Everyday language
What does it feel like?
Everyday words describe the person’s lived experience. They matter, but they do not by themselves establish the policy test.
QuestionWhat is happening to me?
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ClaimHub Resources · Language map
One claim.
Four vocabularies.
A person may say “I’m too sick to work.” A clinician may describe a diagnosis. An employer sees duties. The policy asks a different question again. The claim becomes clearer when those languages are connected instead of treated as interchangeable.
Plain-language explanations
Claim-specific examples
Links into ClaimBuddy
The policy ultimately asks
Can you perform the material duties of the insured occupation?
Interactive explainer
Watch the claim change as the language becomes more precise.
Select each layer. The point is not that one language is “better”; each answers a different question.
→
The claim ladder
Move from condition to insured impact.
Click a rung to expand it. A strong claim connects all four instead of jumping straight from a diagnosis to “disabled”.
Common confusion points
These pairs look similar. They are not the same.
Flip each card to see the practical distinction and the claim implication.
Diagnosis
Medical label — what the condition is called
Disability
Policy outcome — whether you meet the insured work test
Claim tip
Open full comparison →
Always pair each diagnosis with duty-impact evidence.
Illness
Everyday health problem language
Incapacity
Policy trigger word for when benefits logic starts
Claim tip
Open full comparison →
Build a date ladder: symptom onset → cannot perform duties → DOA → first notice.
Total disability
Usually: cannot perform the insured occupation (or no work/earnings from it)
Partial disability
Some work continues; benefit often a proportion of the total benefit from an earnings or hours drop
Claim tip
Open full comparison →
List duties that stopped and duties that continue. Capture pre-disability versus current earnings and hours. Do not volunteer light duties without reading the residual clause.
Pre-existing condition
Exclusion clocks and causation — look-back, first-year window, what caused disablement
Date of Absence
When policy incapacity / duties-stopped is deemed to have begun
Claim tip
Open full comparison →
Build both clocks: look-back notes versus the day material duties stopped. Do not let a later diagnosis or an earlier ache move DOA without evidence.
Injury
Event-based harm
Illness
Disease, disorder, or deterioration — often no single accident
Claim tip
Open full comparison →
Document the story: sudden event vs gradual onset.
Symptom
What you feel
Functional limitation
What you cannot do at work because of it
Claim tip
Open full comparison →
Use format: "Because of [symptom], I cannot [duty]."
Capacity (unaided)
WHO-ICF: what you can do without aids in a standard setting
Performance (with treatment)
WHO-ICF: what you actually do with treatment, aids, and environment
Claim tip
Open full comparison →
Write both: function without current treatment, and function on the treatment you actually take — including side-effects.
Functional capacity
Work-duty performance
Activities of daily living
Home/self-care tasks
Claim tip
Open full comparison →
Confirm which test your policy clause actually uses.
Impairment
Clinical reduction in function
Disability (policy)
Contractual benefit entitlement test
Claim tip
Open full comparison →
Translate impairment findings into material-duty language.
Sickness
Colloquial absence from work
Incapacity
Defined policy concept with date and test consequences
Claim tip
Open full comparison →
Do not assume employer sick-note acceptance equals insurer incapacity acceptance.
Job title
Label on contract or email signature
Material duties
Tasks that actually define whether you can work
Claim tip
Open full comparison →
Describe duties from reality, not business card.
Explore the language
Search and filter the map.
⌕
01
What people say
Everyday words — loose, emotional, not policy tests
🤒
What people say
Sickness
Feeling unwell or off work for health reasons — often short and vague.
This is
- A casual way to say you cannot work today
- May appear on sick notes or HR forms
This is not
- A policy disability test
- Proof that benefits are payable
Policy angle
Policies rarely define 'sickness' on its own. Look for incapacity, disability, or inability to perform duties.
Evidence that helps
Sick note, HR absence record
Often mixed with: Illness, Incapacity
"I have been off sick for two weeks."
🩺
What people say
Illness
A health problem — usually disease or disorder, mental or physical, often ongoing.
This is
- Broader than a single sick day
- Covers depression, cancer, chronic pain, autoimmune disease, etc.
This is not
- Automatically the same as 'injury'
- The same as policy 'disability'
Policy angle
People say 'illness'; policies say 'incapacity' or 'disability'. The policy tests work impact, not the word illness.
Evidence that helps
Diagnosis, treatment records, specialist letters
Often mixed with: Condition, Diagnosis, Disability
"My illness started after a stressful project period."
