2.2 Short- and Long-Term Disability

List of 13 items.

• Purpose

  The purpose of Crescent School’s (School) short-term disability (STD) plan is to provide against loss of earnings for employees who are unable to perform the essential duties of their job due to a health issue. Where an eligible employee is forced to be absent from work for a continuous period of more than three (3) working days due to a health issue, short-term disability benefits may be available, and the 4th day of absence will automatically trigger the STD process.
  
  

  The School is committed to accommodating disabled employees with modified work, where possible. Employees are expected to participate and cooperate in any modified work program and remain at work whenever possible.

• Eligibility

  If an employee is unable to perform the essential duties of their job as a direct result of a health issue for more than three (3) consecutive work days, the Short-Term Disability (STD) process will be automatically triggered.
  
  

  Full-time, part-time or sessional employees who have Class “A” benefits and who have completed three (3) months of continuous service with the School may be eligible for short-term disability benefits if they qualify, subject to a third-party review. If approved, the School will issue STD benefits beginning on the first (1st ) day of disability. The first four (4) days of an STD leave will also be documented as sick days and deducted from the employee’s annual allotment.
  
  

  Employees with Class “A” benefits who have fewer than three (3) months of continuous service may be granted up to three (3) days of sick leave with regular salary at the discretion of their Supervisor (in accordance with the Incidental Sick Days policy), and absences beyond three (3) days will be unpaid.
  
  

  Employees with Class “B” benefits and employees who do not qualify for benefits are not eligible for paid short-term disability benefits. After exhausting available incidental sick days they may be eligible for Employment Insurance Sick Benefits.

• Determination of a Qualified Disability

  An employee may qualify for STD benefits provided that the employee meets the following criteria and it is approved by a third party as required:

  • Is covered for STD on the date of disability; and
  • Is eligible to receive STD benefits on the date of disability; and
  • Is disabled due to a health-related issue and from performing the essential duties of their job; and
  • Is under the regular care of a Physician or Specialist and that care is monitored by the Third-party Plan Administrator; and
  • Is complying with recognized prescribed treatment and care as approved, verified and monitored by the Third-party Plan Administrator; and
  • Has submitted Proof of Disability in the form of a completed Attending Physician Statement (APS) to the Third-party Plan Administrator within fourteen (14) calendar days from the date of disability; and
  • Has consented to the release of medical information by signing the Authorization section on the STD Application Form in those circumstances where additional medical information is required to adjudicate their claim; and
  • Cooperates with all requests for medical documentation and provides proper notification of medical status changes; and
  • Completes all required subrogation/waiver forms.

  
  Where it is felt that information provided on the STD application form is not sufficient to support the approval criteria, the third-party Plan Administrator may request additional medical information or communicate with the employee’s Physician or Specialist for clarification. The third-party Plan Administrator may require the employee to submit an independent medical examination, as it deems necessary during the benefit period.
  
  

  If the STD application form is not received by the third-party Plan Administrator within fourteen (14) calendar days after the date of disability, STD benefit payments may not be issued.
  
  

  Crescent School relies on the Third-party Plan Administrator to determine eligibility for benefits and recommend benefit payment, therefore all decisions and recommendations made by the Third-party Plan Administrator are binding.

• Cost of Medical Forms

  Costs associated with the completion of the initial STD Application form and any other supplementary forms that may be required by the Third-party Plan Administrator to assess the claim are the responsibility of the person applying for the disability benefit.
  
  

  The School will be responsible for paying for any independent medical examinations and functional abilities evaluations.
  
  

• Rate of Pay by Years of Service

  Day 1–60	Day 61–112
  100% of regular base salary	70% of normal pay for employees with less than 5 years of service 80% of normal pay for employees with 5 but less than 8 years of service 90% of normal pay for employees with 8 but less than 10 years of service 100% of normal pay for employees with 10 or more years of service

  
  The benefit is based on the employee’s base pay on the date last worked prior to disability.
  
  

  No benefit is payable for any period during which the employee is not being treated by a qualified physician or specialist.

• Termination of STD Benefits

  STD benefits payable terminate at the earliest of the following dates:

  • Sixteen (16) weeks from the date of disability; if the disability continues beyond 16 weeks, the employee becomes eligible to apply for Long-Term Disability benefits. The application for LTD benefits should be made no later than 6 weeks before the end of the STD benefit period;
  • The employee is medically fit to return to the pre-disability position or any equivalent position;
  • The date on which the employee ceases to meet the STD approval criteria;
  • The date on which the employee resumes or starts working for wage or profit except under an approved rehabilitation/return-to-work program;
  • On any day the employee is on an approved leave of absence agreed to prior to the date of disability;
  • The date on which the employee becomes eligible for maternity, parental leave or compassionate care benefits in accordance with respective provincial and federal legislation. Maternity leave is deemed to commence on the earlier of the date the employee’s elected maternity leave starts or the date of delivery;
  • The date on which an employee refuses to comply with any treatment recommendations including engaging in and completing a recognized rehabilitation program or participating in any requested independent medical evaluations;
  • The date on which an employee refuses to provide proof of disability;
  • The date the employee is no longer under the care of a Physician or Specialist;
  • The date of the employee’s death;
  • On any day the employee is incarcerated;
  • For any period the employee is engaged in employment outside of Crescent School for wage or profit;
  • For any period the employee is outside of Canada except in those instances where an employee is going to another country to receive medical treatment not readily or immediately available in Canada at an accredited hospital, medical clinic or other similar facility or in those instances where the Third-party Plan Administrator has approved the employee being outside of Canada.

