Glossary

Policy terms, policy traps, and doctor questionnaire entries — hover names on your dashboard or doctor page for a quick definition; click any entry for the full explanation and cross-links.

Policy traps

Stage-relevant insurer traps — same entries as dashboard Policy trap alerts.

Trap	Quick definition	Evidence focus
Diagnosis trap	A diagnosis label alone does not prove you cannot perform material duties.	Functional-capacity / duty-impact matrix, employer confirmation of material duties, treati…	→
Job-title trap	Job title may understate workload, pressure, travel, supervision, and error consequences.	ESCO or confirmed occupation profile, material duties list, job spec, performance expectat…	→
Date trap	DOA, notice, submission, complete claim, waiting period, and rejection dates are rarely the same day.	Separate fields for symptom onset, DOA, employer date, insurer-stated DOA, first notice, f…	→
Threshold-shift trap	The standard at submission may be broader than the standard applied at rejection.	Policy wording on disability test, submission correspondence, guide vs policy comparison, …	→
Policy-vs-guide trap	HR emails and claim guides may use broader language than binding policy wording.	Uploaded policy schedule, member certificate, rejection letter citing specific clauses, si…	→
Employer-record trap	Payroll, absence records, and employer statements may be decisive but sit with HR — not you.	Employer statement, payroll, leave records, sick-note register, termination/absence corres…	→
Specialist-evidence trap	Missing specialist evidence is unsafe if you were never told what, why, who obtains it, or who pays.	Specialist reports, insurer further-evidence letters, IME instructions, material duties se…	→
Gross-benefit trap	Benefit % is not final until earnings definition, caps, offsets, and tax are checked.	Payslips, policy benefit clause, offsets schedule, tax notes, CAMAF/medical-aid contributi…	→
Pre-existing trap	An old diagnosis is not the same as proving a pre-existing exclusion under your policy dates.	Cover start proof, look-back treating notes, occupational-health clearances, new-event rec…	→
Appeal-story trap	Emotional narrative should become a structured issue matrix with evidence and remedies.	Review-ground matrix, chronology, gap table, draft review letter, record-access responses.	→
Mitigated-state trap	Discrimination law often tests function WITHOUT treatment or aids; income-protection policies usually test WITH ongoing treatment. Mixing those tests is how a claim is argued as if the person is 'fine on meds'.	Policy treatment-compliance clause, treating-practitioner notes on function with and witho…	→

Policy traps overview →

Claim readiness checklist

Eight claim-profile checks — same entries as dashboard and policy reader checklists. Applies to both group claims (SA: an employer-held policy; Australia: employer-held, or via a superannuation fund) and individual policies (held directly by you in either country) — the terminology differs by country and policy type, but the readiness checks below apply across all of them.

Check	Quick guidance
Waiting period identified and continuity evidence planned	Name the waiting period in days and plan sick notes, leave, and payroll proof for every day.	→
Date of Absence recorded (user + insurer if known)	Record your Date of Absence and capture the insurer's DOA if it differs — conflicts are common.	→
First notice date and proof identified	Identify when you first told the employer or insurer and what proof exists (email, form, call log).	→
Own-occupation / Initial Period test noted	Note whether Initial Period own-occupation applies — not just a job title.	→
Material duties described (not job title only)	List core duties — client load, travel, supervision, cognition — not just the job title.	→
Proof-of-claim checklist started	Start the proof-of-claim checklist — forms, medical evidence, employer records, policy schedule.	→
Employer/insurer record requests planned if needed	Plan access requests when employer or insurer records you need sit with HR, payroll, or the fund.	→
Review / ombud deadline tracked	Track internal review and ombud deadlines — missing a date can end your complaint rights.	→

Doctor questionnaire

Ten disability-test questions for your treating practitioner — same entries as the workspace doctor page.

#	Question	Purpose
1	Which test applies now?	Initial Period is usually own-occupation; Extended Period may shift.	→
2	What is the relevant occupation?	Define the actual role — not a generic title.	→
3	What are the material duties?	Separate core duties from incidental tasks.	→
4	What medical events changed capacity?	Onset, deterioration, treatment, side-effects.	→
5	How does illness affect work function?	Map symptoms to duties, stamina, and reliability.	→
6	Was incapacity continuous through waiting period?	Breaks in incapacity can reset the clock.	→
7	What evidence is missing?	Name the gap and the holder.	→
8	Who controls the missing evidence?	Employer, insurer, hospital, specialist.	→
9	What is the insurer's actual reason?	Quoted clause vs everyday language in the letter.	→
10	What would cure the issue?	Specific record, specialist answer, or duty-impact line.	→

Core policy terms

Term	Meaning	Trap to watch
Disability	The policy outcome if you meet the disability test — usually inability to perform material duties of your own occupation.	Diagnosis trap — a certificate label is not the test.	→
Waiting period	Continuous incapacity that must run before benefits start — often measured from Date of Absence.	Date trap — mixing sick days with DOA resets or fails the period.	→
Date of Absence	The date the policy treats incapacity as having begun — often not the first sick day.	Date trap — employer, doctor, and insurer frequently pick different dates.	→
Incapacity	Ongoing inability to perform insured duties under policy rules — not the same as HR sick leave.	Illness vs incapacity confusion.	→
Disablement	The process or state of becoming unable to function as before — in COIDA and some funds a rated percentage; in everyday talk a gradual collapse of capacity.	Not the same as the policy disability test, and not the same as a discrimination-law 'person with a disability'.	→
Capacity vs performance	WHO-ICF: capacity is what you can do unaided in a standard setting; performance is what you actually do with treatment, aids, and environment.	Mitigated-state trap — IP usually assesses treated performance; ADA/UK/EEA guidance often looks at the unmitigated baseline.	→
Own occupation	Initial-period test: can you do the material duties of your actual role, not any job.	Job-title trap — generic titles understate the role.	→
Cover start	When cover commenced — compared to symptom history and pre-existing look-back.	Pre-existing trap.	→
Total vs partial disability	Two policy doors: total usually means you cannot perform the insured occupation; partial / residual means some work continues and a formula (earnings or hours drop) pays a proportion of the total benefit. Not a medical severity score.	Threshold-shift trap if the test changes after the Initial Period; also using leftover tasks to deny total without applying the residual clause.	→

SA medicine schedules

Scheduling ladder for medicines in Clinical Atlas — hover each schedule, drill down to linked medications and therapies.

Medicine schedules overview →