MORTGAGE i n s u r a n c e PROTECTION PLAN booklet GM TC (09/15)
INTRODUCTION The Equitable Life Insurance Company of Canada (the Insurer ) has issued a Group Policy and agrees to provide the Insurance for which a premium has been paid in the amount(s) and at the time(s) shown in the Application subject to these Terms and Conditions which forms part of the Group Policy. SECTION 1 - DEFINITIONS In addition to the other terms which are defined throughout the Certificate, in this Booklet: Accident means a sudden, unforeseen, and fortuitous event caused purely by external, violent and accidental means that occurs while this Certificate is in force. Actively Employed means legally employed or self-employed in an occupation for an income directly from that occupation for at least 25 hours per week for 30 consecutive working days or, if seasonally employed, for at least 25 hours per week for 13 consecutive weeks during a consecutive 12 month period. Administrator means, Bingham Group Services Corp., P.O. Box 15, 991 Hornby St., Vancouver, British Columbia V6Z 1V3, the administrator appointed by the Insurer to administer the Group Policy on their behalf. Application means the Group Creditor Mortgage Insurance Application and/or Confirmation under the Group Policy signed by each Debtor and Co-Debtor, if any, with respect to the Obligation. Certificate means collectively, the Application and this Booklet. Co-Debtor means the person named in the Application as the co-applicant, if any. Claimant means one of the following people who makes a claim under this Certificate: the Insured Person; a person who is jointly liable with the Insured Person for the Obligation; or an agent or other legal representative of any such person. Complications Of Pregnancy means a condition diagnosed in North America by a Physician, who is not related to the Insured Person by blood or marriage, licensed in Canada, which is distinct from pregnancy but which is adversely affected or caused by pregnancy. Complications of pregnancy does not include: false labor, back pain, occasional spotting, Physician prescribed rest during the period of pregnancy, morning sickness and similar conditions. Creditor means the lender shown in the Application who is the Primary Beneficiary for all benefits under the Certificate unless transferred as described in the Portability section of this Booklet, in which case creditor shall mean the new lender who will also then be the Primary Beneficiary. Debtor means the person named in the Application as the applicant. Effective Date of Insurance means the date your Insurance begins and is the later of the date your Application for Insurance under the Group Policy is approved by the Insurer or the date the first Insurance premium is received by the Insurer, during the lifetime of each Insured Person if that Insurance is approved. Group Policy means the Group Insurance Policy issued by the Insurer to the policy owner. Income means the salary, wages, bonuses, commissions, fees and 1
other monetary payments regularly earned by the Insured Person from an occupation. Income does not include monies from any other source, including from or as investments, dividends, interest, rent, royalties, annuities, distribution of deferred compensation or pension plans, sick pay, benefits received under a former wage or salary continuation plan, or other benefit programs. Injury means bodily injury that is the direct result of an accident, independent of an illness, disease, condition or bodily infirmity. Insurance means the insurance in effect for each Insured Person under the Group Policy subject to the terms of the Certificate. Insured Person means the Debtor and Co-debtor who is/are eligible for the Insurance applied for in the Application at the time he/she/they applied for that Insurance, who have paid the applicable Insurance premium and whose Insurance under the Group Policy is in effect. In no event will more than two Insured Persons be insured under the same Certificate. Insurer means The Equitable Life Insurance Company of Canada. Joint means that the Insurance on the Debtor and Co-Debtor is on a joint basis if Joint Coverage is elected in the Application, both meet the eligibility requirements and are approved by the Insurer for Insurance. Life Insurance means the life insurance in effect with respect to each Insured Person, under the Group Policy. Medical Professional means a person who is a Physician or a duly licensed medical practitioner, psychologist or health care practitioner or services provider while acting within the scope of that license. Medical Treatment means advice, consultation, diagnostic test, diagnosis, medical care, medication, treatment or other health related services either provided by, at the request of or under the direction of a Medical Professional. Obligation means a mortgage with the Creditor, covered under the Certificate. Own Occupation means the