ClaimHub Resources · Policy language
Understand the words that shape the insured test, the common trap attached to each term, and the evidence that usually matters. Each term links to a deeper explainer and, where relevant, the Language Map.
9 terms shown
The policy outcome if you meet the disability test — usually inability to perform material duties of your own occupation.
Trap: Diagnosis trap — a certificate label is not the test.
Evidence: Duty-impact matrix, occupation profile, treating-doctor answers to the policy test.
Open explainer →Continuous incapacity that must run before benefits start — often measured from Date of Absence.
Trap: Date trap — mixing sick days with DOA resets or fails the period.
Evidence: Absence records, sick notes covering the full period, insurer DOA.
Open explainer →The date the policy treats incapacity as having begun — often not the first sick day.
Trap: Date trap — employer, doctor, and insurer frequently pick different dates.
Evidence: Separate fields for symptom onset, first sick note, your DOA, insurer DOA.
Open explainer →Ongoing inability to perform insured duties under policy rules — not the same as HR sick leave.
Trap: Illness vs incapacity confusion.
Evidence: Functional-capacity statement mapped to material duties.
Open explainer →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.
Trap: Not the same as the policy disability test, and not the same as a discrimination-law 'person with a disability'.
Evidence: Policy wording, COIDA vs IP distinction, ICF capacity vs performance.
Open explainer →WHO-ICF: capacity is what you can do unaided in a standard setting; performance is what you actually do with treatment, aids, and environment.
Trap: Mitigated-state trap — IP usually assesses treated performance; ADA/UK/EEA guidance often looks at the unmitigated baseline.
Evidence: State which axis the assessor used, and keep both scores if they differ.
Open explainer →Initial-period test: can you do the material duties of your actual role, not any job.
Trap: Job-title trap — generic titles understate the role.
Evidence: Job spec, duty list, employer confirmation.
Open explainer →When cover commenced — compared to symptom history and pre-existing look-back.
Trap: Pre-existing trap.
Evidence: Member certificate, scheme start date.
Open explainer →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.
Trap: Threshold-shift trap if the test changes after the Initial Period; also using leftover tasks to deny total without applying the residual clause.
Evidence: Pre-disability vs current payslips and hours, duty list (stopped vs continues), residual clause.
Open explainer →