disability · insurance

Disability

Insurance - South Africa (Income Protection / ASISA)

Definition

Inability to perform the material and substantial duties of one's own occupation (or, later, any occupation for which reasonably suited), triggering income-replacement benefits.

Prerequisite chain

Condition. Illness or injury exists (medically diagnosed)
Functional status. Material/substantial job duties (or any suitable job's duties) can't be performed
Applied test. Tested WITH treatment - ongoing medical care is usually required, and benefit is reassessed if treatment restores capacity

Assessment basis (treatment / aids) — Heavily accounts for medication and aids/treatment. Insurers routinely require claimants to undergo and comply with reasonable treatment; if treatment restores capacity to work, benefits can be reduced or terminated. Non-compliance with treatment can itself be grounds for repudiation.

Qualifiers

Severity. Own Occupation (early years) vs. Any Occupation (often after 24 months)
Duration. Temporary (income protection) vs. Permanent (lump sum)
Scope. Partial/residual disability benefits available on many policies

Impact

Negatively affects the ability to perform occupational duties or earn an income.

Example

A claimant under an income protection policy is required to continue psychiatric treatment; if medication substantially restores work capacity, the insurer may move the claim from "totally disabled" to "partially disabled" or decline further benefits.

Source: ASISA (Association for Savings and Investment South Africa) disability definitions; Policyholder Protection Rules (PPR) under the Long-term Insurance Act 52 of 1998

Language map: disability · Incapacity · Mitigated-state trap