LTD Plan Details - Argus Bermuda
Sign In
LTD Plan Details
Total Disability
Total Disability:
Occurs if an employee becomes disabled while insured under the Long Term Disability Benefit and remains totally disabled beyond the end of the Elimination Period.
A condition due to injury or sickness that requires the regular and ongoing care of a physician appropriate to the injury or sickness, the result of which prevents the insured employee from engaging in his usual occupation.
Argus Pays:
The benefits for which that employee is eligible in accordance with the Schedule of Benefits and all the provisions of the policy.
The net Monthly Benefit as shown in the Schedule of Benefits reduced by any disability income the insured employee receives. Employees participating in a rehabilitation programme approved by Argus will be eligible for disability benefits while participating in the programme for a period of up to 24 months.
Benefit Details
Rehabilitation:
Defined as when an insured employee returns to work on other than a full time basis or participates in a rehabilitation programme.
Argus Pays: If an insured employee is participating in an approved rehabilitation programme, Argus may pay part or all of any approved rehabilitation expenses incurred by the insured employee.
Partial Disability:
A state of disability following a period of total disability, where the total disability lasts at least as long as the Elimination Period. During this state, the insured employee is gainfully employed, but is unable to perform at least one major duty of his occupation for any employer.
Argus Pays: If an insured employee is deemed partially disabled, they will receive an adjusted Monthly Benefit based on the amount payable for total disability.
Survivor Benefit:
If a disabled employee dies after having received at least six Monthly Benefit payments, the surviving spouse or child will be eligible for benefits.
Argus Pays: The amount equal to the net Monthly Benefit paid immediately preceding the death of the disabled employee, multiplied by three.
Residing Outside Bermuda:
Argus Pays: No more than six Monthly Benefit payments will be made while a disabled employee is travelling or residing outside of Bermuda, unless the disabled employee undergoes a regular medical examination at a time and place specified by Argus, as satisfactory proof of continuing disability. Costs of such medical examination will be paid by Argus. Any travel costs incurred in connection with such medical examination(s) will be payable by the disabled employee.
Pregnancy:
Argus Pays: Pregnancy in itself does not constitute disability; however, complications of pregnancy that prevent an employee from working will be considered as a disability. Benefits will not be payable during a leave of absence for pregnancy.
Other Paid and Unpaid Leaves of Absence:
Argus Pays: Benefits will not be payable for any period during a leave of absence for any reason; however, the employee may satisfy the Elimination Period during such leave.
Benefit Exclusions
Long Term Disability Benefits will not be paid in the following situations:
- While a disabled employee is imprisoned
- Any disability due to or arising from a self-inflicted sickness or injury, while sane or insane
- War, declared or undeclared, or insurrection of any kind, or active participation in a riot or rebellion
- Commission of, or attempt to commit, an indictable criminal offence or felony
- Injury sustained when the employee is driving while the blood alcohol level exceeds 80 milligrams of alcohol per 100 millilitres of blood, or as otherwise defined by the relevant legislation