Executive Long-Term Disability Insurance Policy dated January 1, 2019

Throughout this document the words "we", "our”', "us", and "the Company" means Zurich American Life Insurance Company. The words "you" and "your" mean the insured employee of the Policyholder sponsoring this Plan. Some terms and provisions are written as required by insurance law. Important terms are defined in the “Glossary” Section of the Certificate. Defined terms appear in italic print. If you should have any questions about the content or provisions, please consult us at the toll-free number provided below. We will assist you in any way to help you understand your benefits.

The benefits described in this Certificate are subject in every way to the entire Group Insurance Policy. If the terms and provisions of the Certificate are different, the Policy will govern. The Group Insurance Policy includes this Certificate, the Benefits Schedule(s), and any riders or amendments issued with the Group Insurance Policy. The Policyholder's application and any application or evidence of insurability completed by you or on your behalf, when applying for coverage or an increase in coverage, are also considered part of the Policy.

Your coverage may be cancelled or changed in whole or in part under the terms and provisions of the Policy. The Policy is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments. When making a benefit determination under the Policy, we have discretionary authority to determine your eligibility for benefits and to interpret the terms and provisions of the Policy.

For purposes of effective dates and ending dates under the Group Policy, all days begin at 12:01 a.m. and end at 12:00 midnight Eastern Standard Time at the Policyholder's address.

Zurich American Life Insurance Company is located at:

Toll Free Number:                     ###-###-####

Social Security Advocacy Program:             ###-###-####

Claim Information Toll Free Number:             ###-###-####

Outside the United States: 719 ###-###-####

In the event you need to contact someone about this insurance policy for any reason, please contact your Policyholder. If you have additional questions you may contact us at the following address and telephone number:

If you have been unable to contact or obtain satisfaction from the company, you may contact the Virginia State Corporation Commission's Bureau of Insurance at:

Toll Free Number for Virginia Residents          ###-###-####

Toll Free Number for Non-Virginia Residents          ###-###-####

Written correspondence is preferable as a record of the inquiry is maintained. When contacting the Company or the Bureau of insurance, have the Policy number available.

No benefits are covered under this Certificate in the absence of payment of current premiums subject to the grace period and the “Premium” Section of the Group Insurance Policy. Unless specifically provided for in any applicable termination or continuation of coverage provision, described in this Certificate or under the terms of the Group Insurance Policy, this Plan does not pay benefits for a disability incurred before coverage starts under this Plan. This Plan will not pay any benefits for any losses, claims or expenses that start after coverage ends.

Benefits may be modified during the term of this Plan as specifically provided under the terms of the Group Insurance Policy or upon renewal. If benefits are modified, the revised benefits (including any reduction in benefits or elimination of benefits) apply to any losses incurred that start on or after the effective date of the Plan modification. There are no vested rights to receive any benefits described in the Group Insurance Policy or in this Certificate beyond the date of termination or renewal including if the loss, accident or disability starts on or after the effective date of the Plan modification, but prior to your receipt of amended Plan documents.

                

If you have any questions or problems with your Policy, you may contact us at the address below or one of the other organizations listed:

This notice is to advise you that should any complaints arise regarding this insurance, you may contact the following:

For your information, the following is your state’s Department of Insurance contact information:

PROBLEMS WITH YOUR INSURANCE? – If you are having problems with your insurance company or agent, do not hesitate to contact the insurance company or agent to resolve your problem.

You can also contact the OFFICE OF THE COMMISSIONER OF INSURANCE, a state agency which enforces Wisconsin’s insurance laws, and file a complaint. You can contact the OFFICE OF THE COMMISSIONER OF INSURANCE by contacting :

This disability plan provides you with a source of monthly income if you should become disabled and unable to work because of an sickness or injury while covered under this Plan.

This Certificate of Coverage ("Certificate") is a written document prepared by the Company. It tells you important information about your Plan such as:

The Certificate may include attachments such as amendments and riders, which describe additional provisions about your Plan. Please read the entire document carefully to fully understand your long term disability plan.

To be eligible for coverage under this Plan, the following requirements must be met:

Your employer determines the criteria that are used to define the eligible class(es) for insurance coverage under this Plan. Your employer determines if you are in an eligible class. Such criteria are based solely upon the conditions related to your employment.

The criteria describing eligible classes of employees are listed on the Benefits Schedule attached to this Certificate. Refer to the Benefits Schedule or contact your employer to determine if you are in an eligible class.

If you are working for your employer in an eligible class, the date you are eligible for coverage is the Plan effective date.

