 65;
b) the date the member is first entitled to at least a 62% unreduced service pension.

Pre-existing condition clause

No benefits will be paid for a disability arising from an illness or injury for which the member
obtained medical care before they became insured. Medical care is considered to be
obtained when a person consults a doctor, uses medication on the advice of a doctor, or
receives other medical services or supplies.

This exclusion does not apply if disability starts after:
a) the member has been continuously insured for one year, or
b) the member has not had medical care for the illness or injury for a continuous period of
90 days ending on or after the date the insurance took effect.

Own-occupation assessment

During the initial assessment period (first 24 months of LTD benefits), the disability is
assessed on the basis of the duties of the specific assignment the member regularly
performed before the disability commenced. The member will be considered disabled if,
because of illness, disease or injury, the member is unable to perform the significant duties
pertaining to the member’s specific assignment.

Gainful employment

Under the any occupation definition (after 24 months of LTD benefits), a member is
considered disabled if illness, disease or injury prevents the member from being gainfully
employed.

Gainful employment means work:

• a member is medically able to perform;
• for which the member has at least the minimum qualifications;
• that provides income of at least 60% of the member’s monthly earnings; (in assessing a member’s ability to be gainfully employed, the carrier will multiply the member’s monthly earnings by the Consumer Price Index)
• that exists either in the province or territory where the member worked when the disability started or where the member currently lives.

Rehabilitation program

A disabled member receiving LTD benefit payments may, at any time, be required to join a
rehabilitation program, which is appropriate to their circumstances. Refusal to enter and
participate in a rehabilitation program considered appropriate to the member’s
circumstances will result in the termination of benefit payments.

Mental/nervous disorders
No special exclusions or limitations apply to these types of disabilities.

Recurrence of disability
If the disability is not continuous, the days an insured member is disabled during the
elimination period can be accumulated to satisfy the elimination period; as long as no
interruption is longer than 20 consecutive Working Days and the disability arises from the
same disease or injury.

If a disabled member recovers, returns to work and subsequently goes off on disability
again for the same or a related illness within 100 working days after the previous disability
ends; or within 24 months after the end of an approved rehabilitation program, the member
does not have to satisfy another elimination period for disability benefits to begin again.

Proof of claim
Satisfactory written proof of claim must be given to the insurer within 90 days of the end of
the Elimination Period. Upon request, proof of continuance of disability must be submitted to
the insurer within 90 days.

Waiver of premium
A member will not be required to submit premium payments during the period that benefits
are being received.

OTIP Services

Mandatory Early intervention program
LTD plan members, who are absent from work due to an illness or injury for 15 consecutive
days or more, will be contacted by an OTIP early intervention rehabilitation consultant to
discuss their circumstances. The LTD plan may, upon approval, fund services such as
equipment, treatment and assessments, which would not otherwise be available to the
member.

A member’s ability to understand and cope with their illness or disabling injury will be
enhanced by being able to discuss their concerns with an OTIP rehabilitation consultant
before they are eligible for LTD benefits. The goal is to provide members with assistance
that will help them return to their regular work and possibly prevent or shorten the duration
of an LTD claim.

Learn more about the Early Intervention Program.

Claims payment
All claims are submitted to OTIP’s claims unit at our head office in Waterloo, for assessment
and adjudication.

Denied claims
If a claim is denied, an OTIP disability service representative will assist the member through
the appeal process. A senior member of OTIP LTD Services also serves on the Appeals
Committee