Occupational HIV infection

Definite diagnosis of infection with Human Immunodeficiency Virus (HIV) resulting from accidental injury during the course of the insured person’s normal occupation, which exposed the person to HIV contaminated body fluids.

The accidental injury leading to the infection must have occurred after the later of the effective date of this coverage, or the effective date of last reinstatement of this coverage.

Benefit payment under this condition requires satisfaction of all of the following:

• the accidental injury must be reported to the insurer within 14 days of the accidental injury;
• a serum HIV test must be taken within 14 days of the accidental injury and the result must be negative;
• a serum HIV test must be taken between 90 days and 180 days after the accidental injury and the result must be positive;
• all HIV tests must be performed by a duly licensed laboratory in Canada or the United States of America;
• the accidental injury must have been reported, investigated and documented in accordance with current Canadian or United States of America workplace guidelines.

The diagnosis of occupational HIV infection must be made by a specialist.

Exclusions

No benefit will be payable under the definition of "occupational HIV infection" if:

• the insured person has elected not to take any available licensed vaccine offering protection against HIV;
• a licensed cure for HIV infection has become available prior to the accidental injury;
• HIV infection has occurred as a result of non-accidental injury including, but not limited to, sexual transmission and intravenous (IV) drug use.

An HIV infection is detected by the presence of HIV antibodies in the blood. It may take as long as six months before these antibodies are detectable. Also, an initial test must be done within 14 days following accidental exposure in the workplace to determine if the insured person was not already infected by the HIV. A second test is taken within 90 to 180 days following the accidental exposure to determine if the insured has been infected. If the test taken after 90 days is positive, there’s no need to undergo a second one in 180 days. However, if the test done within 90 days is negative, the insured person must undergo another test within 180 days to confirm the positive or negative diagnosis.