If you are in an eligible class on the date of hire, your eligibility date is the date you are hired. If you enter an eligible class after your date of hire, your eligibility date is the date you enter the eligible class.

If you have met all your eligibility requirements, and you are in active employment, your coverage takes effect at 12:01 a.m. Eastern Standard Time on the date you are eligible for coverage.

If you are absent from work due to injury, sickness, a mental illness, temporary layoff or leave of absence, on the date your insurance would otherwise become effective, your coverage, increase in coverage or a new benefit will begin the date you return to active employment.

You will be provided with plan design and enrollment information when you first become eligible. If you are not required to contribute towards the cost of coverage, you are not required to request coverage or complete an enrollment form. Your enrollment will be handled by your employer.

A change in your monthly benefit due to a change in your covered monthly earnings will be effective on the date of the change if you are in active employment or if you are on a covered layoff or leave of absence. If you are not in active employment due to injury or sickness, any increased or additional coverage will begin on the date you return to active employment.

A change in your monthly benefit due to a change in your eligible class will be effective on the date of the change if you are in active employment or if you are on a covered layoff or leave of absence. If you are not in active employment due to injury or sickness, any increased or additional coverage will begin on the date you return to active employment.

A change in your covered monthly benefit due to a change in the Policy by an amendment elected by the Policyholder, will be effective on the date of the change, if you are in active employment, or if you are on a covered layoff or leave of absence. If you are not in active employment on the date a benefit payable change would otherwise be effective, any increased or additional coverage will begin on the date you return to active employment. A change in your benefit payable because of a change made by the Company will normally be effective on the Policy Anniversary Date, or as otherwise determined by state or federal law, or by us. However, if you are not in active employment on the date a benefit payable change would otherwise be effective, the benefit payable change will not be in force until you return to active employment.

Neither an increase nor a decrease in coverage will affect a payable claim that occurs prior to the increase or decrease.

We will bill your employer for the premium and any amount you owe. Your employer will pay the premium on your behalf.

Once you have satisfied the elimination period, your premium and contributions, if any, will be waived for any period you are eligible to receive monthly benefits.

Your coverage under this Plan ends on the earliest of:

If premium payments continue to be made on your behalf, we may deem your employment to continue for purposes of remaining eligible for coverage under this Plan as described below.

If you are not in active employment due to illness or injury, or medical or occupational leave as agreed to by your employer and us, your coverage may continue for the duration of the leave, up to 12 months.

If you are on an employer-approved leave of absence or educational leave, and if premium is paid, you will be covered through the end of the month that immediately follows the month in which your leave of absence begins.

If your Long Term Disability coverage ends, you may apply to reinstate coverage, subject to the rules described in the "When Does Your Coverage Begin?" Section. If we approve your request, the reinstatement will be effective on the first day of the month coinciding with or following the approval date.

If you return to active employment within six months of the date your coverage terminated, and you request coverage from your employer within 31 days of your return, the pre-existing condition limitation will apply only to the extent it would have applied if your coverage had not ended.

If you were granted a leave of absence according to the "“Family and Medical Leave Act of 1993", your coverage will continue under this provision through the end of the month plus four additional months from the date your leave begins.

 

Coverage will be continued until the end of the later of:

We consider any statements you or your employer makes in a signed application for coverage or an evidence of insurability form, or that your employer makes in the application process, a representation and not a warranty. If any of the statements you or your employer make are not complete and/or not true at the time they are made, we can:

We will use only statements made by the employer in the application process and statements made by you in a signed application as a basis for doing this. If a statement is used in a contest, a copy of that statement will be furnished to you or, in the event of your death or incapacity, to your eligible survivor or personal representative.

If the Policyholder gives us information about you that is incorrect, we will:

Our failure to implement or insist upon compliance with any provision of this Policy at any given time or times shall not constitute a waiver of our right to implement or insist upon compliance with that provision at any other time or times. This applies whether or not the circumstances are the same.

During the first two years that your insurance is in force, we may use any statement you have made in contesting the validity of that coverage. This also applies to any increase in your coverage for the two years that follow the effective date of that increase, if evidence of insurability was required in order for the increase to take effect.

Once coverage, including an increase in coverage has been continuously in effect for two years, the validity of your insurance may not be contested by us unless your statement was in writing on a form signed by you and was fraudulently made in order to obtain that coverage or increase.

As used herein, the term "third party," means any party that is, or may be, or is claimed to be responsible for illness or injuries to you that caused your disability. Such illness or injuries are referred to as "third party injuries". "Third party" includes any party responsible for payment of benefits for loss of time or wages as a result of third party injuries.

