LABOUR ACCIDENT MEDICAL INSURANCE PLAN (LAMP)

All Eligible Members of The Ontario Teamster Construction Benefit Trust Fund and their Dependents, under the age of 70 for the Accidental Death and Dismemberment and Hospital Cash Benefits, and under the age of 80 for the Emergency Out of Province Hospital/Medical Coverage, are eligible under LAMP. The LAMP plan covers you and your Eligible Dependents, 24 hours a day, each day of the year, against losses resulting from injuries which are received anywhere in the world.

There are three main components to LAMP:

• Accidental Death and Dismemberment Benefit
• Hospital Cash Benefit
• Emergency Out of Province Hospital/Medical Coverage

Definitions for the Purposes of LAMP

"Member" means a Member eligible for benefits under the Ontario Teamster Construction Benefit Trust Fund.

"Insured Person" means a Member, Spouse, and/or Dependent Child insured under the Trust Fund.

“Activities of Daily Living” means the following six activities:

• Maintaining continence, controlling urination and bowel movements, including the ability to use ostomy supplies or other devices such as catheters;
• Transferring: moving between a bed and a chair, or a bed and a wheelchair;
• Dressing: putting on and taking off all necessary items of clothing;
• Toileting: getting to and from a toilet, getting on and off a toilet, and performing associated personal hygiene;
• Eating: performing all major tasks of getting food into the body; and
• Bathing: washing in either a tub or shower, including the task of getting in and out of the tub or shower.

“Brain Death” means the permanent, irreversible, cessation of electrical activity in both the upper brain and brain stem as certified by a qualified Physician.

“Dependent Parent” means a parent or grandparent of either the Member or the Spouse, who is dependent upon the Member or the Spouse for support, maintenance and care.

“Emergency” means medical treatment or surgery for an unforeseen sickness or injury which makes it necessary to receive immediate treatment from a Physician or Surgeon for the immediate relief of an acute symptom of which upon the advice of a Physician or Surgeon cannot be delayed until the Insured Person returns to his or her province of residence.

"Hospital" means an incorporated or licensed Hospital having accommodation for resident bed patients, a laboratory, a registered graduate nurse always on duty and an operating room where surgical operations are performed by a legally qualified Physician or surgeon, but in no event shall this include a Convalescent or nursing home or home for the aged or health spa.

“Immediate Family Member” means the Insured Person’s spouse, child including adopted children and step-children, parent, legal guardian, parent-in-law, brother or sister, including stepbrothers or stepsisters, grandparents, grandchildren, daughter-in-law son-in-law, brother-in-law and sister-in-law.

“Injury” means bodily injury which is sustained as a direct result of an unintended and unanticipated accident, provided such accident is external to the body and occurs while insured under LAMP.

“Loss” when used with reference to:

• "Quadriplegia", "Paraplegia", and "Hemiplegia" means the complete and irreversible paralysis of such limbs;
• “Hand” or “Foot” means the complete severance through and above the wrist or ankle joint but below the elbow or knee joint;
• “Arm” or “Leg” means the complete severance through or above the elbow or knee joint;
• “Thumb and Index Finger” means the complete severance through or above the first phalange;
• “Fingers” means the complete severance through or above the first phalange of all four Fingers of one Hand;
• “Toes” means the complete severance of both phalanges of all the Toes of one Foot;
• “The Entire Sight of One Eye” means the total and irreversible Loss of Sight such that corrected visual acuity must be 20/200 or less in such eye;
• “The Entire Sight of Both Eyes” means the total and irrecoverable Loss of Sight in both eyes such that corrected visual acuity must be 20/200 or less and the field of vision must be less than 20 degrees in both eyes. A Physician certified in Ophthalmology must clinically confirm the diagnosis in writing;
• “Hearing in One Ear” means the diagnosis of permanent Loss of Hearing in One Ear with an auditory threshold of more than 90 decibels. A Physician certified in Otolaryngology must confirm the diagnosis in writing;
• “Hearing” means the diagnosis of permanent Loss of Hearing in Both Ears, with an auditory threshold of more than 90 decibels in each ear. A Physician certified in Otolaryngology must confirm the diagnosis in writing;
• “Speech” means the complete and irrecoverable Loss of the ability to utter intelligible sounds;
• “Loss of Use” means the total and irrecoverable Loss of Use provided the Loss is continuous for twelve consecutive months and such Loss of Use is determined to be permanent.

“Loss” when used herein may also include “Loss of Life”.

“Medically Necessary” means the services or supplies provided by a Hospital, Physician or Surgeon, licensed dentist or other licensed provider that are required to identify or treat an Insured Person’s Sickness or Injury and that are defined as follows:

• Consistent with the symptom or diagnosis and treatment of the Insured Person’s Sickness or Injury;
• Appropriate with regard to standards of good medical practice;
• Not solely for the convenience of the Insured Person, a Physician or Surgeon or other licensed provider; and
• When applied to the care of an in-patient, it further means that the Insured Person’s medical symptoms or conditions require that the services cannot be safely provided as an Outpatient.

“Permanent and Total Disability" means Injury which prevents the Member or Spouse from performing at least two of the six Activities of Daily Living, without assistance from another person for the rest of their life. The disability must be determined, as of twelve months after the date of Injury, to be total, permanent, and irreversible and certified to be such by a Physician acceptable to the Insurance Company. The Member’s or Spouse’s inability to actually obtain employment is not a criterion to qualify for the Permanent and Total Disability Benefit.

“Private Passenger Type Vehicle” means any means of transportation not operated for commercial purposes, designed to carry passengers and that is pulled, propelled or fuelled in any way, including cars, trucks, motorcycles, snowmobiles or boats.

LAMP Survivor Extension of Benefits

Your surviving Spouse and surviving Dependent Children, including any Child conceived before and born after your death, will be insured under LAMP on the date of your death. The Trust Fund will maintain premium payments under the LAMP benefit, on behalf of your surviving Dependents, to the earlier of:

• The date of death of the surviving Spouse/Dependent, or
• The date which is two years from the date of your death, or
• The date your Spouse remarries, or
• The date on which the surviving Child ceases to qualify as a "Dependent", or
• The date your Dependents become insured under another group policy providing similar benefits.

Any extended benefits payable are subject to the provisions and limitations of the plan.