Sentrix Digital · Library · Wiki
Wiki
A live index of what the Library already holds — language, glossary, traps, gaps, workflow, clinical atlas, Compass programmes, news — plus names that are referenced on the site but do not yet have their own article. It rebuilds from those sources; new terms appear here when they are added.
469 defined · 15 need definition · 484 total · showing 11
All A B C D E F G H I J L M N O P Q R S T U V W X Y Z
All kinds Claim workflow (9) Clinical atlas — condition (106) Clinical atlas — medicine (87) Confusion pair (11) Disability / incapacity (33) Dispute hub (2) Evidence gap (6) Glossary (27) Language map (20) Life insurer (85) Module (8) Needs definition (15) News (3) Ombud guidance (4) Ombud precedent (9) Policy scan (12) Policy trap (11) Rejection ground (12) Social Security Compass (36)
A
- Appeal-story trap Policy trap Internal review and ombud processes reward issue-by-issue responses — policy clause, insurer fact, your evidence, cure action, remedy sought. Unstructured anger or long personal essays rarely shift technical declinatures.
D
- Date trap Policy trap Each date triggers different policy effects — waiting-period satisfaction, late-notice declinature, pre-existing look-back, and rejection timelines. Mixing them in one narrative gives insurers an easy administrative escape.
- Diagnosis trap Policy trap Insurers may accept your ICD-10 code or specialist diagnosis but still dispute incapacity. The policy test is whether symptoms prevent the material duties of your own occupation — not whether a condition name sounds severe on paper.
E
- Employer-record trap Policy trap Insurers often rely on employer-controlled records for DOA, attendance patterns, and role confirmation. If those records were never requested or are incomplete, adverse findings may rest on silence.
G
- Gross-benefit trap Policy trap Headline replacement ratios ignore offsets for other income, pension contributions, medical aid, UIF, tax treatment, and payment route. Net entitlement can differ materially from the quoted percentage.
J
- Job-title trap Policy trap Insurers, IME assessors, and employers often reason from a generic job title instead of how the role actually runs — client load, deadlines, cognitive demand, site travel, supervision duties, and error risk. Own-occupation cover fails when the assessed role is narrowed to sedentary admin that is not your material duties.
M
- Mitigated-state trap Policy trap WHO-ICF splits capacity (unaided, standard setting) from performance (with treatment, aids, and environment). South African income-protection wording typically assesses the treated/mitigated state and requires ongoing care. The ADA, UK Equality Act, and SA EEA Code often look at the unmitigated baseline for disability status. An assessor who treats 'stable on medication' as capacity for work is using the wrong axis for an IP test — and the opposite error (demanding unaided function on an IP claim) is equally wrong.
P
- Policy-vs-guide trap Policy trap Marketing brochures, employer HR packs, and claim-form checklists are not the policy contract. When wording drifts, insurers may rely on the narrowest binding clause — especially on exclusions, waiting periods, and evidence duties.
- Pre-existing trap Policy trap Insurers separate baseline conditions, look-back periods, treatment before cover, and post-inception deterioration. A historic label on a script does not automatically defeat cover if duties stopped after cover started for a worsening trajectory. South African group wording is often two-limb (look-back AND disablement in the first twelve months). Australian files split the PDS definition, Insurance Contracts Act s 47 awareness, and a separate non-disclosure remedy.
S
- Specialist-evidence trap Policy trap Insurers may reject for absent consultant reports or IME findings without a clear prior request ladder. The fairness of the rejection depends on notice, specificity, and whether occupational duties were correctly described to the assessor.
T
- Threshold-shift trap Policy trap Employers, guides, or claim forms may suggest a lower evidence threshold than the policy test applied later. Insurers sometimes shift from own-occupation to any-occupation reasoning without clear disclosure.