By accepting benefits under this Plan, you or your representatives further agree to:

We may recover full cost of all benefits paid by this Plan under this Certificate without regard to any claim of fault on your part, whether by comparative negligence or otherwise.

The coverage under a Plan does not replace or affect the requirements for coverage by Workers' Compensation or State Disability Insurance. However, any Workers' Compensation benefits are considered a deductible source of income.

If payments are made in amounts greater than the benefits that you are entitled to receive, we have the right to recover any overpayments. Refer to the “Claim Information” Section for the process we use to recover overpayments.

No. For purposes of the Policy, the Policyholder acts on their own behalf. Under no circumstances will the Policyholder be deemed our agent.

We will assess your ability to work and the extent to which you are able to work by considering the facts and opinions from your physicians, and physicians and medical practitioners or vocational experts of our choice.

We may require you to be examined by a physician, other medical practitioner and/or vocational expert of our choice. We will pay for this examination. We can require an examination as often as it is reasonable to do so. We may also require you to be interviewed by our authorized representative. Refusal to be examined or interviewed may result in denial or termination of your claim.

You must be continuously disabled through your elimination period. The days that you are not disabled will not count toward your elimination period. We will treat your disability as continuous if your disability stops for 30 days or less during the elimination period. No benefit is payable for or during the elimination period.

Your elimination period is described in the Benefits Schedule.

Yes. If you are working while you are disabled, the days you are disabled will count toward your elimination period.

You will begin to receive benefits when we approve your claim, providing the elimination period has been satisfied and you are disabled. We will send you a monthly benefit for any period for which we are liable.

"Covered Monthly Earnings" means your gross monthly income from your employer in effect just prior to your date of disability. It includes your total income before taxes. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plans, or flexible spending account.

It does not include income received from commissions, bonuses, overtime pay, any other extra compensation, or income received from sources other than your employer.

We will follow this process to calculate your benefit amount:

 

The amount figured in Item 4) is your monthly benefit. The monthly benefit will be recalculated when your income changes or you receive any new deductible sources of income.

After the elimination period, if you are disabled for less than one month, we will send you 1/30^th of your benefit for each day of disability.

Monthly Benefit means your benefit amount after any deductible sources of income have been subtracted from your gross disability benefit.

Maximum Monthly Benefit means the maximum benefit amount for which you are insured under this Plan as shown in the Benefits Schedule.

Gross Disability Benefit means the benefit amount before we subtract deductible sources of income and disability earnings.

Deductible Sources of Income means other income from deductible sources listed in the Plan that you receive or are entitled to receive while you are disabled. This income will be subtracted from your gross disability benefit.

For the first 12 months of payable benefits:

If the answer from Item 1) is less than or equal to 100% of your indexed monthly earnings, we will not further reduce your monthly benefit.

If the answer from Item 1) is more than 100% of your indexed monthly earnings, we will subtract the amount over 100% from your monthly benefit.

will change, and we will consider a portion of your disability earnings to be a deductible source of income. Fifty percent of your disability earnings will be added to your other deductible sources of

income, if any. The sum will be deducted from your gross disability benefit. This amount will be your monthly benefit.

We may require you to send proof of your disability earnings on a monthly basis. We will re-calculate your benefit each month and adjust your monthly benefit based on your monthly disability earnings.

As part of your proof of disability earnings, we can require that you send us appropriate financial records, including copies of your IRS federal income tax return, W-2's and 1099's, which we believe are necessary to substantiate your income.

After the elimination period, if you are disabled for less than one month, we will send you 1/30th of your monthly benefit for each day of disability.

During the first 24 months of disability benefits, if your monthly disability earnings exceed 80% of your indexed monthly earnings, we will stop your benefits and your claim will end.

Beyond 24 months of disability benefits, if your monthly disability earnings exceed 60% of your indexed monthly earnings, we will stop your benefits and your claim will end.

Disability earnings means the earnings which you receive while you are disabled and working, plus the earnings you could receive if you were working to your greatest extent possible. this would be, based on your restrictions and limitation:

Salary continuance paid to supplement your disability earnings will not be considered payment for work performed.

We will review your status from time to time. We will require satisfactory proof of earnings and continued disability. No disability benefits will be paid, and insurance will end if we determine you are able to work under a transitional work arrangement or other modified work arrangement and you refuse to do so without good cause.

If you become disabled while you are on a covered layoff or leave of absence, we will use your monthly earnings from your employer in effect just prior to the date your absence begins.