🩹
What people say
Injury
Harm from a specific event — accident, fall, surgery, assault, sport trauma.
This is
- Usually has a when/where/how story
- Often documented in hospital or casualty records
This is not
- Every medical problem (many illnesses have no single injury event)
- Automatically excluded or covered — check policy
Policy angle
Some policies split accident vs illness benefits or apply conduct exclusions to self-inflicted injury. Read exact wording.
Evidence that helps
Hospital report, ICD external-cause codes, employer incident report
Often mixed with: Illness, Condition
"Back injury after lifting equipment on site."
📋
What people say
Condition
Neutral umbrella for any diagnosed or reported health issue.
This is
- Useful when you are unsure of illness vs injury
- Common on forms and medical certificates
This is not
- A substitute for explaining work impact
- A policy-defined claim ground by itself
Policy angle
Insurers may latch onto a condition label (e.g. 'anxiety') without assessing duty impact — that is the diagnosis trap.
Evidence that helps
Medical certificate, specialist report
Often mixed with: Diagnosis, Pre-existing condition
A form may say 'pre-existing condition' — that does not automatically defeat post-cover deterioration.
02
What doctors write
Clinical record language — facts about health, not your job
🏷️
What doctors write
Diagnosis
The medical label a doctor assigns — a name for what they think you have.
This is
- ICD-10/11 code, specialist opinion, hospital discharge summary
- Starting point for medical chronology
This is not
- Proof you cannot work
- The insurer's final decision
Policy angle
Strongest trap in IP claims: rejection because 'diagnosis not severe enough' when the real test is occupational function.
Evidence that helps
Consultation notes, specialist report, hospital summary
Often mixed with: Disability, Incapacity, Symptom
"Major depressive disorder" on a script is a diagnosis, not a disability finding.
💫
What doctors write
Symptom
What you experience — pain, fatigue, brain fog, panic, nausea, weakness.
This is
- Subjective but real
- Often what makes duties impossible day to day
This is not
- Always visible on tests
- Less important than diagnosis — symptoms drive function
Policy angle
Mental illness and pain clauses sometimes demand 'objective' evidence. Functional mapping still links symptoms to duties.
Evidence that helps
Your symptom log, doctor notes, medication side-effect record
Often mixed with: Diagnosis, Functional limitation
"Cannot concentrate for more than 20 minutes" is a symptom with direct work impact.
📉
What doctors write
Impairment
Medical loss or reduction of body or mind function — clinical, not occupational.
This is
- Used in reports, RFC forms, disability assessments
- Can exist without total work absence
This is not
- The same as policy disability
- Only about job title
Policy angle
Impairment % from a medical board does not automatically equal IP benefit entitlement under own-occupation wording.
Evidence that helps
Functional assessment, specialist impairment rating
Often mixed with: Functional limitation, Disability
30% whole-person impairment may still prevent your specific consulting role.
🔭
What doctors write
Prognosis
Doctor's view of likely future course — recovery, stability, or deterioration.
This is
- Supports waiting-period and benefit-duration arguments
- Needed when insurer expects return to work
This is not
- A guarantee of outcome
- Optional fluff — it shapes benefit period disputes
Policy angle
Temporary vs permanent disability clauses hinge on prognosis language — capture exact doctor wording.
Evidence that helps
Specialist letter, treating practitioner opinion
Often mixed with: Diagnosis, Functional capacity
"Guarded prognosis with episodic relapse" affects return-to-work expectations.
03
What work needs
The bridge insurers actually care about — can you do the job?
⚙️
What work needs
Functional capacity
What you can and cannot do in real life — especially material work duties.
This is
- Attendance, stamina, cognition, safety, reliability, travel tolerance
- The evidence insurers often say is 'missing'
This is not
- A diagnosis
- Your job title
- A generic sick note alone
Policy angle
Own-occupation IP claims live or die here. This is the bridge from medical notes to policy test.
Evidence that helps
Duty-impact statement, OT report, detailed doctor questionnaire
Often mixed with: Diagnosis, Disability, Activities of daily living
"Cannot manage client deadlines, supervision, or site travel" = functional, not just medical.
🎯
What work needs
Material duties
Core tasks that actually matter in your role — not incidental admin.
This is
- Client delivery, decision-making, safety oversight, billable hours, error risk
- Defined from contract, JD, and reality
This is not
- Job title alone
- Every minor task in a long HR description
Policy angle
Job-title trap: 'manager' understates cognitive load, client pressure, or travel demands.
