Effective April 1, 2019, OHIP+ will no longer provide drug coverage for individuals under the age of 25 who have access to private insurance. Therefore, prescription drug claims for children and youth 24 years of age and younger with private plan coverage will have to be submitted directly to their private plan. Click here for details!

AD&D Benefit Details

Cosmetic Disfigurement Benefit

If you suffer a third degree burn in a non-occupational accident, the Company will pay a percentage of the Principal Sum, depending on the area of the body which was burned according to the following table:

Body Part:

 

(A)

Area Classification

(B)

Maximum allowable % for Area Burned

(C)

Maximum % of Principal Sum Payable

Face, Neck, Head

11

9%

99%

Hand & Forearm

5

4.5%

22.5%

Either Upper Arm

3

4.5%

13.5%

Torso

(Front or Back)

2

18%

36%

Either Thigh

1

9%

9%

Either Lower Leg (below knee)

3

9%

27%

 


The maximum percent of Principal Sum Payable (C) is determined by multiplying the Area Classification (A) by the Maximum Allowable percent for Area Burned (B).  In the event of a 50% surface burn, the Maximum Allowable percent for Area Burned (B) is reduced by 50%.  This table only represents the maximum percent of the Principal Sum payable for any one accident.  If the Insured suffers burns in more than one area as a result of any one accident, benefits will not exceed $25,000.

Repatriation Benefit

When injuries covered by this policy result in a loss of life outside 150 km from your city of permanent residence or outside of Canada and occurs within 365 days from the date of the accident, Chubb Life Insurance Company of Canada will pay the actual expense incurred for preparing the deceased for burial and shipment of the body to the city of residence of the deceased, but not to exceed $15,000.00.

Rehabilitation Benefit

When injuries shall result in a payment being made by Chubb Life Insurance Company of Canada under the Schedule of Losses excluding the Loss of Life benefit provided by the policy, Chubb Life Insurance Company of Canada will also pay the reasonable and necessary expenses actually incurred up to a limit of $15,000 for special training provided:

  1. such training is required because of such injuries and in order for you to be qualified to engage in an occupation in which you would not have been engaged except for such injuries;
  2. expenses be incurred within two years from the date of the accident;
  3. no payment will be made for ordinary living, traveling or clothing expenses.

Family Transportation Benefit

When injuries covered by this policy, result in your confinement as an inpatient in a hospital outside 150 km from your city of permanent residence or outside of Canada and requires personal attendance of a Member of your immediate family as recommended by the attending physician, in writing, Chubb Life Insurance Company of Canada will pay for the expense incurred by the Member of your immediate family, for the transportation by the most direct route by a licensed common carrier to you while confined, but not to exceed $15,000.00.

"Member of your immediate family" means your spouse, legal or common law, parents, grandparents, and children over age 18, brother or sister.

In-Hospital Confinement Monthly Income

In the event you sustain an injury which results in a payment being made under the Schedule of Losses, excluding the Loss of Life Benefit, and you are hospital confined as an in-patient and are under the care of a legally qualified and registered physician or surgeon other than himself, the Company will pay for each full month, one percent (1%) of your Principal Sum, subject to a maximum benefit of $2,500, or one-thirtieth of such monthly benefit for each day of partial month, retroactive to the 1st full day of such confinement but not to exceed 365 days in the aggregate for each period of hospital confinement.

Hospital” as used herein means a legally constituted establishment which meets all of the following requirements:

  1. operates primarily for the reception, care and treatment of sick, ailing or injured persons as in-patients;
  2. provides 24 hour a day nursing service by registered or graduate nurses;
  3. has a staff of one or more licensed physicians available at all times;
  4. provides organized facilities for diagnosis and surgical facilities;
  5. is not primarily a clinic, nursing home or convalescent home or similar establishment nor, other than incidentally, a place for alcoholics or drug addicts;

In-patient” means a person admitted to a hospital as a resident or bed-patient and who is provided at least one day’s room and board by the hospital.