If your disability earnings routinely fluctuate widely from month to month, we may average

your disability earnings over the most recent three months to determine if your claim should continue.

If we average your disability earnings, we will terminate your claim if:

We will not pay you for any month during which disability earnings exceed the above amounts. The minimum monthly benefit will not be paid when disability earnings exceed the above amounts.

Deductible Sources of Income are other income benefits you, your spouse or your dependent children may be entitled to receive because of your disability or retirement. These benefits are taken into consideration when your monthly benefit is calculated and may reduce your monthly benefit.

We will subtract from your gross disability benefit the following deductible sources of income:  

Amounts paid to your former spouse or to your children living with such spouse will not be included.  

•the United States Social Security Act;

•the Canada Pension Plan;

•the Quebec Pension Plan;

•the Railroad Retirement Act; or

•any similar plan, act or law of any country, state or province.

Benefits paid to your former spouse or your children living with such spouse will not be included.

•    receive as disability benefits under your employer's retirement plan;

Disability payments under a retirement plan will be those benefits which are paid due to disability and do not reduce the retirement benefit which would have been paid if the disability had not occurred.

Retirement benefits will be those benefits that are paid based on your employer's contribution to the retirement plan. Disability benefits which reduce the retirement benefit under the Plan will also be considered as a retirement benefit.

Regardless of how the retirement funds from the retirement plan are distributed, we will consider your and your employer's contributions to be distributed simultaneously throughout your lifetime.

Amounts received do not include amounts rolled over or transferred to any eligible retirement plan. We will use the definition of eligible retirement plan as defined in Section 402 of the Internal Revenue code including any future amendments that affect the definition.

With the exception of retirement payments, or amounts that you receive from a partnership, proprietorship or any similar draws, we will only subtract deductible sources of income which are payable as a result of the same disability.  

We will not reduce your payment by your Social Security retirement income if your disability begins after age 65 and you were already receiving Social Security retirement payments.

We will not subtract from your gross disability benefit income you receive from, but not limited to, the following:

If your monthly benefit is reduced to zero due to subtracting deductible sources of income, you will receive a minimum monthly benefit. Your minimum monthly benefit is listed on the Benefits Schedule.

 

We may apply your minimum monthly benefit toward any outstanding overpayment.

Once we have subtracted any deductible source of income from your gross disability benefit, we will not further reduce your monthly benefit due to a cost of living increase from that source.

What If We Determine You May Qualify For Deductible Income Benefits?

Your monthly benefit may not be reduced by the estimated amount if you:

If you receive a lump sum payment from any deductible source of income, the lump sum will be pro-rated on a monthly basis over the time period for which the sum was given. If no time period is stated, we will use a reasonable one.

You will receive a benefit for each month you remain disabled up to the maximum benefit period.

Your maximum benefit period is based on your age when your disability occurred. Refer to the Benefits Schedule for specific maximum benefit period durations.

Your claim will end, and benefits will stop on the earliest of the following:

 

We will pay disability benefits on a limited basis for a disability caused by, or contributed to by, any one or more of the following conditions:

The lifetime cumulative maximum benefit period for all disabilities caused by, or contributed to by:

is 24 months during your lifetime. Only 24 months of benefits will be paid for any combination of such disabilities even if the disabilities:

We will continue your benefits beyond the 24-month period if you meet one or both of these conditions:

If you become re-confined at any time during the recovery period and remain confined for at least 14 days in a row, we will continue your benefits during that additional confinement and for one additional recovery period up to 90 more days.

We will not pay beyond the limited pay period as indicated above, or the maximum benefit period, whichever occurs first. We will not apply any period of confinement to your lifetime cumulative maximum.

We will not apply the mental illness limitation to dementia if it is a result of:

Your Plan does not cover any disabilities caused by, contributed to by, or resulting directly or indirectly from:

What Is a Pre-Existing Condition?

You have a pre-existing condition if both 1 and 2 are true:

When the Plan becomes effective, we will provide coverage for you if:

Your coverage is subject to payment of premium.

Your monthly benefit will be limited to the amount that would have been paid by the prior carrier. We will reduce your monthly benefit by any amount for which your prior carrier is liable.

You may be eligible for a monthly benefit even if your disability results from a pre-existing condition if, you were:

In order to receive a monthly benefit you must satisfy the pre-existing condition provision under:

If you do not satisfy item one or two above, we will not pay benefits under our Plan.

If you satisfy item one, we will determine your benefits according to our Plan provisions.

