Accident Disability Insurance Benefit

Sun Life's accident insurance plans - Essential and Preferred - include an optional Accident Disability Insurance Benefit. Injured employees and spouses can count on a weekly stream of income if they become Totally Disabled as a result of a covered accident. Disability for spouses is defined as the inability to perform two or more Activities of Daily Living.

How does it work?

Employees and their spouses choose a flat dollar weekly benefit amount of coverage. If a serious injury occurs, we start paying the insured person once the Elimination Period is satisfied.

What's covered?

The benefit is available for any covered accident, such as a fall, sports injury or traffic accident that results in the insured becoming Totally Disabled. . The benefit is paid regardless of any other disability insurance the employee or spouse may have.

Employees

Help with meeting expenses while injured
Guaranteed Issue
Available to employees and spouses
No reduction for other sources of income
Portable (with Accident insurance, subject to state availability)
Optional benefits (for employee only)
- First Day Hospital
- Partial Disability

Employers

Accident-only disability coverage affordable to a wide group of employees
Financial protection for employees
Competitive group pricing

An employee must enroll in Accident Insurance in order to purchase the employee disability benefit. An employee and his or her spouse must enroll in Accident Insurance in order to purchase the spouse disability benefit. The disability must be due to a covered accident (not sickness). Spouse disability benefit amount cannot exceed the employee's benefit amount.

Accident Insurance is a limited benefit policy. It provides accident coverage only. It does not provide basic hospital, basic medical, or major medical insurance. The certificate and its riders have exclusions and limitations that may affect any benefits payable. Benefits payable are subject to all terms and conditions of the certificate. The policy, certificate, and any rider, if applicable, may not be available in all states.

Group insurance policies are underwritten by Sun Life Assurance Company of Canada (Wellesley Hills, MA) in all states, except New York, under Policy Form Series 12-GP-01, 12-AC-C-01, 12-AC-R-01, and 12-AC-R-02, subject to state availability. Product offerings may not be available in all states and may vary depending on state laws and regulations. Accident insurance is not available in New York.

Accident plans

The exclusions and limitations listed below may vary by state.

What exclusions apply to the benefits payable for both Accident Insurance and the Accident Disability benefits?

No benefits will be payable for any loss or Period of Disability that is a result of a Covered Accident that is due to or results from: war or an act of war, or any involvement in any period of any type of armed conflict (this does not include acts of terrorism); active military duty; riding in or driving any motor-driven vehicle in a race, stunt show, speed test or while Intoxicated; operating, learning to operate, serving as a crew member of, jumping or falling from any aircraft, including those which are not motor-driven (this does not include: 1) flying as a fare paying passenger in a scheduled or chartered flight operated by a commercial airline; or 2) flying as a passenger with no duties on board an aircraft operated by a private business to transport its personnel or guests); engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting or any similar activities; participating in or practicing for any semi-professional or professional competitive athletic contest in which any compensation is received; committing of or attempting to commit an assault, felony or other criminal act; committing or attempting to commit suicide or injuring oneself intentionally; voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless administered on the advice of a Physician and used as directed; improper or illegal use of inhalants or huffing; a Sickness or infection including physical or mental condition which is not caused solely by or as a direct result of a Covered Accident; an Injury arising out of or in the course of any work for pay or profit (if off-job coverage is elected); participation in a Riot, Rebellion or Insurrection (for Accident Disability Benefit only). Exclusions may vary depending on state requirements.

What limitations apply to the Accident Disability benefits payable?

Limitations include but are not limited to the following. No benefit is payable for any Period of Disability: while the insured is not under the Continuing Care of a Physician for the Injury causing the Disability, unless the insured has reached a maximum point of recovery and is still Disabled; for any period the insured does not submit to any medical examination or clinical assessment requested by us; for any Period of Disability during which the insured is incarcerated; for any period during which the insured would not receive regular pay from the Employer if the insured was not Disabled (any period during which benefits are suspended will not count towards the Maximum Benefit Duration).

SLPC 25144 07/13 (Exp: 07/15)

Sun Life Financial

Accident Insurance

Accident Disability Insurance Benefit

How does it work?

What's covered?

Employees

Employers