Spousal Occupational Training Benefit

When injuries to you result in a payment being made by Chubb Life Insurance Company of Canada under the Loss of Life benefit, Chubb Life Insurance Company of Canada will pay in addition, the expenses actually incurred, within 365 days from the date of the accident, by your spouse for a formal occupation training program for the purpose of specifically qualifying your spouse to gain active employment in an occupation for which your spouse would otherwise not have sufficient qualifications. The maximum payable hereunder is $15,000.00.

Day Care Benefit

If you suffer a loss of life in a covered accident while the policy is in force, Chubb Life Insurance Company of Canada will pay, in addition to all other benefits payable under the policy a "Day Care Benefit" equal to the reasonable and necessary expenses actually incurred, subject to the lesser of 5% of your Benefit amount or a maximum of $5,000.00 per year, on behalf of your Dependent child who is enrolled in a legally licensed Day Care center on the date of the accident or who enrolls in a legally licensed Day Care center within 365 days following the date of the accident.

The "Day Care Benefit" will be paid each year for 4 consecutive years, but only upon receipt of satisfactory proof that your child is enrolled in a legally licensed Day Care center.

“Dependent Child” means either a legitimate or illegitimate child adopted child, step-child or any child who is in a parent-child relationship with you and who is unmarried, twelve (12) years of age and under, and Dependent upon you for maintenance and support.

Parental Care Benefit

If you sustained an injury, which results in loss of life within 365 days of the date of accident, the Company will pay a Parental Care Benefit for an eligible Dependent Parent.
A Dependent Parent is eligible if, at the time of the accident:

  1. he/she is resident in a licensed nursing care facility; or
  2. he/she is enrolled in a home health care program; or
  3. he/she is living in the Insured Person’s residence; or
  4. he/she is receiving support and care provided by the Insured Person as evidenced by:
    i.    cancelled cheques
    ii.    Income Tax returns showing the parent as a Dependent; or
    iii.    other similar forms of proof.


The amount of the Parental Care Benefit will be the lesser of 10% of the Insured Person’s Principal Sum Amount or $5,000.

Dependent Parent” means the Insured Person’s parents or grandparents who are Dependent upon the Insured Person for support, maintenance and care.

Special Education Benefit

If you suffer a loss of life in a covered accident while the policy is in force, Chubb Life Insurance Company of Canada will pay, in addition to all other benefits payable under this policy, a “Special Education Benefit” equal to 5% of your Benefit amount, (subject to a maximum of $5,000 per year), on behalf of any Dependent child who, on the date of the accident, was enrolled as a full-time student in any institution of higher learning beyond the 12th grade level, or was at the 12th grade level and subsequently enrolls as a full-time student in an institution of higher learning within 365 days following the date of the accident.

The “Special Education Benefit” is payable annually for a maximum of four consecutive annual payments but only if the Dependent child continues his/her education as a full-time student in an institution of higher learning.

Bereavement Benefit

When injuries covered by this policy result in loss of life within 365 days from the date of the accident, the Company will pay the reasonable and necessary expenses actually incurred by the Spouse and Dependent children of the insured person for up to six (6) sessions of grief counseling, by a Professional Counselor, subject to a maximum of $1,000.00.
“Professional Counselor” means the treatment or counseling by a therapist or counselor who is licensed, registered or certified to provide such treatment.

Seat Belt Benefit

In the event you sustain an injury which results in a payment being made under the Schedule of Losses, your Benefit amount will be increased by 10%, if at the time of the accident, you were driving or riding in a Vehicle and wearing a properly fastened Seat Belt.

Due proof of Seat Belt use must be provided as part of the written proof of loss.

Vehicle” means a private passenger car, station wagon, van, or jeep-type automobile.

Seat Belt” means those belts that form a restraint system.