If you only satisfy item 2), we will administer your claim according to our Plan provisions. However, your monthly benefit will be the lesser of:

Your benefits will end on the earlier of the following dates:

If you have a recurrent disability, as determined by us, we will treat your disability as part of your prior claim and you will not have to complete another benefit elimination period if:

Your recurrent disability will be subject to the same terms of the Plan as your prior claim and will be treated as a continuation of that disability.

If you become covered under any other group long term disability plan, you will not be eligible for benefits under this disability Plan.

When we receive proof that you have died, while totally disabled, we will pay your Eligible Survivor a lump sum benefit equal to three months of your gross disability monthly benefit if, on the date of your death:

However, we will first apply the survivor benefit to any overpayment that may exist on your claim.

If you have no Eligible Survivors, payment will be made to your Estate, unless there is none.

We have a vocational rehabilitation program available to assist you in returning to work. We will determine whether you are eligible for this program, at our sole discretion. In order to be eligible for rehabilitation services and benefits, you must be medically able to engage in a return to work program.

Your claim file will be reviewed by one of our rehabilitation professionals to determine if a rehabilitation program might help you return to gainful employment. As your file is reviewed, medical and vocational information will be analyzed to determine an appropriate return to work program. We will make the final determination of your eligibility for participation in the program. We will provide you with a written rehabilitation plan developed specifically for you.

The rehabilitation program may include at our sole discretion, but is not limited to, the following services and benefits:

We will pay an additional benefit of ten percent of your gross disability benefit to a maximum benefit of $5,000. This benefit is not subject to policy provisions which would otherwise increase or reduce the benefit amount such as deductible sources of income. However, the maximum benefit and maximum benefit period will apply.

In addition, we will continue benefits for you for three months following the date your disability ends if we determine you are no longer disabled while:

This benefit payment may be paid in a lump sum.

Benefits for the rehabilitation program will end on the earliest of the following dates:

A worksite modification might be what is needed to allow you to perform the material and substantial duties of your regular occupation with your employer. One of our designated professionals will assist you and your employer to identify a modification we agree is likely to help you remain at work or return to work. This agreement will be in writing and must be signed by you, your employer and us. When this occurs, we will assist your employer with the cost of the modification, up to the greater of:

You are required to submit a claim to us in writing by mail or fax. Claim forms may be obtained from your employer or from us. Follow the procedure chosen by your employer to report a disability claim to us.

We encourage you to notify us of your disability claim as soon as possible, so that a claim decision will be made in a timely manner. Written notice of a claim should be sent within 90 days after the date Your disability begins. Failure to give notice within the time prescribed does not invalidate or reduce any claim if it is shown that it was not reasonably possible to give the notice within that time, and notice was given as soon as was reasonably possible. However, you must send us written proof of your claim no later than 90 days after your elimination period. If it is not possible to give proof within 90 days it must be given no later than two years after the time proof is otherwise required except in the absence of legal capacity.

If you submit a claim before you have been notified of our decision on any coverage amount requiring evidence of insurability, your amount of coverage will be determined as if our final underwriting decision had been made prior to the date of claim.

The claim form is available from your employer, or you can request a claim form from us. If you do not receive the form from us within 15 days of your request, send us written proof of claim without waiting for the form.

You must notify us immediately when you return to work in any capacity.

You and your employer must fill out your own sections of the claim form. You must then give your claim form to your attending physician for your disability. Your physician should fill out his or her section of the form and send it directly to us.

Your proof of claim must be provided at your expense. It must include the following information:

We may request that you provide us with proof of continuing disability indicating that you are under the regular care of a physician. This proof shall be in writing and satisfactory to us.

You will be required to give us authorization to obtain additional medical information from your medical providers. You may also be required to provide us with non-medical information such as copies of your IRS Federal Income Tax return, W-2's and 1099's, as part of your proof of continuing disability.

This proof must be provided at your own expense and must be received within 30 days of a request by us. We will deny your claim or stop sending you payments if the appropriate information is not submitted.

Benefits will be paid to you on a monthly basis upon our receipt of satisfactory proof of loss. Benefits payable other than for loss of time will be paid within sixty days of our receipt of satisfactory proof of loss.

We have the right to recover any overpayments for amounts paid greater than the benefits that you are entitled to receive. This includes but is not limited to our error, your receipt of deductible sources of income or fraud. We will not recover more money than the amount we paid you.