occupation in which the Insured Person, claiming the total disability benefit, is Actively Employed on the date of the Injury or Sickness. If that Insured Person was Actively Employed in more than one occupation on that date, own occupation shall be that occupation in which that Insured Person was Actively Employed for the most hours during the week immediately preceding that date. Physician is a duly licensed medical practitioner while acting within the scope of an active license to practice medicine in Canada. The Physician cannot be an Insured Person or a relative of an Insured Person, including a sibling, parent, spouse or child of an Insured Person or the spouse of any such person. The Physician cannot be a business associate of an Insured Person. Pre-Existing Condition means for Life Insurance, an illness, disease or physical condition, whether diagnosed by a Physician or not, for which symptoms occurred, or for which Medical Treatment was either sought, recommended, required or obtained, or for which prescription drugs were prescribed or taken, within the twelve (12) consecutive months immediately preceding the Effective Date of Insurance shown in the Application in the case of Life Insurance. For Disability Insurance, means an illness, disease or physical condition, whether diagnosed by a Physician or not, for which symptoms occurred, or for which Medical Treatment was either sought, recommended, required or obtained, or for which prescription drugs were 2
prescribed or taken, within the twelve (12) consecutive months immediately preceding the Effective Date of Insurance shown in the Application and which caused, directly or indirectly, such Total Disability to begin within 12 months following the Effective Date of Insurance. Recurring Disability means a Total Disability which is a recurring Disability of a previous Total Disability and is due to the same cause or causes. The Insurer will consider this to be one continuous period of Total Disability excluding the time when the Insured Person was not totally disabled. Sickness means an illness or disease that is diagnosed, in writing, by a Physician licensed and medically qualified to provide that diagnosis and is substantiated by objective medical evidence satisfactory to the Insurer. The effective date of this diagnosis shall be the date the diagnosis is established by that Physician, as supported by that Insured Person s medical records. Total Disability and Totally Disabled mean: For the first 12 months for which an Insured Person is claiming total disability benefits, the inability of the Insured Person to perform the essential duties of that Insured Person s Own Occupation due to Injury or Sickness, independently of any other cause or contributing factor and that Insured Person is not in fact working or earning remuneration from that occupation. Thereafter, the inability of that Insured Person to engage in any occupation or perform any work for remuneration or profit for which the insured may be qualified by reason of education, training or experience due to Injury or Sickness independently of any other cause or contributing factor and that Insured Person is not in fact working or earning remuneration in any occupation. Total Disability Insurance means the total disability insurance in effect, if any, in relation to each Insured Person, under the Group Policy. Waiting Period means the first 60 days of each period of Total Disability. You and Your means the Debtor and Co-Debtor, if any, and to whom, respectively, the Insurance contemplated hereby pertains. SECTION 2 - ELIGIBILITY To be eligible for the Insurance applied for in the Application, the Debtor, and if also applying for Insurance in that Application the Co-Debtor, must on the Effective Date of Insurance: 1) Be a natural person (the directors, officers, employees and shareholders of partnerships, corporations or other forms of business entities are eligible for coverage but in their specific, individual capacities, respectively); and 2) Be a resident of Canada, at least 18 years of age but not yet reached age 65; and 3) Have an Obligation with a repayment term of not more than 35 years; and 4) If applying for Total Disability Insurance, be Actively Employed. If a Debtor or Co-Debtor, if any, was not eligible on the Effective Date of Insurance for the Insurance applied for, then notwithstanding the payment of premium for such Insurance, such Insurance shall be deemed to have never been in effect for the Debtor or Co-Debtor, if any, and in the event of a claim, the liability of the Insurer shall be limited to repayment to the Debtor of the premium paid, without interest, for that Insurance. SECTION 3 - LIFE INSURANCE Life Insurance will come into effect for an Insured Person on the Effective Date of Insurance if each of the following is met: 3