Evidence that helps
Job description, performance reviews, your own duty list, employer statement
Often mixed with: Occupation, Own occupation
Job title 'Partner' on a letterhead is not sedentary admin if the role needs client-facing pressure.
🚧
What work needs
Functional limitation
A specific barrier — X symptom stops Y duty, with severity and frequency.
This is
- Structured links: fatigue → cannot finish workday; anxiety → cannot present to clients
- Feeds doctor questionnaire and claim pack
This is not
- Vague 'I feel terrible'
- A diagnosis restated without duty link
Policy angle
Build a limitation matrix: limitation → duty affected → medical source → still missing evidence.
Evidence that helps
Symptom log mapped to duties, OT/psych report, employer observation
Often mixed with: Symptom, Impairment
"Medication morning sedation prevents 08:00 client meetings three days per week."
🏠
What work needs
Activities of daily living (ADL)
Basic self-care and home tasks — dressing, bathing, cooking, mobility.
This is
- Common in severe disability and lump-sum policy tests
- Sometimes used in medical assessments
This is not
- The main test for own-occupation income protection
- A substitute for work-duty evidence
Policy angle
ADL-focused evidence may not answer whether you can perform your occupation — know which test applies.
Evidence that helps
OT ADL assessment, hospital rehab notes
Often mixed with: Functional capacity, Material duties
Can shower independently but still cannot sustain a full consulting day — different tests.
04
What policies test
Binding claim language — definitions in your policy wording
📜
What policies test
Disability
Policy-defined inability to meet the insured disability test — not a medical opinion.
This is
- Defined in policy wording — own occupation, any occupation, partial, etc.
- What the insurer must decide
This is not
- Whatever a doctor wrote on a certificate
- A universal medical status
Policy angle
Always ask: which test applies now — Initial Period own occupation vs Extended Period any occupation?
Evidence that helps
Policy clause, functional-duty proof, insurer assessment file
Often mixed with: Diagnosis, Impairment, Incapacity
Policy may require inability to perform material duties of own occupation for 6+ months.
📅
What policies test
Cover start
When your group income protection membership or benefit cover began.
This is
- Date on policy schedule, member certificate, or HR benefits confirmation
- Used for pre-existing condition and eligibility arguments
- May differ from employment start date
This is not
- The same as symptom onset or Date of Absence
- Automatically the day you joined the employer
- Proof that a claim must be accepted
Policy angle
Commencement of cover clauses often require you to be actively at work. Insurers use this date for look-back and pre-existing exclusions.
Evidence that helps
Policy schedule, member certificate, HR benefits pack, employer confirmation
Often mixed with: Employment start, Symptom onset, Waiting period
Cover from 1 Mar 2022 on schedule — insurer may argue symptoms before that date are pre-existing.
⏳
What policies test
Waiting period
Deferred or elimination period — continuous absence/incapacity before benefits start.
This is
- A fixed period defined in policy wording (days or months)
- Measured from Date of Absence or first day of incapacity — check your clause
- Requires continuity evidence across the whole period
This is not
- The same as symptom onset or your first sick note
- Optional — most group IP policies have one
- Automatically over because HR accepted absence
Policy angle
Also called deferred period or elimination period. Benefits usually start only after you satisfy this period without recovery gaps that reset the clock.
Evidence that helps
Policy schedule, absence register, medical certificates covering full period, employer statement
Often mixed with: Symptom onset, Date of Absence, Sickness, Incapacity
3-month waiting period from DOA — insurer may dispute if you returned to light duties for one week mid-period.
⛔
What policies test
Incapacity
Unable to work (or meet earnings) as defined by the policy — close cousin to disability.
This is
- Common label in SA group income protection policies
- Often tied to Date of Absence and waiting period
This is not
- Any day you feel too ill to attend
- Automatic because HR accepted a sick note
Policy angle
Date of Absence usually marks when incapacity began for benefit purposes — a different date from symptom onset or first sick note.
Evidence that helps
Policy definition, chronology, employer statement, medical records
Often mixed with: Sickness, Disability, Date of Absence
Incapacity for policy purposes may start when you cannot perform material duties, not first mild symptoms.
📆
What policies test
Date of Absence
The date incapacity began for policy purposes — often when material duties stopped, not first symptoms.
