Home > Health Plan > Accidental Death & Dismemberment

Employee Accidental Death and Dismemberment Benefit

If you die or lose a hand, a foot or your sight, the insurance carrier will pay a benefit based on the Table of Losses shown below. The loss or death must be the direct result of an Accidental Injury that occurs while you are insured by the Group Policy. Also, the loss must occur within 90 days of the accident date and submitted within 180 days of the accident.

TABLE OF LOSSES

The full sum is paid for loss of: Life Both hands Both feet Sight of both eyes One hand and one foot One hand and sight of one eye One foot and sight of one eye One half the full sum is paid for the loss: One hand One foot Sight of one eye

No more than 100% of the Maximum Benefit will be paid for any one accident, no matter how many of the above listed losses occur as a result of that accident.

Your beneficiary designation for Employee Life Insurance will apply to benefits for loss of life under the AD&D benefit.

Loss of hand or foot means the irrecoverable loss of the hand or foot as a result of an Accidental Injury. Loss of sight means total sight loss that cannot be restored

Accidental Death coverage is in addition to any Life Insurance Benefit.

Death Benefit

• For Active Participants and Retirees up to age 65 only the Benefit is $5,000.
• For Retiree age 65 and older the Benefit is $2,000.

Accidental Loss of any (2)members (hands, feet. eyes)

• For Active Participants and Retirees up to age 65 only the Benefit is $5,000.
• For Retiree age 65 and older the Benefit is $2,000.

Accidental Loss of any (1)members (hands, feet. eyes)

• For Active Participants and Retirees up to age 65 only the Benefit is $2,500.
• For Retiree age 65 and older the Benefit is $1,000.

Under what circumstances will a loss not be covered by this AD&D Benefit?

1. We will not pay for any loss that results in any way from Any disease of infirmity of mind or body, and any medical or surgical treatment thereof; or
2. Suicide or attempted suicide, while sane or insane, or
3. Any intentionally self-inflicted injury; or
4. War, declared or undeclared, whether or not the Insured is a member of any armed forces; or
5. Commission of, participation in, or an attempt to commit an assault or felony; or
6. Being under the influence of any narcotic, hallucinogen, barbiturate or amphetamine, gas or fumes, poison or any other controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter, amended, unless as prescribed by the Insured's licensed physician. Conviction is not necessary for a determination of being under the influence; or
7. Intoxication as defined by laws of the jurisdiction in which the accident occurred. Conviction is not necessary for a determination of being intoxicated; or
8. Active participation in a riot. Riot means all forms of public violence, disorder, or disturbance of the public peace, by three or more persons assembled together, whether with or without a common intent and whether or not damage to person or property or unlawful act is the intent or the consequence of such disorder.

Will this AD&D Benefit continue if I become disabled?
If you are Totally Disabled and Your Life Insurance Benefit is being continued under the waiver of premium provision, this Accidental Death and Dismemberment Benefit will end.

Important Notice: This website provides only a brief explanation of the Health and Welfare Plan under the Beverage and Brewery Local 67 Health and Welfare Trust Fund. It is not a summary plan description. If there are any inconsistencies between this explanation and the Plan document, the Plan document shall control. Also, please refer to the Summary Plan Description for additional information about the benefits available and procedures of the Beverage and Brewery Local 67 Health and Welfare Trust Fund or contact the Welfare Fund Office.

Copyright 2007 Teamsters Local 67. All Rights Reserved
2120 Bladensburg Rd., NE
 Washington, DC 20018