Summary Plan Description

Accidental Death and Dismemberment Payments

This Benefit is for Participants Only

If you are eligible under this plan and you die and your death is a result of an accident (on or off the job), your beneficiary receives an additional $30,000. This benefit is payable for death resulting within 365 days from the date of the accident. An additional benefit of $10,000 is available if you die in an automobile accident and the plan has proof you were wearing a seat belt device.

If you are involved in an accident which does not result in death but causes the loss of hands, feet or eyes, you receive a lump sum benefit the amount of which is based upon the Schedule of Indemnities, below. This benefit is payable for loss resulting within 365 days from the date of the accident. If more than one specific loss results from the same accident, your benefit is for the loss for which the largest amount is payable.

For the purpose of this benefit, "loss" is defined as total severance at or above the wrist or ankle joint, irreversible paralysis, or entire and irrecoverable loss of sight. Not more than one payment per limb per lifetime is allowable.

Schedule of Indemnities
In the event of loss of The plan pays
Both hands, or both feet, or sight of both eyes $60,000
One hand and one foot $60,000
One hand and sight of one eye $60,000
One foot and sight of one eye $60,000
Quadriplegia (paralysis of all four limbs) $60,000
One hand or one foot $15,000
Sight of one eye $15,000
Paraplegia (paralysis of the legs or lower part of the body) $15,000
Hemiplegia (paralysis of one side of the body) $15,000

Benefits are not provided under accidental death and dismemberment for a death or dismemberment caused by or as a result of:

  1. Disease of the body, mental infirmity, illness, pregnancy, heart attack, stroke, or diagnostic test; or medical or surgical treatment, except a loss resulting from a surgical operation necessary because of an injury not excluded, provided surgery is performed within 365 days of the injury.
  2. Ptomaines, disease or bacterial infections not the result of an injury, except pyogenic infections which should occur through or with an accidental cut or wound.
  3. Intentionally self-inflicted injuries; or illnesses or injuries self-inflicted or sustained in the following circumstances:
    • Suicide or attempted suicide while sane or insane.
    • While engaged in any activity that results in committing an assault, battery or felony.
    • While performing any acts of violence or physical force that would not be performed by a reasonably prudent person in similar circumstances.
    • While participating in a riot.
    • Recreational use of, abuse of or overdose of legal, illegal or over-the-counter drugs or other substances, whether or not the person was then capable of intending to inflict self-injury.

Being under the influence of a chemical substance will not be considered to affect the person's ability to form intent.