Short Term Disability

This benefit is provided directly by the CSI Canada Insurance Plan and Trust Fund, and the services of Manulife are accessed at the discretion of CSI for claims adjudication and management.

1 Intent

The Short Term Disability (STD) policy sets out the terms and conditions under which insured active employees of a participating School may receive income protection payments from the CSI-Canada Insurance Plan and Trust Fund (CSI) during the recovery period of illness or injury, and assistance with early and safe return to work.

2 Eligibility

You are eligible under this policy while you are an insured active employee of a participating School.

You are covered under the STD policy when you were actively at work on the last workday before the onset of the illness or injury. Further, you are covered under the STD policy and will be considered for benefit entitlement on the day that you, due to illness or injury, cannot return to active work as scheduled following:

  • any period of paid leave (e.g. paid vacation); or

  • a temporary lay-off for any period as required by law; or

  • any period of statutory unpaid leave (e.g. parental leave).

    If you receive pay in lieu of notice you are eligible for coverage under the STD policy for the period of notice you would have otherwise received under employment standards legislation.

    2.1 Definition of Disability

    The STD Program provides income protection to you for the period of time that you are considered to be totally disabled and meet the requirements set out in this policy.

    Totally disabled means a restriction or lack of ability due to an illness or injury which prevents you from performing the essential duties of your own occupation. The availability of work will not be considered in assessing your disability. If you must hold a government permit or licence to perform the duties of your job, you will not be considered totally disabled solely because your permit or licence has been withdrawn or not renewed. Disability benefits are not payable during any period of disability that you engage in any occupation or employment for wage or profit except as part of a rehabilitation program approved by your participating School.

    2.2 Recurrent Disability

    Continuous periods of total disability include all periods of total disability that meet all of the following conditions:

  • Commence while you are eligible and covered under this benefit, and

  • Are not separated by more than thirty (30) consecutive days, and

  • Are due to the same or related cause or causes.


    If all the above conditions are met, the recurrence is considered to be the same period of disability with respect to the maximum duration of STD benefits and the terms set out in this policy. The duration of the maximum STD payments will be extended by the number of days during which you returned to full, regular, active work. Any recurrence due to the same illness or injury or a related cause that occurs more than thirty (30) days following your return to full, regular work as an active employee is considered to be a new period of total disability with respect to the
    maximum duration of STD benefits and the terms set out in this policy. 

    If you return to full regular work for at least one full day and becomes disabled due to a different cause the disability will be treated as a new disability with respect to the maximum duration of STD benefits and the terms set out in this policy.

    In no event will more than 150 days of STD benefit be payable for one period of disability.

    2.3 STD Benefits

    Once you are eligible to receive benefits and have been confirmed to be totally disabled, STD payments commence from the 15th consecutive day of total disability and continue as long as you comply with the requirements set out in this policy. STD benefit payments are payable semi-monthly, on the following schedule:

  • Benefits for the first to 15th day of a calendar month will be paid on the 18th day of the month;

  • Benefits for the 16th to the last day of a calendar month will be paid on the third day of the      
      following month.

    In cases where the third or 18th day of a calendar month falls on a weekend, benefits will be paid on the Monday immediately following. A pro rata payment shall be made for any period in which you are not entitled to benefits for the entire semi-monthly period.

    The benefit payable is equal to two-thirds or three-fourths of your regular semi-monthly compensation as in effect at the date of occurrence of your disability, in accordance with the option selected by your participating School. If your school pays any portion of the STD premium the STD benefit payable to you will be taxable. If you pay the full cost of the STD premium, the STD benefit payable to you will be non-taxable.

    Regular semi-monthly compensation for STD benefits is based on your compensation as in effect at the date of occurrence of your disability. The maximum benefit period, including the waiting period, is 164 consecutive days of total disability.  In no event will more than 150 days of STD benefit be payable for one period of disability.

    2.4 STD Benefit Reductions

    Should you receive or be eligible to receive income from the following other sources, any such amounts will be deducted from your STD benefit:

  • for the same or subsequent disability under CPP/QPP disability benefits;

  • under CPP/QPP retirement benefits;

  • under a motor vehicle insurance plan that pays first, before EI, which provides disability benefits
      under any government law to the extent that the law does not prohibit such a deduction (At    
      present,  the only acceptable such plans are the Quebec Automobile Insurance Plan, The  
      Ontario Motorist Protection Plan, The Automobile Insurance Plan of Saskatchewan, and the
      Manitoba Autopac).

  • under any other group disability plan;

  • under a registered pension plan;

  • damages for lost earnings recovered by a third party, where allowed by law; or

  • severance, termination or damages for pay in lieu of salary or wages, where allowed by law.