This is
- Anchor date for waiting period and benefit chronology
- Recorded by you, employer, and insurer — may differ between them
- Often the day you could no longer perform core occupational duties
This is not
- The same as symptom onset or first mild sick day
- Automatically the date on your first medical certificate
- Chosen by you alone — insurers calculate and may dispute it
Policy angle
DOA disputes are common. Insurers may select an earlier date (pre-existing) or later date (light duties). Build a date ladder with evidence for each rung.
Evidence that helps
Employer absence register, medical certificates, duty-impact statement, insurer claim file
Often mixed with: Symptom onset, Incapacity, Waiting period, Cover start
Symptoms from March; stopped client-facing duties 12 June (your DOA); first certificate 14 June.
◐
What policies test
Total vs partial disability
Two policy doors, not two medical grades: total usually means you cannot perform the insured occupation; partial (residual) means some work continues and earnings or hours have dropped.
This is
- A wording choice in the policy — total, partial, residual, or proportionate
- Often an earnings or hours formula once some work continues
- Still a duty test: residual usually requires that you cannot do one or more material duties
- Capable of flipping over time — total in month one, residual on a graded return
This is not
- A medical severity score (mild / moderate / severe is not the test)
- The same as temporary versus permanent
- Automatically total because you have a serious diagnosis
- Automatically partial because you answered an email from the sofa
Policy angle
Read the residual / partial clause before you accept a total-disability frame — or before you volunteer light duties. Many Australian and South African IP wordings pay a proportion of the total benefit when current earnings sit below the baseline the formula uses (sometimes with a minimum drop, often 20%). Hours-based formulae exist too. Offsets, the waiting period, and own occupation versus any occupation still apply. This is organisation of the test, not a calculation of your claim.
Evidence that helps
Pre-disability payslips and hours, current payslips and hours, duty list of what stopped versus what continues, employer confirmation of light duties, policy residual clause and definition of pre-disability earnings
Often mixed with: Temporary disability, Functional limitation, Own occupation, Material duties, Disability
Reduced from five client days to two, earnings at 40% of the old figure — that is often argued as partial / residual, not as a failed total-disability claim.
🕰️
What policies test
Pre-existing condition
A policy exclusion with clocks and causation — not ‘anything a doctor ever wrote’. Look-back window, disablement window, and what actually caused duties to stop.
This is
- A clause that can exclude disablement caused by a condition known, treated, or symptomatic in a defined period before cover
- Often two clocks on South African group wording: look-back (commonly six months) and first twelve months of cover
- In Australia, a PDS definition plus Insurance Contracts Act s 47 (awareness) — and a separate non-disclosure remedy
- A matter the insurer usually has to prove, with contemporaneous notes, not a later summary
This is not
- Every old diagnosis on a script or medical-aid history
- Automatically the same as non-disclosure or a retrospective exclusion added at claim stage
- Proved by a historic injury years before the look-back (NFO CR403)
- Still alive on typical SA group wording if disablement falls after the first twelve months (NFO CR356)
Policy angle
Read the actual exclusion: whose knowledge, which months, whether symptoms without treatment count, and whether disablement must fall inside a first-year window. Separate a stable baseline from a new post-cover event. South African group files often follow NFO CR356 (two limbs) and CR403 (onus and causation). Australian files split PDS wording, s 47 awareness, and ICA s 29 disclosure. This is organisation of the test — not a decision on your claim.
Evidence that helps
Cover start / entry date, look-back medical notes, occupational-health or fitness clearances just before cover, first advice or treatment dates, new-event records, date duties stopped, treating opinion on causation
Often mixed with: Diagnosis, Cover start, Date of Absence, Illness, Waiting period
Back injury in 2003, cover in 2016, leg weakness from 2017 — the 2003 label is not the six-month look-back the clause asked for.
👔
What policies test
Own occupation
Policy test: cannot perform material duties of the job you actually do.
This is
- Usually applies in Initial Period
- Needs real duty evidence, not generic title
This is not
- Any job you could theoretically do
- A medical impairment percentage
Policy angle
Extended Period may shift to any/suitable occupation — track when the test changes.
Evidence that helps
Material duties list, functional statement, employer role confirmation
Often mixed with: Material duties, Suitable occupation
Cannot perform your actual consulting role even if you could do sedentary admin elsewhere.
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Apply it to the claim
Reference language becomes useful when it is tied to the person’s actual work and evidence.
Use ClaimBuddy to capture material duties, functional limitations and dates. The shared case record then carries the claimant’s evidence into ClaimHub.