That Insured Person applied for Life Insurance in the Application. Premiums have been paid for that Life Insurance on or before the Effective Date of Insurance. That Insured Person was eligible for that Life Insurance on the Effective Date of Insurance. Subject to the terms of this Certificate and the Group Policy the Insurer will pay the Principal Sum to the Creditor upon receipt of proof, satisfactory to the Insurer, that this Insured Person s death occurred while Life Insurance for that Insured Person was in effect and did not result from an Exclusion. Where the Debtor and Co-Debtor are both insured with respect to the same mortgage, no more than one Principal Sum is payable. In no event will the Principal Sum include the mortgage payments in arrears or accrued interest thereon. Upon the death of an Insured Person for which the Principal Sum is payable, the Certificate shall end which means that there is no Insurance in effect on any other Insured Person. Where on the Effective Date the Principal Amount Insured is less than the Mortgage Amount, the Principal Sum will be the lesser of: 1) The Insured Person s mortgage balance with the Creditor on the date of death as advised by the Creditor provided the appropriate premium has been paid and received by the Insurer when due. 2) The Maximum coverage amount shown in the Application provided the appropriate premium has been paid and received by the Insurer when due. When the Principal Amount Insured is less than the Mortgage Amount, item 1 of the Principal Sum definition shall be equal to the proportion that the Principal Amount Insured bears to the Mortgage Amount. The Principal Amount Insured, Maximum and Mortgage Amount are shown in the Application. SECTION 4 - TOTAL DISABILITY INSURANCE Total Disability Insurance will come into effect for an Insured Person on the Effective Date of Insurance if each of the following is met: That Insured Person applied for Total Disability Insurance in the Application. Premiums have been paid for that Total Disability Insurance on or before the Effective Date of Insurance. That Insured Person was eligible for that Total Disability Insurance on the Effective Date of Insurance. Subject to the terms of the Certificate and the Group Policy, the Insurer will pay the total disability benefit to the Creditor, for each day of the Insured Person s Total Disability while Total Disability Insurance for that Insured Person is in effect, upon receipt of proof, satisfactory to the Insurer, of each of the following: Total Disability of that Insured Person due to an Injury or Sickness that is continuous throughout the entire Waiting Period. That Injury or Sickness first occurred while the Total Disability Insurance for that Insured Person was in effect and that Total Disability began within 180 days of that Injury or Sickness. That Insured Person is Actively Employed on the first day of that Total Disability and for at least 25 hours, including paid vacation time, during the week immediately preceding that date. That Insured Person is under the regular care and attendance of a Physician who is medically qualified to provide that care for that Injury or Sickness. No total disability benefit will be paid for Total Disability during the Waiting Period. A new Waiting Period applies to each period of Total Disability 4
unless we receive proof, satisfactory to us, that this subsequent period of Total Disability is a Recurring Disability due to the same Injury or Sickness for which the total disability benefit was paid under the Certificate. Payment will be calculated from the 61st day of Total Disability. The daily total disability benefit will be equal to 1/30th of the Monthly Total Disability Benefit. Total Disability Benefits do not cover the amount of residual value or balloon payment. If more than one Insured Person is Totally Disabled at the same time, regardless of whether each have Total Disability Insurance under the Certificate, the Insurer shall only pay the Creditor one Total Disability Benefit for each day of Total Disability. Monthly Total Disability Benefit is the lesser of the Monthly Insured Amount or the Max/month amount. Both amounts are shown in the Application. Payment of the total disability benefit will cease on the earliest of the following dates: 1) The date the Insurer asks for proof of continued Total Disability and such proof is not provided within 31 days of that request. 2) The date on which all scheduled mortgage payments have been made excluding arrears and accrued interest. 3) The date that the maximum number of monthly payments have been paid. 4) The date the Total Disability Insurance terminates as set out in Section 8 of this Booklet, for the Insured Person for whom total disability benefits are being paid. 5) The date the Total Disability ceases. 