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Disability Income Insurance: Individual: 101

Definition of Total Disability

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A Disability Insurance Policy promises to pay benefits should you become "totally disabled." Disability policies generally have two definitions of total disability: "Own-occupation" and "Any-suitable-occupation." Some policies include both "Own occupation" and "Any-suitable-occupation" definitions.

Another common provision a listing of conditions for which a person is presumed to be disabled.

It is common for disability policies to include other provisions concerning the definition of "total disability" such as a requirement that:

  • You must be under the regular care of a licensed physician other than yourself.
  • You must not be gainfully employed in any occupation for which you are or become qualified.

Own-occupation

Under an "own-occupation" disability policy you are "totally disabled" if you are unable to perform the material duties of your own occupation. For example, if you are a surgeon, you injure your hand and can no longer perform surgery. You are "totally disabled" within the definition of this type of policy because you can no longer perform your own occupation, even though you could still continue to practice as a doctor.

Any-suitable-occupation

Under an "any-suitable-occupation" policy you are totally disabled if you are unable to perform the material duties of any occupation for which you are reasonably suited by education, training, or experience. For example, if the surgeon with the hand injury had this definition in her policy, she would not be considered to be totally disabled because she could still practice medicine as a doctor, just not as a surgeon.

Both definitions

Even though there are policies available which apply an "own-occupation" definition for the life of the disability, many disability policies use both "own-occupation" and "any-suitable-occupation" definitions. The "Own-occupation" definition is generally applied during the first two years of disability, and the "any-suitable-occupation" definition starts after two years.

Applying this combination of definitions to the above example of the surgeon, she would only be eligible for benefits for the first two years of her disability. After that she would not be totally disabled because she could perform any-suitable-occupation: she could work as a doctor.

Presumptive disability

Most individual disability policies contain a provision that you will be presumed to be disabled if certain events occur, For example, a common provision is that you will be considered to be totally disabled if you lose use of two or more limbs or the total loss of sight.


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