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… | → |
GIP readiness checklist
Eight claim-profile checks — same entries as dashboard and policy reader checklists.
| 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.