6) The date the Insured Person for whom total disability benefits are being paid reaches age 65. The notice and proof requirements set out in Section 6 of this Booklet must be met. The insurer will not pay the total disability benefit for a period of Total Disability that occurred more than 12 months, inclusive of the Waiting Period, prior to the Insurer s receipt of the notice and proof. In addition to the notice and proof requirements, the Insured Person, if requested by the Insurer must provide at their expense: Signed authorizations and/or consents that permit the Insurer to obtain information and records that would verify the Injury, Sickness, Total Disability, Active Employment, occupation, education, training and/or experience. Copies of the complete reports, notes and records of the primary care Physician, each attending Physician and each medical facility including each hospital as it relates to the Injury, Sickness, medical history, diagnosis and prognosis. Statements from the Insured Person s primary care and attending Physician(s) to be completed in full, on forms provided or approved by the Insurer. The Insurer can at its option and expense obtain, as reasonably necessary, reviews, opinions, assessments, evaluations, testing and/or examinations of the Insured Person by a Medical Professional. Failure by that Insured Person to submit to an assessment, evaluation, testing or examination will result in the termination of Total Disability Insurance for that Insured Person and no total disability benefits will be paid. SECTION 5 - EXCLUSIONS AND LIMITATIONS No benefits shall be payable for the death or Total Disability of an Insured Person, if such death or Total Disability results directly or indirectly from or is contributed to or by: 1) War or act of war, hostilities of any kind, or active participation in a riot, rebellion or insurrection; 5
2) Suicide, attempted suicide or an intentionally self-inflicted injury; 3) Abuse or ingestion of either alcohol, poison, intoxicant or narcotic; 4) Commission or attempted commission of a criminal offence; 5) Flight in a non-scheduled aircraft; 6) A Pre-Existing Condition as defined in Section 1. In addition to the above, no total disability benefits shall be payable for Total Disability that results directly or indirectly from or is contributed to or by: 1) Abortion, miscarriage, childbirth, parental leave or pregnancy except Complications of Pregnancy is not excluded; 2) Cosmetic or elective surgery. 3) Any identified or unidentified Sickness, disease, bodily injury, condition or symptom for which You received medical advice, consultation or treatment during the 12 calendar months immediately preceding the Effective Date of Insurance; 4) The Insured does not survive the waiting period. If diagnosed or treated outside of Canada, the benefit will be payable only if all the following conditions are satisfied: a) The complete medical records are made available to the Insurer. Should a record be in a language other than English or French, the cost for translating to English will be the responsibility of the Insured Person. b) Based on medical records, we are satisfied that: (i) The same diagnosis would have been made if the illness, injury or (ii) accident had occurred in Canada; Immediate treatment would have been indicated under Canadian standards; and (iii) The same treatment, involving the particular surgical procedure, would have been advised if treatment had taken place in Canada. c) The Insured must undergo an independent medical examination by a Physician appointed by us, if we make such a request. 5) The insured does survive the waiting period. Subject to the date that total disability benefit payments cease as described in Section 4 of this Booklet, total disability benefit payments for each Insured Person are limited to a maximum of twenty (20) months of payments for each period of Total Disability including Recurring Disability and to a maximum lifetime total of forty eight (48) months of payments regardless of the duration, or number of periods, of Total Disability. Suicide Clause If an Insured Person commits suicide, while sane or insane, within two years of the Effective Date of Insurance, the Insurer s liability will be limited to payment to the Debtor, of the premiums paid in respect of the Insured Person who committed suicide, without interest. If Insurance was in effect on both the Debtor and the Co-Debtor and one of them has committed suicide, the Insurance for the survivor will continue in effect. SECTION 6 - NOTICE AND PROOF A Claimant must give notice of claim within 30 days of the happening of the event giving rise to the claim. Notice of claim may be given by telephoning the Administrator at the toll free number or by writing to the Administrator. Claims forms will be furnished to the Claimant within 15 days of receipt of notice of claim. If the claims forms are not furnished within 15 days of receipt of notice of claim, the Claimant may submit proof of claim to the Insurer within 90 days of that event, in the form of a written statement of the circumstances of the happening of the event giving rise to the claim, the loss occasioned thereby and the right of the Creditor to receive the applicable benefits. The Claimant must furnish the Insurer with such proof 6