We have the right to do any one or all of the following:

If the overpayment occurred as a result of your receipt of deductible sources of income, during the period for which you have received a benefit under this Plan, we will exclude from the amount to be recovered, any advocate or legal fees incurred by you to obtain such deductible sources of income, provided you return the overpayment to us within 30 days of our written request. If you do not return the overpayment to us within 30 days, such fees will not be excluded. You will remain responsible for repayment of the total overpaid amount.

Examples of deductible sources of income are:

All full list of deductible sources of income is located in the “Long Term Disability Benefits” Section of the Certificate.

Any unpaid premium due for your coverage under this Policy may be recovered by us by offsetting against amounts otherwise payable to you under this Policy, or by other legally permitted means.

We will have the right and opportunity to have a physician, dentist, vocational expert or other medical or vocational professional of our choice examine you when you request benefits for new and ongoing claims under this Plan.

Multiple exams, evaluations and functional capacity exams may be required during your disability for an ongoing claim. This will be done at all reasonable times while a claim for benefits is pending or under review. This will be done at our expense at no cost to you.

You can start legal action regarding your claim 60 days after proof of claim has been given to us and up to three years from the time proof of claim is required, unless otherwise provided under federal law.

If this Policy provides benefits under a Plan which is subject to the Employee Retirement Income Security Act of 1974 (ERISA), the following provisions apply. Whether a Plan is governed by ERISA is determined by a court, however, your employer may have information related to ERISA applicability. If ERISA applies, the following items constitute the Plan: the additional information contained in this document, the Policy, including your Certificate of Coverage, the Benefits Schedule and any additional summary plan description information provided by the Plan Administrator. Benefit determinations are controlled exclusively by the Policy, your Certificate of Coverage, and the information in this document.

If you wish to file a claim for benefits, you should follow the claim procedures described in your certificate of coverage. To complete your claim filing, we must receive the claim information it requests from you (or your authorized representative), your attending physician, and your employer. If you or your authorized representative has any questions about what to do, you or your authorized representative should contact us directly.

We will give you notice of the decision no later than 45 days after the claim is filed. This time period may be extended twice by 30 days if we determine that such an extension is necessary due to matters beyond the control of the Plan and we notify you of the circumstances requiring the extension of time and the date by which we expect to render a decision. If such an extension is necessary due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days within which to provide the specified information. If you deliver the requested information within the time specified, any 30-day extension period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, we may decide your claim without that information.

If your claim for benefits is wholly or partially denied, the notice of adverse benefit determination under the Plan will:

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

You have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeals should be sent to the address specified in the claim denial. A decision on review will be made no later than 45 days following receipt of the written request for review. If we determine that special circumstances require an extension of time for a decision on review, the review period may be extended by an additional 45 days (90 days in total). We will notify you in writing if an additional 45-day extension is needed.

If an extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days to provide

the specified information. If you deliver the requested information within the time specified, the 45-day extension of the appeal period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, we may decide your appeal without that information.

You will have the opportunity to submit written comments, documents, or other information in support of your appeal. You will have access to all relevant documents as defined by, applicable U.S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination.

The review will be conducted by us and will be made by a person different from the person who made the initial determination and such person will not be the original decision maker's subordinate. In the case of a claim denied on the grounds of a medical judgment, we will consult with a health professional with appropriate training and experience. The health care professional who is consulted on appeal will not be the individual who was consulted during the initial determination or a subordinate. If the advice of a medical or vocational expert was obtained by the Plan in connection with the denial of your claim, we will provide you with the names of each such expert, regardless of whether the advice was relied upon.

A notice that your request on appeal is denied will contain the following information:

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim.

The Company, for itself and as claims fiduciary for the Plan, is entitled to legal and equitable relief to enforce its right to recover any benefit overpayments caused by your receipt of deductible sources of income from a third party. This right of recovery is enforceable even if the amount you receive from the third party is less than the actual loss suffered by you but will not exceed the benefits paid you under the Policy. The Company and the Plan have an equitable lien over such sources of income until any benefit overpayments have been recovered in full.

The Plan, acting through the Plan Administrator, Zurich American Life Insurance Company delegates to and its affiliate's discretionary authority to make benefit determinations under the Plan. The Company may act directly or through their employees and agents or further delegate their authority through contracts, letters or other documentation or procedures to other affiliates, persons or entities. Benefit determinations include determining

eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan. All benefit determinations must be reasonable and based on the terms of the Plan and the facts and circumstances of each claim.

General definitions used throughout this Certificate include:

Accident means a sudden unforeseeable external event that caused bodily injury to an Insured while coverage is in force under the Policy.

Active Employment means you are working for your employer for earnings that are paid regularly and that you are performing the material and substantial duties of your regular occupation. You must be working at least the minimum number of hours as described under eligible class(es) in each plan.

