incapacity · insurance

Incapacity for Work

Insurance (general/international - Income Protection)

Definition

The insured's inability, due to illness or injury, to perform the material and substantial duties of their occupation (or, later in a claim, any occupation), triggering income-replacement benefits.

Prerequisite chain

Condition. Illness or injury exists
Functional status. Material duties of own or any occupation can't be performed
Applied test. Assessed WITH ongoing treatment as a condition of benefit; reassessed if treatment restores capacity

Assessment basis (treatment / aids) — Heavily accounts for treatment and aids: insurers generally require ongoing medical treatment as a condition of benefit, and will reassess (and can reduce/terminate) benefits if treatment restores work capacity — assessed in the treated/mitigated state, similar to the SA income-protection approach.

Qualifiers

Severity. Total vs. partial incapacity for work
Duration. Deferred/waiting period, then ongoing while incapacity persists
Scope. Own Occupation (early period) vs. Any Occupation (later period), per policy wording
Other. Often requires the claimant to be "under the regular care of a medical practitioner" and following prescribed treatment

Impact

Prevents the claimant from earning income from their occupation.

Example

A claimant's income protection benefit is reviewed after 24 months and moved from an "Own Occupation" to an "Any Occupation" test, requiring reassessment of whether any suitable work is now possible.

Source: General international income protection/disability insurance policy wording

Language map: disability · Incapacity · Mitigated-state trap