satisfactory to the Insurer as is reasonably possible, in the circumstances, of the happening of the event giving rise to the claim, the loss occasioned thereby and the right of the Creditor to receive the applicable benefits. Failure to give notice of claim or proof of claim within the time set out above will not invalidate a claim if the notice or proof is given as soon as reasonably possible and in no event later than one year from the date of the event giving rise to the claim if it is shown that it was not reasonably possible to give notice or furnish proof within such time. Additional Information Required For Total Disability Claims In the case of a claim for Total Disability benefits, the Insurer will also require a certification that the Insured Person who suffers from the Total Disability requires and is receiving regular treatment from a licensed Physician unrelated to the Insured Person, such certification to be signed by such Physician, and where applicable from time to time, written proof, satisfactory to the Insurer, of continuing Total Disability. SECTION 7 - THIRTY DAY RIGHT OF INSPECTION The Debtor and Co-Debtor shall have thirty days from the Effective Date of Insurance to cancel the Insurance. Such cancellation may be effected by giving written notice of cancellation to the Administrator. The notice must be postmarked no later than the thirtieth day after the Effective Date of Insurance. Upon receipt of such written notice, the Insurance shall be deemed to have never been in force and a full refund of the premium shall be paid to the Debtor or person entitled thereto. SECTION 8 - TERMINATION The Insurance shall automatically terminate without notice upon the earliest of the following dates: 1) The date the Obligation to the Creditor is paid in full or discharged not including arrears or interest. The Insured Person is obligated to notify the Insurer in writing of the date of discharge. If notification is received by the Insurer, the Insurer is not obligated to return premiums beyond 90 days of the termination date; 2) The date a mortgage payment is outstanding in an amount equal or greater than two (2) consecutive monthly payments; 3) The date a premium payment is outstanding for more than 31 days after becoming due (it being acknowledged and confirmed that premium payment is due monthly on the same date of the month as the first withdrawal date as described in the Pre-Authorized Debit Agreement of the Application, unless the PAD withdrawal date is changed to another date, as shown in the Insurer s records); 4) The date that either the Insurer or the Administrator receives written notice of cancellation signed by the Debtor or Co-Debtor; 5) The date of death of an Insured Person unless excluded from coverage, then Insurance in effect on the surviving Insured Person, if any, continues in accordance with the Certificate and Group Policy; 6) The date a Life Insurance Benefit is paid; 7) The date an Insured Person reaches age 65 if Insurance is not Joint. If Insurance is Joint, when one Insured Person reaches age 65, the Insurance on that Insured Person ends but the Insurance in effect on the other Insured Person continues until their age 65 in accordance with the Certificate and Group Policy; 8) The effective date of termination, by the Insurer, of the Group Policy. When Insurance terminates it is no longer in effect, the Insurer s liability for that Insurance ends and no further benefits would be paid in relation to that Insurance. 7
SECTION 9 - GENERAL THE CONTRACT This Certificate and the Group Policy together with any written amendments to the Group Policy and/or Certificate signed by an authorized officer of the Insurer constitute the contract between the Insurer and each Insured Person. All statements made in the Application shall be deemed to be representations and not warranties. We may contest the contract, treat it as void and refuse to pay any benefits if any statement or answer on the Application misrepresents or fails to disclose any fact material to the insurance. No statement will be used to void the Insurance or deny a claim unless the statement is contained in the Application. Except for Total Disability Insurance, after the Certificate has been in force for two years from the Effective Date of Insurance, no such statement will be used to void the Insurance or deny a claim, except for fraudulent statements. In addition, if we allow you to reinstate your Insurance or make any change to it after it is issued, based on evidence of insurability, then we can contest that reinstatement, change, addition or increase in coverage if there is any material misrepresentation or omission in the application for reinstatement or change. Except for Total Disability