Reso 2001-399 - Laserfiche WebLink

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SPECIFIED INJURIES OR SICKNESSES LIMITATION LIMITATION, If an Insured Employee is Disabled primarily due to one or more of the SpecifIed Injuries or Sicknesses defmed below; then Partial or Total Disability Monthly BenefIts: 1, will be payable subject to the terms of this Policy; but _ 2. will be limited to 24 months for anyone period of Disability; unless the Insured Employee is confmed to a Hospital. "SpecifIed Injuries or Sicknesses" include any Mental Sickness, or Substance Abuse, as defmed below. CONDITIONS I. If the Insured Employee is confmed in a Hospital at the end of the 24th month for which Policy benefIts are paid for the SpecifIed Injury or Sickness; then benefIts will be payable until he or she is discharged from that facility. 2. In no event will the Monthly BenefIt be paid beyond the Maximum BenefIt Period shown in the Schedule of Insurance, however. DEFINITIONS "Hospital," as used in this provision, means: 1, a general hospital which: (a) is licensed, approved or certifIed by the state where it is located; (b) is recognized by the Joint Commission on the Accreditation of Hospitals; or (c) is operated to treat resident inpatients; has a registered nurse always on duty; and has a lab, x-ray facility and place where major surgery is performed; and 2. a skilled nursing care facility or unit, which provides convalescent or nursing care; and which is recognized as a skilled nursing care facility under Medicare. The term Hospital also includes: 1. a Mental Hospital when treatment is for a Mental Sickness; and 2. a Treatment Center when treatment is for Substance Abuse. ~ental Hospital" means a health care facility (or its psychiatric unit) which: 1. is licensed, certified or approved as a mental hospital by the state where it is located; 2. is equipped to treat resident inpatients' mental diseases or disorders; and 3, has a resident psychiatrist on duty or on call at all times. "Mental Sickness" means any emotional, behavioral, psychological, personality, adjustment, mood or stress-related abnormality, disorder, disturbance, dysfunction or syndrome; regardless of its cause. It includes, but is not limited to: 1, schizophrenia or schizoaffective disorder; 2, bipolar affective disorder, manic depression, or other psychosis; and 3. obsessive-compulsive, depressive, panic or anxiety disorders. These conditions are usually treated by a psychiatrist, a clinical psychologist or other qualifIed mental health care provider. freatment usually involves psychotherapy, psychotropic drugs or similar methods of treatment. 1ental Sickness does not include irreversible dementia resulting from: 1. stroke, trauma, viral infection, Alzheimer's disease; or 2, other conditions which are not usually treated by a mental health care provider using psychotherapy, psychotropic drugs, or similar methods of treatment. ubstance Abuse" means alcoholism, drug abuse, or chemical dependency of any type, reatment Center" means a health care facility (or its medical or psychiatric unit) which: 1, is licensed, certified or approved by the state where it is located; 2. has a program for inpatient treatment of substance abuse; and 3, provides such treatment based upon a written plan approved and supervised by a Physician. 01-L TD-17 98 FL