Introduction

This section reviews the issues which may arise in advancing a claim for disability benefits commencing from an application for short term disability through to a disability which may last beyond the date of trial.

The test for benefits is examined step by step through the consecutive stages of the process of the application. This includes an analysis of the initial threshold test for eligibility and the differing tests for benefits as time proceeds over the elimination period, “own occupation” and “any occupation” periods as is usually defined in the group policy. An understanding of the successive steps is important to counsel acting for the individual as a vulnerability in any one will surely lead to a defence from the insurer.

The issue of the recurrent disability is also reviewed. This is particularly important when the insured is no longer employed and hence has no insured employment to which they may return.

Also discussed is the question of what other sums received by the insured may operate to reduce the benefit claim.