     

     

    2.5 Continuation of STD Benefits

    To continue to be entitled to STD benefits you must:

  • Be totally disabled;

  • Be under the continuous care of a physician licensed to practice medicine in Canada;

  • Comply with treatment protocols appropriate for the condition and focused on promotion of
      recovery and return to work;

  • Participate in any reasonable rehabilitative programs designed to assist you to return to work
      while accommodating the functional limitations related to the total disability;

  • Provide regular medical evidence as considered necessary by CSI and/or the third party              
      Disability Case Manager for the purposes of determining ongoing entitlement, level of disability
      and for rehabilitative (i.e. return to work) program planning; and

  • Attend a medical examination or abilities assessment, when required (at CSI’s expense), with a
      physician or specialty provider for the purposes of assessing your level of disability and the
      current treatment plan, and/or identifying abilities and limitations.

    2.6 STD Exclusions & Limitations

    STD benefits are not paid when:

  • The illness or injury is covered by workers’ compensation;

  • You are outside of Canada unless this is approved by and pre-arranged with CSI;

  • You are receiving comparable benefits under the Maternity and Parental leave benefits under
      the EI Act or the Quebec Parental Insurance Plan;

  • The illness or injury occurs while you are not eligible for benefits, except where required by
      law; and

  • You have plastic surgery solely for cosmetic purposes except where attributable to illness or
      injury;

    STD benefits are not paid for illnesses or injuries resulting from:

  • service in the armed forces, war, participation in a riot or disorderly conduct;

  • intentionally self-inflicted injuries;

  • participation in a criminal offence; or

  • drug or alcohol abuse   unless you are participating   in an approved rehabilitation and/or
      treatment plan and/or unless there is a medical condition that would cause total disability even if
      drug and alcohol abuse ended.

    2.7 Termination of STD Benefits

    STD benefits cease when:

  • You are no longer under the care of a licensed physician in Canada;

  • You are no longer totally disabled;

  • The end of the maximum benefit period (164 days) is reached;

  • You are not submitting the required medical information in the timelines specified by CSI or a
      third party Disability Case Manager;

  • You   refuse to return to reasonable,  suitable or accommodated work that is within your
      functional capacity based on objective medical evidence;

  • You perform any work for wage or profit unless otherwise approved by CSI and your School;

  • You are serving a prison sentence;

    Furthermore, STD benefits cease on:

  • Your last day of active employment;

  • The date you retire; or

  • The date you die.
    3 Application Process for STD Benefits

    Application for STD benefits requires completion of two forms; the Application of Temporary Disability Benefits Form (available at http://www.csionline.org/csibenefits/images/can_ins_forms/ DisbApplicationSTD.pdf) and the Certification of Disability form (available at http://www.csionline. org/csibenefits/images/can_ins_forms/DisbCertificationSTD052006.pdf)The completed forms are to be submitted directly to CSI.

    Your entitlement for STD benefits is reviewed and assessed by the third party Disability Case Manager (currently Manulife Financial). Your School will not have access to your private medical information, unless authorized by you in writing. CSI will commence, cease or adjust the STD benefits in accordance with the advice of the Disability Case Manager. It is important that you provide the required information as soon as possible as no STD benefit payments can be made until the STD claim has been assessed by the Disability Case Manager. You are responsible for the costs associated with the application for STD benefits, including but not limited to the completion of any medical reports requested in order to assess entitlement for STD benefits. Once approved for STD benefits, and during your recovery period, additional medical evidence may be required to support continuing total disability.

    4 Rehabilitation Programs and Return to Work

    When you are totally disabled, you may be able to perform some of the duties of your own occupation, or of an available alternative occupation. The third party Disability Case Manager may assist with arranging such rehabilitation opportunities. Participation in the Rehabilitation Program will not disqualify you from receiving STD benefits while the rehabilitation program continues as long as you continue to be otherwise eligible and entitled to STD benefits.

    The Rehabilitation Program is focused on you achieving a full return to work with your School and could include one or a combination of:

  • A gradual return to work by adjustment of work hours;

  • Adjustment of duties and/or tasks; or

  • Temporary reassignment to another occupation.

    When you are participating in a Rehabilitation Program, you are eligible to receive STD benefits and regular earnings during the period of rehabilitation to a maximum total of 100% of pre-disability earnings. During the rehabilitation plan, your School will pay you for the hours/days worked, and the applicable STD benefit amount will be paid for the hours/days you did not work. Where there is rehabilitative work available at your School on an unpaid basis only, you will continue to receive STD benefits for the hours/days worked.

    5 Appeals

    Where you do not agree with the decision regarding entitlement for STD benefits, you may appeal the decision. All appeals are to be made in writing, with supplementary medical information included, to CSI within thirty (30) calendar days from the date of the decision letter. You are responsible for the payment of any costs associated with the provision of medical reports that may be required for the appeal. STD benefits will cease while a claim is under appeal.

    If you disagree with the decision rendered on your appeal, you may appeal your case to the CSI Board of Trustees, whose decision in the matter shall be final and binding on you and CSI.

    6 Advisory

    Please be advised that the CSI Canada Short Term Disability plan has been designed to qualify under the Employment Insurance (EI) Premium Reduction Program, with the intent to ensure eligibility for premium reduction for participating schools.

    In any circumstance where this program jeopardizes the eligibility for premium reduction for participating Schools, the EI Premium Reduction Program requirements will take precedence over this plan wording.

    Full Issue: No. 347 - January 5, 2012

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