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Exclusions, Limitations and Reduction of Coverage

Restrictions
Exclusions
Exclusions Related to Disability Benefit Only
Exclusions Related to Loss of Employment Benefit
Exclusions Related to Critical Illness Benefit
Exclusion in Case of Multiple Events

Restrictions

  • No death benefit is provided in the case of suicide during the first 2 years of insurance. Premiums, however, are refunded by Desjardins Financial Security. No death benefit is provided if your spouse commits suicide during the first 2 years of insurance.
  • If death occurs in the year following an accidental dismemberment or the loss of use of a limb, only the amount provided for accidental death will be paid.
  • No benefit is payable under the Life Benefit or the Accidental Death and Dismemberment Benefit if the participant is diagnosed with a terminal illness.

Exclusions

Exclusion related to Pre-existing Medical Conditions (Life, Accidental Death and Dismemberment, Disability)

Some claims related to health conditions in existence before enrolment may be rejected. No benefit is paid if death or disability occurs during the first year of coverage and its cause is related to a health problem (illness or injury), and the health problem existed during the 6 months preceding enrolment.

This exclusion does not apply if you were not treated for this problem during the 6 months that follow the effective date of coverage.

For level or deferred payment financing, this exclusion is applicable during the 12 months that follow the date of each purchase; however, you must have been treated for this condition in the 6 months preceding this date. This exclusion does not apply if you were not treated during the 6 months that follow the date of purchase.

You are deemed by the Insurer to have received treatment for an illness, for symptoms related to an illness or for an injury if you consulted a physician or another health care professional, or received treatment from such a specialist underwent an examination, took medication, or were hospitalized.

Exclusions Related to Disability Benefit Only

You will not receive disability benefits if:

  • you intentionally inflicted the injuries causing the disability, whether you were sane or insane; or
  • your disability is due to war whether or not declared, an insurrection or a riot; or
  • you become disabled as a result of committing or attempting to commit a criminal offence.

Exclusions Related to Loss of Employment Benefit

You will not receive loss of employment benefits if:

  1. your employment is seasonal, casual, part time or temporary;
  2. your employment is not considered insurable by Human Resources Development Canada;
  3. you were aware of your loss of employment when enrolling in the insurance plan;
  4. you lose your employment within 30 days of the effective date of coverage;
  5. you voluntarily resign;
  6. the loss of employment is due to a strike, a lockout, fraud or a criminal offence;
  7. the loss of employment is due to the expiry of a contract for which you were hired;
  8. the interruption in employment is regarded as a leave that does not result in the termination of employment;
  9. the loss of employment coincides with your retirement.

Exclusions Related to Critical Illness Benefit

You will not receive critical illness benefits:

  1. for any cancer or terminal illness that existed before the effective date of coverage. This exclusion also applies if the illness was diagnosed before or during the 90 days that follow the effective date of coverage;
  2. if the symptoms or medical problems resulting in the initial diagnosis of cancer or a terminal illness appear before the effective date of coverage. This exclusion also applies if the symptoms or problems appear within 90 days of the effective date of coverage;
  3. if you are no longer living 31 days after the date of the initial diagnosis;
  4. for medical conditions not specifically provided for under the insurance;
  5. if the critical illness results directly or indirectly
    • from suicide, attempted suicide or self-inflicted injuries, whether you are sane or insane;
    • from war, whether or not declared, an insurrection or a riot;
    • from committing or attempting to commit a criminal offence;
    • from the use of any medication, intoxicant, drug or narcotic, unless prescribed or recommended by a physician.

For level or deferred payment financing, exclusions 1 and 2 apply on the date of each purchase.

Exclusion in Case of Multiple Events

If the insurer pays benefits under the Disability Benefit or Loss of Employment Benefit, no other claim filed on your behalf will be considered. This exclusion continues to be in effect for as long as monthly benefits are paid under the initial claim.

 
 
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