Your work site must be:

Normal vacation is considered active employment.

If your employment status is being continued under a severance or termination agreement, you will not be considered in active employment.

Temporary and seasonal workers are excluded from coverage

Administrator means the person(s) or organization(s) that are designated by the Policyholder to perform certain functions on behalf of the Policyholder.

Appropriate Care means the determination of an accurate and medically supported diagnosis of the Insured's disability, or ongoing medical treatment and care of the Insured's disability by a physician that conforms to generally-accepted medical standards, including frequency of treatment and care.

Confined or Confinement means a hospital stay of at least 8 hours per day.

Covered Monthly Earnings means your gross monthly income from your employer in effect just prior to your date of disability. It includes your total income before taxes. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plans, or flexible spending account.

It does not include income received from commissions, bonuses, overtime pay, any other extra compensation, or income received from sources other than your employer.

Deductible Sources of Income means income from the deductible sources listed in the Plan that you receive or are entitled to receive while you are disabled. This income will be subtracted from your gross disability benefit.

Disability Benefit when used with the term retirement plan, means money which:

Eligible Classes means the classes of employees that your employer has selected as being eligible to receive coverage under a Plan. Your employer alone determines the criteria that is used to define the eligible class(es) for insurance coverage under this Plan.

Eligibility Date means the date you become eligible for insurance.

Eligible Survivor means your spouse, if living, otherwise your children under age 26 equally.

Elimination Period means a period of continuous disability that must be satisfied before you are eligible to receive benefits from this Plan.

Employee means a person who is in active employment with the employer and the employees, individual proprietors, and partners of one or more affiliated corporations, proprietorships or partnerships if the business of the employer and such affiliated corporations, proprietorships or partnerships is under common control. Employee shall exclude in any case, temporary employees and employees who work for the employer less than the number of hours per week indicated in the Benefits Schedule. This term does not include employees who normally work less than 20 hours a week for the employer.

Employer means the Policyholder and subsidiaries or affiliates of the Policyholder that the Policyholder has requested in writing to have included under the Policy, and we, which request we have approved such request.

Expatriate means an employee who is working outside his or her country of permanent residence or citizenship.

Full-Time means the number of hours set by the employer as a regular work day for full-time employees in the Insured's eligible class.

Gainful Occupation means an occupation for which you are or become reasonably fitted by training, education or experience.

Good Cause means a medical reason preventing your participation in the rehabilitation program or in a transitional work arrangement. Satisfactory proof of good cause must be provided to us.

Grace Period means a period of time following the premium due date during which premium payment may be made.

Gross Disability Benefit means the total benefit amount for which an employee is insured under this Plan before we subtract deductible sources of income and disability earnings subject to the maximum benefit.

Home Office means means 1299 Zurich Way, Schaumburg, Illinois 60196.

Hospital or Institution means an accredited facility licensed to provide care and treatment for the condition causing your disability.

Indexed Monthly Earnings For the first year you are disabled your indexed monthly earnings will be equal to your monthly covered earnings. After you have been disabled for one year, your indexed monthly earnings means your covered monthly earnings adjusted on each anniversary of benefit payments, after a 12 month period of disability by the lesser of 10% or the current annual percentage increase in the Consumer Price Index. Your indexed monthly earnings may increase or remain the same, but will never decrease.

The U.S. Department of Labor publishes the consumer price Index (CPI-W). We reserve the right to use some other similar measurement if the Department of Labor changes or stops publishing the CPI-W. Indexing is only used as a factor in the determination of the percentage of lost earnings while you are disabled and working in the determination of any gainful occupation.

Injury means bodily injury that is a direct result of an accident and independent of all other causes. The injury must occur, and the disability must begin while you are covered under this Plan. Exception: any disability that occurs more than 60 days after the injury will be considered a sickness for the purpose of determining benefits under this Policy.

Insured means any person covered under this Plan for whom premium has been paid.

Law, Plan or Act means the original enactment of the law, plan or act and all amendments.

Leave of Absence means you are temporarily absent from active employment for a period of time that has been agreed to in advance in writing by your employer. Your normal vacation time or any period of disability is not considered a Leave of Absence.

Limited means what you cannot or are unable to do.

Master Policy means the Group Insurance Policy obtained by the Policyholder under which your employer participates and receives group long term disability insurance to cover eligible employees.

Material and Substantial Duties means duties that:

Maximum Capacity means based on your restrictions and limitations:

Maximum Period of Payment means the longest period of time we will make payments to you for any one period of disability.

