Accidental Death & Dismemberment Benefits
Accidental Death & Dismemberment Benefits
July 18, 2018
In the unfortunate case of an accidental death or serious injury while an active and an eligible participant in the NYCDCC Welfare Fund (the “Welfare Fund”), you or your designated beneficiary may be entitled to Accidental Death & Dismemberment (“AD&D”) benefits. The AD&D benefit is issued through a policy by the Amalgamated Life Insurance Company. [1] AD&D is a policy that pays additional benefits to you or your beneficiary, provided that there is an Accidental Death or Dismemberment.
This policy pays a benefit if, as a result of an accident while you are an active and eligible participant in the Welfare Fund, you sustain a serious injury or die within 365 days of the accident. Depending on the loss caused by the accident, the benefit maximum, or “principal sum” under the AD&D plan is $6,000.
SCHEDULE OF BENEFITS
For Loss of: |
The Benefit* is: |
| Life | $6,000 (Principal Sum) |
| Both Hands or Both Feet or Sight of Both Eyes | $6,000 (Principal Sum) |
| One Hand and One Foot | $3,000 (Principal Sum) |
| Speech, and Hearing in Both Ears | $6,000 (Principal Sum) |
| Either Hand or Foot and Sight of One Eye | $3,000 (Principal Sum) |
| Movement of Both Upper and Lower Limbs (Quadriplegia) | $6,000 (Principal Sum) |
| Movement of Both Lower Limbs (Paraplegia) | $6,000 (Principal Sum) |
| Movement of the Upper and Lower Limbs on One Side of the Body (Hemiplegia) | $3,000 (One-Half of Principal Sum) |
| Either Hand or Foot | $3,000 (One-Half of Principal Sum) |
| Sight of One Eye | $3,000 (One-Half of Principal Sum) |
| Movement of One Limb (Uniplegia) | $1,500 (One-Quarter of Principal Sum) |
| Thumb and Index Finger of Either Hand | $1,500 (One-Quarter of Principal Sum) |
|
*If more than one loss is suffered in the same accident, payment will be made only for the loss for which the largest amount is payable. |
|
After suffering a covered loss, a claim form, which is offered by the Fund Office, should be filled out within 30 days of the loss by you, your beneficiary, or an authorized representative. Your beneficiary for your AD&D benefit will be the same person or person(s) you designated as your beneficiary for your Life Insurance benefit.
Upon submission of an accidental death claim, your beneficiary must provide an original death certificate to the insurance company and evidence of the accident, such as a medical report, policy report, or newspaper clipping. If you are submitting a dismemberment claim, you may be required to have a medical exam conducted by a doctor that is chosen by the insurer. Remember, all forms must be submitted to the Fund Office.
To learn more about your Accidental Death & Dismemberment benefit, please contact the Fund Office at (800) 529-FUND (3863) or (212) 366-7373.
[1] Please refer to your Summary Plan Description (“SPD”) and all recent Summaries of Material Modifications (“SMMs”) to confirm you are eligible for AD&D benefits. Retirees and dependents are not eligible for AD&D benefits.
