Core policy terms
9 core policy terms — click any entry for full detail.
| Term | Meaning | Trap | Evidence needed | |
|---|---|---|---|---|
| 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. | Duty-impact matrix, occupation profile, treating-doctor answers to the policy 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. | Absence records, sick notes covering the full period, insurer DOA. | → |
| 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. | Separate fields for symptom onset, first sick note, your DOA, insurer DOA. | → |
| Incapacity | Ongoing inability to perform insured duties under policy rules — not the same as HR sick leave. | Illness vs incapacity confusion. | Functional-capacity statement mapped to material duties. | → |
| 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'. | Policy wording, COIDA vs IP distinction, ICF capacity vs performance. | → |
| 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. | State which axis the assessor used, and keep both scores if they differ. | → |
| 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. | Job spec, duty list, employer confirmation. | → |
| Cover start | When cover commenced — compared to symptom history and pre-existing look-back. | Pre-existing trap. | Member certificate, scheme start date. | → |
| 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. | Pre-disability vs current payslips and hours, duty list (stopped vs continues), residual clause. | → |