Insurance, we will not do so after the change, addition, increase or reinstated insurance has been in effect for two years during the lifetime of the Insured Person, unless the statement was made fraudulently. PORTABILITY The Insurance provided by the Insurer to each Insured Person under the Group Policy continues to be in effect in the event that you transfer your mortgage to another creditor (except the primary beneficiary shall be the new creditor). The terms of the Certificate continue to apply following such transfer. The Insurance does not apply to additional debt, if any, above the Obligation amount discharged with the previous creditor. Additional protection can be applied for, if offered by us, at your then current age for the additional debt. A second Certificate will take effect for the additional protection if approved by the Insurer. RENEWAL CONDITIONS Insurance can be renewed until the end of the mortgage amortization without evidence of insurability. The Insurance will be automatically renewed, for the same term of Insurance until the termination of the Obligation. A Debtor or Co-Debtor, if any, who does not wish to renew the Insurance applicable to such Debtor or Co-Debtor, if any, will need to contact the Administrator to cancel the applicable Insurance for such Debtor or Co-Debtor, as the case may be. ASSIGNMENT An Insured Person cannot assign any rights or benefits provided by the Insurance. MISSTATEMENT OF AGE If the age of the Debtor or Co-Debtor, if any, has been misstated and, according to his/her correct age, was under or over the Maximum Ages (as provided for in the Application) on the date of the mortgage, no Insurance shall take effect, and the liability of the Company shall be limited to a refund of all premiums paid thereon. If the age of the Debtor or Co-Debtor, if any, has been misstated and Insurance is still in effect, any limiting age affecting the payment of any Principal Sum will be based on the correct age. 8
BENEFICIARY DESIGNATION This policy contains a provision removing or restricting the right of the Insured Person to designate persons to who or for whose benefit Insurance money is to be payable. EARLY PAYOUT If the debt is paid off early, the Insured Person will immediately notify the Administrator. AMENDMENTS AND PREMIUM ADJUSTMENT The Insurer shall have the right to: Amend the Group Policy and/or the Certificate from time to time without notice to the Insured Person. Change the premium payable for the Total Disability Insurance, which new amount must be paid to keep the Total Disability Insurance in effect. APPLICABLE LAW This certificate is governed by the law of the province or territory in which the Debtor lived, as described in the Application, when this insurance took effect. LIMITATION PERIOD A Claimant may begin a lawsuit to enforce a claim up to two years after the claim arises, or longer if permitted by applicable law. Currently, the applicable law with respect to limitation periods is as follows, depending on which jurisdiction s laws apply: Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in: The Insurance Act in effect in the relevant jurisdiction, for contracts governed by the laws of Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Prince Edward Island, Yukon, Northwest Territories, or Nunavut; The Limitations Act in effect in Saskatchewan or Newfoundland, for contracts governed by the laws of those provinces; and The Limitations Act, 2002, for contracts governed by Ontario law. However, laws with respect to limitation periods may change, so please check the most recent law when a claim arises. RIGHT TO DOCUMENTS Upon request, the Debtor, any Co-Debtor and, where relevant to a claim and permitted by law, any Claimant under this Certificate will have the right to obtain a copy of the Application and the Group Policy. However, this right does not extend to information about people other than the person making the request (or, where the request is made by a Claimant, to information about people other than the person with respect to whom a claim is made) or to any confidential commercial information in the Group Policy. 9
PAYMENT OF PREMIUMS AND GRACE PERIOD Premiums are due in the amount(s) and at the time(s) set out in the Application. Where a premium, other than the initial premium, is not paid at the time is is due, the premium may be paid within a period of grace of 31 days from the date on which the premium was due. During the grace period, this certificate will remain in effect. If the premium is not paid during the grace period, this certificate shall be void at the end of the grace period and no insurance coverage will be in effect. Please address all inquiries to the Administrator: Bingham Group Services Corporation P.O. Box 15, 991 Hornby Street, Vancouver, BC, V6Z 1V3 Toll Free: 1.888.799.2472 Fax: 1.888.799.2473 10
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GM TC (09/15)