• Recurrent Disability

  If an employee recovers from the disability, and then becomes disabled again due to the same or related illness or injury within three (3) weeks of the return to active work, the second period of disability will be considered a continuation of the first, and the STD period will be extended by the number of days during which the employee ceased to be totally disabled.

• Different or Unrelated Disability

  If the employee returns to work for at least two (2) weeks and becomes disabled from a different or unrelated illness or injury, it will be considered a new period of disability and a new STD application form will be required to be submitted to the Third-party Plan Administrator.
  
  

  If the employee becomes disabled during their first disability period from different or unrelated causes and has not yet returned to work for one full day, it will be considered a continuation of the first disability period, and benefit payments will continue.

• STD Benefit Appeal

  An employee may appeal the third-party Plan Administrator’s decision to deny, suspend or terminate STD benefits by submitting to the third-party Plan Administrator within fourteen (14) calendar days from the date of denial, suspension or termination of STD benefits subject to the following timelines:

  • Written notice of appealing the decision is to be provided within seven (7) calendar days from the date of denial, suspension or termination of STD benefits; and
  • New and previously un-reviewed medical information is to be provided within fourteen (14) calendar days from the date of denial, suspension or termination of STD benefits.

  
  If a decision to deny STD Benefits is reversed, STD benefits will be paid retroactively from the date that the STD benefit is deemed by the Third-party Plan Administrator to have commenced. If a decision to suspend or terminate STD benefits is reversed, STD benefits will be paid retroactively from the date that the STD benefit was suspended or terminated.
  
  

  If a decision to deny, suspend or terminate STD benefits is upheld, the file with the Third-party Plan Administrator will be closed and the employee will be expected to return to work.
  
  

  If there is no record of medical submitted to the Third-party Plan Administrator within the fourteen (14) calendar day window from the date of denial, suspension or termination of STD benefits, STD benefits appeal will not be considered and the file will be closed and the employee will be expected to return to work.

• Exclusions

  Disabilities for which benefits will not be paid, even when arising while an employee had coverage and met the approval criteria for disability, include disabilities arising from:

  • Acts of civil unrest, insurrection or war, while on active duty in the armed forces, whether war be declared or not, participation in a riot;
  • Elective surgery or cosmetic treatment that is not medically required – except where surgery is attributable to an illness or injury (Laser eye surgery and in-vitro fertilization procedures are not excluded from this policy);
  • The commission of a crime or criminal offence under provincial or federal laws or provoking an assault or during a period of incarceration;
  • Drug addiction or alcoholism unless the employee is actively engaging in a treatment program that specializes in the treatment of such disabilities that has been approved by the Third-party Plan Administrator.
  • While on a leave of absence. This includes, for example, any period the employee is in receipt of Maternity or Parental Leave benefits under the Employment Insurance Act.

• Involuntary Termination While on Short Term Disability

  In the event of involuntary termination of employment, employees are eligible to continue receiving Short Term Disability payments for the maximum benefit period (16 weeks) in accordance with all Employment Standards requirements.

• Other Benefits While on Short Term Disability

  Employees receiving short-term disability benefits continue to be eligible to participate in the School’s group benefits package.

• Definitions

  Active employment means you must be working for Crescent School on a permanent full-time, part-time or sessional basis and paid regular earnings.

  
  

  Disability means that because of illness or injury, you cannot perform the essential duties of your job. Furthermore, you are not considered disabled or under a disability unless you are under the regular care and treatment of a licensed physician in Canada, who is practicing within the scope of their license during the entire period of disability.

  
  

  Disability benefits means money that is paid as a monthly benefit when your claim for disability benefits has been approved by the Third-party Plan Administrator.

  
  

  Employer or School means Crescent School.

  
  

  Illness means sickness, disease, or other medical conditions.

  
  

  Injury means bodily injury resulting directly from an accident or incident. The disability resulting from the injury must begin while you are covered under the Plan.

  
  

  Physician means a person (other than the employee, the employee’s spouse, child, brother, sister or parent, or the child, brother, sister or parent of the employee’s spouse) who is:

  Operating within the scope of their license; and either

  • Licensed to practice medicine and prescribe and administer drugs or to perform surgery; and
  • Legally qualified in Canada as a medical practitioner and required to be recognized, under the policy for insurance purposes.

  
  

  Sick time means days an employee is unable to work due to illness or injury and is paid by the School. Employees with Class A benefits are provided with an annual allotment of ten (10) paid sick days; prorated for part-time staff.

  
  

  Specialist means a Physician as defined above who has completed advanced education and clinical training in a specific area of medicine (their specialty area.)

  
  

  Third-party Plan Administrator is contracted by the School to administer the terms and conditions of the Short Term Disability benefit plan provisions.

  
  

  Maximum benefit period is the sixteen (16) weeks or 112 calendar days that STD benefits may be paid commencing from the employee’s 1st day of absence. (note that 5 sick days will be deducted from the employee’s annual allotment.