Mental Illness means a psychiatric or psychological condition classified in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) published by the American Psychiatric Association, most current as of the start of a disability. Such disorders include, but are not limited to, psychotic, emotional or behavioral disorders, schizophrenia, depression, bipolar illness, or disorders relating from stress or to substance abuse or dependency. If the DSM is discontinued or replaced, these disorders will be those classified in the diagnostic manual then used by the American Psychiatric Association as of the start of the disability. These conditions are usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other methods of treatment as standardly accepted in the practice of medicine.

Monthly Benefit means your benefit amount after any deductible sources of income and disability earnings have been subtracted from your gross disability benefit.

Part-Time Basis means the ability to work and earn between 20% and 80% of your indexed monthly earnings.

Payable Claim means a claim for which we are liable under the terms of the Policy.

Physician means a person performing tasks that are within the limits of his or her medical license; and:

 

We will not recognize you or a person related to you as a physician for a claim that you send to us. This includes but not limited to your spouse, children, parents, siblings, brothers-in-law, sisters-in-law, or step children.

Plan means a line of coverage under the Policy.

Policy means the Policy provided to the employer.

 

Policyholder means an employer who as applied for coverage under the Policy for eligible employees and their dependents.

Prior Plan means the Plan of insurance providing similar benefits sponsored by the employer in effect directly prior to the Policy effective date.

Reasonable Accommodation means modifications or adjustments to a job, an employment practice or the work environment that makes it possible for a disabled person to perform the material duties of their occupation without causing undue hardship to any employer. It must meet federal standards of Reasonable Accommodation as detailed in the Americans with Disabilities Act of 1991 and any later amendments.

Reasonable Occupation means any gainful activity for which you are, or may reasonably become fitted by education, training, or experience.

Recurrent Disability means a disability, which is:

 

Regular Care means:

Regular Occupation means the occupation you are routinely performing when your disability begins. We will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location.

Rehabilitation Program means a program, approved by us, designed to assist you to return to work.

Retirement Plan means a defined contribution plan or defined benefit plan. These are plans, which provide retirement benefits to employees and are not funded entirely by employee contributions. Retirement plan includes but is not limited to any plan that is part of any federal, state, county, municipal or association retirement system.

Salary Continuation or Accumulated Sick Leave means continued payments to you by your employer of all or part of your monthly earnings, after you become disabled as defined by the Policy. This continued payment must be part of an established Plan maintained by your employer for the benefit of all employees covered under the Policy. Salary continuation or accumulated sick leave does not included compensation paid to you by your employer for work you actually perform after your disability begins. Such compensation is considered disability earnings and would be taken into account in calculating your monthly benefit.

Sickness means an illness, disease or disabling pregnancy. The sickness must begin while you are covered under this Plan.

Spouse means the Insured’s lawful spouse, (not including a spouse who is legally separated from the Insured.

We, Us and Our means Zurich American Life Insurance Company.

You, Your means an insured employee who is eligible for our coverage under this Plan.

This Long Term Disability Plan provides financial protection for you by paying a portion of your income if you become disabled due to an illness or injury while covered under this Plan. The amount you receive is based on the amount you earned before your disability began. In some cases, you can receive disability payments even if you work while you are disabled.

This Benefits Schedule (hereinafter "Schedule") is a summary of some of the features and benefits of your employer’s Long Term Disability Plan. It is not a contract. You are not necessarily entitled to insurance because you received this Schedule. You are only entitled to insurance if you are eligible in accordance with the terms of the certificate, you have met your employer’s eligibility requirements and premium has been paid. For a complete description of the terms, conditions, exclusions and limitations of your employer’s Plan, refer to your Certificate. In the event of a discrepancy between this Schedule and the Certificate, the Certificate will control.

The table below shows the maximum duration for which benefits may be paid. All other limitations of the Policy will apply.

Total Benefit: The total benefit payable to you on a monthly basis (including all benefits provided under this Plan) will not exceed 100% of your covered monthly earnings unless otherwise stated in the Certificate under specific conditions.

Your Plan does not cover disabilities related to all injuries, illness or disease. Refer to your Certificate for a complete list of exclusions and limitations.

The following disabilities have limited benefits under this Plan: mental Illness, mental disorders, drug and alcohol addiction. Refer to the Certificate for a detailed description of the benefits and the limitations.

If you are receiving or are eligible to receive benefits for a disability under a prior disability Plan that was sponsored by your employer or was terminated before the effective date of this Plan, then no benefits will be payable for the disability under this Policy.