Home Alteration and Vehicle Modification

In the event you sustain an injury which results in a payment being made under the Schedule of Losses excluding the Loss of Life Benefit and such injury subsequently requires the use of a wheelchair to be ambulatory, Chubb Life Insurance Company of Canada will pay the reasonable and necessary expenses actually incurred within 365 days from the date of accident for:

  1. the one time cost of alterations to your principal residence to make it wheelchair accessible and habitable; and
  2. the one time cost of modifications necessary to a motor vehicle utilized by you to make the vehicle accessible or drivable for you.

Benefit payments herein will not be paid unless:

  1. home alterations are made by a person or persons experienced in such alterations and recommended by a recognized organization, providing support and assistance to wheelchair users;
  2. vehicle modifications are carried out by a person or persons with experience in such matters and modifications are approved by the Provincial vehicle licensing authorities.

The maximum payable under both Items a) and b) are subject to a maximum benefit the greater of $15,000 or 10% of the Principal Sum, to a maximum of $50,000.00.

Exposure and Disappearance

Loss resulting from unavoidable exposure to the elements shall be covered to the extent of the benefits afforded you.

If your body has not been found within one year of the disappearance, stranding, sinking or wrecking of the conveyance in which you were riding at the time of the accident it shall be presumed, subject to all other conditions of this policy, that you suffered a loss of life resulting from bodily injuries sustained in an accident covered under this policy

Identification Benefit

In the event accidental Loss of Life is sustained by you not less than one hundred and fifty (150) kilometers from your normal place of residence and identification of the body by a Member of the Immediate family has been requested by the police or a similar governmental authority, the Company will reimburse the reasonable expenses actually incurred by such Member for:

  1. transportation by the most direct route to the city or town where the body is located; and
  2. hotel accommodation in such city or town, subject to a maximum duration of three (3) days.

The reimbursement of such expenses incurred is subject to the accidental loss of life indemnity being subsequently payable in accordance with the terms of this policy following the identification of the body as the Insured Person.  Chubb Life Insurance Company of Canada will pay 10% of the principal sum up to the maximum of $10,000.00, for all such expenses.

Payment will not be made for board or other ordinary living, traveling or clothing expenses, and transportation must occur in a vehicle or device operated under a license for the conveyance of passengers for hire.

Benefits payable under this section will be limited to only one (1) policy in the event this benefit is contained in two (2) or more policies issued to the Policyholder by the Company.

Serious Illness Benefit

If, while coverage is in effect but only after coverage has been in effect for a period of ninety days you are then diagnosed with any one of the covered illnesses listed below and the Insured person satisfies the following conditions:

  1. has been hospitalized as an in-patient continuously for at least 48 hours, and
  2. survives for a period of thirty days thereafter, and
  3. the Insured Person is under age 65.


Chubb Life Insurance Company of Canada will pay 10% of the principal sum up to the maximum amount of $10,000.00.

Covered Serious Illnesses
Encephalitis        Parkinson’s Disease    Tuberculosis
Yersinia Pestis        Acute Poliomyelitis    Typhoid Fever
Necrotizing Fascitis    Acute Rheumatic Fever    Meningitis

Chubb Life Insurance Company of Canada shall only be obligated to pay the critical illness benefit once notwithstanding that an Insured Person may be diagnosed with more than one of the covered illnesses.

This website describes the conditions of eligibility, coverage and claims procedures under the Teamsters and Toronto Ready Mix Producers Benefit Plan Fund. The Board of Trustees are solely responsible for establishing the eligibility rules of the Trust Fund.

Downloads

Claim Forms:

Brochures:

Others:

*Please note that some changes were made to the booklet after April 2018 and these have been highlighted in red for your information.

Teamsters and Toronto Ready Mix Producers Benefit Plan Fund
c/o Benefit Plan Administrators
90 Burnhamthorpe Road West, Suite 300
Mississauga, Ontario L5B 3C3