Employment Insurance Regulations

63 A Weekly Indemnity Plan shall meet the following requirements:

• (a) an insured person who is employed by an employer and covered by the plan becomes eligible to claim benefits under the plan in respect of an illness or injury on or before the first day of the month following

  • (i) the last day of a period of not more than three months of continuous employment beginning on the day of commencement of the employment, or

  • (ii) if the plan is based on an hour-bank principle, the day on which the person has an accumulation of not more than 400 hours of active employment;

• (b) if an insured person is required to serve an elimination period during which no benefit is payable under the plan, that period does not exceed seven consecutive days beginning with the first day of the period of incapacity due to illness or injury;

• (c) benefits are paid in full under the plan regardless of

  • (i) the amount of the benefits that are payable to an insured person under the Act, and

  • (ii) the amount of the benefits, payable from any other source, that do not constitute earnings under section 35;

• (d) the benefits payable to an insured person under the plan are equivalent to an amount that is equal to or greater than 55% of the insured person's normal weekly insurable earnings;

• (e) subject to the elimination period referred to in paragraph (b), full benefits payable to an insured person under the plan are reinstated

  • (i) in the case of the recurrence of an illness or injury, after three months of active employment following their most recent absence due to that illness or injury or, where the plan is based on an hour-bank principle, after the accumulation of the first 400 hours of active employment by that person following their most recent absence due to that illness or injury, and

  • (ii) in the case of a new illness or injury, after one month of active employment following their most recent absence due to another illness or injury or, where the plan is based on an hour-bank principle, after the accumulation of the first 150 hours of active employment by that person following their most recent absence due to another illness or injury;

• (f) in any case not referred to in paragraph (e) and subject to the elimination period referred to in paragraph (b), benefits are payable under the plan in respect of an illness or injury until the earliest of

  • (i) the end of a period of at least 15 weeks during which the benefits are paid,

  • (ii) the end of the period of incapacity due to the illness or injury,

  • (iii) the date the insured person retires, and

  • (iv) the date of the insured person's separation from employment for any reason other than illness or injury, where notice of the separation was given before the onset of the illness or the occurrence of the injury; and

• (g) the only conditions precluding the payment of benefits under the plan to an insured person to whom they would be otherwise payable are conditions that preclude payment to an insured person

  • (i) who is not under the care of a licensed physician,

  • (ii) whose illness or injury is covered by federal or provincial laws respecting workers' compensation, the Canada Pension Plan or An Act respecting the Québec Pension Plan, where amounts paid under those laws or Acts constitute earnings under section 35,

  • (iii) whose illness or injury is intentionally self-inflicted,

  • (iv) whose illness or injury results from service in the armed forces,

  • (v) whose illness or injury results from war or participation in a riot or in a disturbance of the public order,

  • (vi) who becomes ill or is injured during a leave of absence or a period of paid vacation,

  • (vii) who is in receipt of benefits under section 22, 23, 23.1, 23.2 or 23.3 of the Act,

  • (viii) whose illness or injury is sustained while committing a criminal offence,

  • (ix) who is engaged in employment for a wage or profit during any period for which the person claims benefits under the plan,

  • (x) who becomes ill or is injured after having lost employment by reason of a stoppage of work attributable to a labour dispute at the place where the person was employed, if the person's right to benefits under the plan is reinstated on their return to active employment,

  • (xi) who is an inmate of a prison or similar institution,

  • (xii) who is not entitled to benefits payable under the Act because the person is not in Canada,

  • (xiii) whose illness results from the use of drugs or alcohol and who is not receiving continuing treatment for the use of drugs or alcohol,

  • (xiv) whose illness or injury, resulting from a motor vehicle accident, is covered by a provincial plan described in paragraph 35(2)(d),

  • (xv) who is receiving a retirement pension from the employer,

  • (xvi) who is absent from work because of plastic surgery performed solely for cosmetic purposes, except where the need for surgery is attributable to an illness or injury, or

  • (xvii) who, in the case of a recurring disability, is receiving benefits under a group long-term disability plan that contains a reinstatement provision, where the reinstatement period under that plan does not exceed six months.