Illness and Injury

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​Exclusions


Long Term Disability Insurance

Sun Life Financial will not pay benefits for any period:

  • the employee is not receiving appropriate treatment.
  • the employee does any work for wage or profit except as approved by Sun Life Financial.
  • the employee is not participating in an approved partial disability or rehabilitation program, if required by Sun Life Financial.
  • the employee is on a strike except where specifically agreed to by Sun Life Financial.
  • the employee is absent from Canada longer than 4 months due to any reason, unless Sun Life Financial agrees in writing in advance to pay benefits during the period.
  • the employee is serving a prison sentence or is confined in a similar institution.

Sun Life Financial will not pay benefits if an employee's disability results directly or indirectly from a condition which existed on or before the date the employee's coverage began. However, this limitation will not apply to the employee if:

  • the employee has not had medical care for the condition for a continuous period of 90 days ending on or after the date the employee's coverage began, or
  • the employee has been covered for Long Term Disability with the employer for at least 13 continuous weeks during which the employee has been actively working (up to 3 days of absence does not count) and the employee has not been treated by a doctor, or any medical personnel under the direction of a doctor, for the condition, or
  • the employee became totally disabled more than 1 year after the employee's coverage began. If coverage ends due to a lay-off, Sun Life Financial will consider any period of work before the lay-off towards fulfilling this limitation.

If the employee's coverage ends and the employee is covered again under this contract, Sun Life Financial will use the latest date the employee's coverage began when applying the above limitation, except otherwise indicted above.

Sun Life Financial will not consider the employee totally disabled if the employee's disability results from drug or alcohol abuse. However, this limitation will not apply while the employee is participating in a Sun Life Financial approved treatment program or the employee has an organic disease which would cause total disability even if drug and alcohol abuse ended.

Sun Life Financial will not pay benefits for total disability resulting from:

  • the hostile action of any armed forces, insurrection or participation in a riot or civil commotion.
  • participation in a criminal offense.

Business Travel Accidental Death and Dismemberment Insurance 

No benefit is payable for:
  • expenses paid for or furnished under the terms of any other Health Care Plan arranged through the employer,
  • services provided by an agency or department of any government normally provided free-of-charge,
  • non-emergency medical treatment, routine health check-ups, eye and ear examinations, eye glasses and hearing aids, or treatment that can be reasonably delayed until return to Canada,
  • dental care,
  • dental services or supplies and appliances, except as previously mentioned,
  • hospital charges for non-medical services, such as radio or telephone,
  • services not listed as covered expenses,
  • services rendered before coverage became effective or after termination of employment or termination of insurance,
  • cosmetic surgery or treatment, except as required for correction of damage caused by accidental injury sustained while this coverage is in force,
  • services or supplies that are available through any plan established pursuant to the laws or regulations of any government, including any motor vehicle no fault coverage required by statute,
  • any service to the extent that any government prohibits payment of benefits,
  • services, drugs or supplies which are deemed experimental in nature,
  • delivery and transportation charges,
  • services and supplies which are required for recreation or sport, but which are not medically necessary for regular activities,
  • services received for confinement, which is primarily for chronic or custodial care,
  • services received in a government hospital unless you are required to pay for such services,
  • services to which you are entitled without charge, or for which there would be no charge if there were no insurance,
  • services received from a dental or medical department maintained by NAV CANADA, a mutual benefit association, labour union, trustee or similar type of group,
  • expenses in respect of services provided by a member of your family or by a person customarily living with you,
  • chronic alcoholism or drug addiction,
  • mental or nervous disorders or psychiatric treatment, unless necessitating hospital or institutional confinement, in which case coverage shall not extend beyond three months,
  • AIDS or AIDS-related disease or disorders
  • any condition for which you received medical advice for treatment during the 90 days immediately prior to becoming insured, until after the expiration of 12 months from the date you are eligible for insurance.
  • normal commuting to and from work,
  • intentionally self‑inflicted injuries, suicide or any attempt thereat, while sane or insane,
  • full-time, active duty in the armed forces,
  • injury sustained while you are performing any common, manual, or mechanical labour that may be construed as part of your regular duties for NAV CANADA,
  • any accident that occurs during the period you are required to live in another community, away from the work premises in the city of permanent assignment, for reasons of training or work assignments lasting longer than 60 days,
  • acrobatic flying as defined by the Department of Transport,
  • operations requiring a special permit or waiver from the Department of Transport even though granted, other than a permit waiver issued because of the territory to be flown over or landed upon, except operations requiring a ferry permit or test flight permit from the Department of Transport where such aircraft does not have a valid certificate of airworthiness and operations requiring aerial work under Transport Canada CAR 702 Operating Certificate; or
  • crop dusting or spraying, seeding, fire fighting, sky-writing, pipeline inspection, power-line inspection, aerial photography, exploration, racing, endurance test or exhibition stunt flying.
Published on February 01, 2016