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RBC Simplified Disability Insurance - Limitations and Exclusions

Unemployment Limitation

This limitation applies only if the Starting Date of the Disability occurs before Your 65th birthday.

If, on the Starting Date of the Disability, You are unemployed or You are not actually working at least 20 hours per week on a regular basis, then the word Disability will be deemed to mean the following for the duration of that Disability:

Disability and Disabled means that due directly to Injury or Sickness:

  1. You are unable to perform the essential duties of any Gainful Occupation for which You have the minimum qualifications;
  2. You are not working at all; and
  3. You are under the regular care of a Physician and receiving Appropriate Treatment.

This limitation does not apply to scheduled vacations or temporary leaves if You are still considered employed by Your employer.

Soft Tissue Injuries and Degenerative Disc Disease Limitation

We will pay a cumulative Policy maximum of twenty-four (24) months of Monthly Benefits for any periods of Disability that are caused or contributed to by Soft Tissue Injuries, back Injuries, neck Injuries or degenerative disc disease.

This cumulative maximum will apply even if the periods of Disability are separate from one another.

Residency Exclusion and Limitation

We will not pay Monthly Benefits for any Disability that occurs while You are outside of Canada and the United States, if the Starting Date of the Disability occurs during the 24 month period immediately following the Policy Date.

If You become Disabled after Your Policy has been in force for 24 months, and the Starting Date of the Disability occurs while You are outside of Canada and the United States, You must return to Canada or the United States within 90 days of the Starting Date of the Disability before You may submit a claim for Monthly Benefits. While You are outside of Canada and the United States:

  1. We will not consider You to be Disabled;
  2. The Elimination Period will not begin or continue; and
  3. We will not pay Monthly Benefits or waive any Premiums.

Pre-existing Condition Exclusion

We will not pay Monthly Benefits nor waive premiums for any Disability that is caused, directly or indirectly, or is in any manner or degree associated with or occasioned by a Pre-existing Condition.

This Pre-existing Condition exclusion will not apply if the Starting Date of the Disability is more than twenty four (24) months after the applicable Effective Date of Coverage.

Pre-existing Condition means any injury, illness, disease, symptom or heath condition (whether or not the injury, illness, disease, symptom or heath condition is diagnosed, correctly or at all) for which, during the 24 months immediately before the applicable Effective Date of Coverage:

  1. You incurred any health-related expenses on the advice of a Physician or any other Health Care Practitioner;
  2. You took any prescribed medication;
  3. You consulted a Physician or any other Health Care Practitioner;
  4. You received any health-related care, advice or treatment, including any diagnostic tests, from a Physician or any other Health Care Practitioner; or
  5. a reasonably prudent person with such injury, illness, disease, symptom or health condition would have consulted a Physician or any other Health Care Practitioner, or would have taken medication previously recommended or prescribed by a Physician.

Other Exclusions

  1. We will not pay Monthly Benefits nor waive premiums for any period of Disability that results, directly or indirectly from, or was in any manner or degree associated with or occasioned by:

    1. any illness or disease, if You have not purchased Sickness coverage
    2. any self-inflicted Injury, whether intentional or unintentional, that occurs while You are Intoxicated;
    3. Your service in the armed forces, the reserves, or any other military organization;
    4. any injury that occurs while You are using or operating any motorized vehicle while You are Intoxicated;
    5. the use of any Drug except as prescribed or directed Your Physician;
    6. any a suicide attempt or other intentionally self-inflicted harm, while sane or insane;
    7. any opportunistic infection or other Sickness that Physicians commonly associate with AIDS or the HIV virus;
    8. any Injury that occurs while You are committing or attempting to commit a crime, whether or not You are charged with the crime;
    9. any subjective condition, including but not limited to chronic fatigue syndrome, chronic pain syndrome, fibromyalgia, Epstein Barr syndrome, fibrositis, environmental illness, multiple chemical sensitivity or any other subjective syndrome or condition;
    10. any psychiatric, psychological, emotional, mental or nervous disorder, including but not limited to depression, anxiety, stress, burnout. This exclusion does not include Disabilities caused by senile dementia or loss of mental capacity resulting from a stroke, head trauma, viral infection or Alzheimer’s Disease.
  2. We will not pay Monthly Benefits nor waive premiums:

    1. for any period of time You are in a jail, under house arrest, or otherwise imprisoned; or
    2. for any Disability resulting from a normal pregnancy or childbirth (but this exclusion does not apply to disabilities caused by complications during pregnancy or childbirth).
  3. We will not pay Monthly Benefits nor waive Premiums for any period of time that You are receiving benefits for loss of earnings under any worker's compensation act or plan.