Exclusions and Limitations

No benefits are payable:

1. for the portion of a period of disability during which you are not under treatment by a legally qualified Physician or  Specialist;
2. for the portion of a period of disability during which you do not participate or cooperate in a reasonable and customary treatment program, or a rehabilitation plan or program which has been recommended by the insurer;
3. while you are entitled to receive Weekly Wage Replacement Benefits under this Trust Fund;
4. 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;
5. for a disability resulting from participation in the commission of a criminal offence;
6. for a disability resulting from intentionally self-inflicted injuries or illness while sane or insane;
7. 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%);
8. 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;
9. an illness or injury caused or contributed to by a Motor Vehicle Accident that occurs in Ontario or Quebec;
10. during any leave of absence;
11. any period for which you are entitled to pregnancy or parental leave of absence by statue, contract or employer arrangement;
12. if you are receiving disability benefits, early Retirement benefits or Retirement benefits under any Employer or Union sponsored pension plan;
13. for disability for which you are entitled to receive reimbursement under any Workplace Safety and Insurance law or similar legislation;
14. 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;
15. 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.

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:

1. has previously notified and received approval in writing from the Insurer, or
2. remains under the regular care of a licensed Physician deemed appropriate by the Insurer, and
3. proof of the ongoing disability can be determined on evidence satisfactory to the Insurer in English or French within 90 days of request.