Sentrix Digital riskatlas.co.za Library

These are policy doors, not medical grades. A serious diagnosis can sit in residual if two days of work continue. A driver who cannot drive can be total under own occupation even if a desk job exists.

Total disability

Usually: cannot perform the insured occupation (or no work/earnings from it)

Partial disability

Some work continues; benefit often a proportion of the total benefit from an earnings or hours drop

Why this matters for your claim — Insurers use leftover tasks to deny total, and leftover earnings to cap residual. They may also treat a graded return as recovery. Keep the formula and the duty list in the same file.

What to capture in ClaimBuddy

Tap a label to open the language-map explainer for that date or concept.

  1. Pre-disability baseline — Earnings and hours the residual formula will use.
  2. Duties that stopped — Material duties you cannot perform.
  3. Duties that continue — Even two hours a week — name them.
  4. Current earnings and hours — Same period as the baseline.

Claim tip

List duties that stopped and duties that continue. Capture pre-disability versus current earnings and hours. Do not volunteer light duties without reading the residual clause.

Pre-disability: 5 client days, R18 000/month. Now: 2 mornings of email, R7 200. Lost: workshops and travel. Residual / partial — not a failed total claim.

Sentrix Digital, Melbourne · ABN 29 203 554 753. Not medical, legal, or financial advice. Organisation and drafting only. Verify with clinicians, schemes, and policy documents. South African complaints: insurer internal review, then the National Financial Ombud (NFO). · info@sentrixdigital.com · +61 (03) 9088 1341 · Admin login