Although your client has 'own occupation' cover for permanent total disability (PTD), she does not h...
Although your client has 'own occupation' cover for permanent total disability (PTD), she does not have 'own job' cover. PTD is often seen as a catch-all benefit. It is sold to cover those situations where the client justly deserves the money but does not suffer from a critical illness. However, by using the phrase 'PTD', we may lose sight of what the benefit stands for. The benefit pays a claim where a client is totally and permanently unable to follow their own occupation.
The ABI Statement of Best Practice defines occupation as 'a trade, profession or type of work undertaken for profit or pay. It is not a specific job with any particular employer and is independent of location.' This means a client is likely to have to be severely disabled to make a claim.
If your client was unable to return to teaching, the insurer should pay the claim, but as she suffers from stress, her condition may not be permanent. For example, she may be able to teach a different age group at another school. So although your client cannot do her own job, she probably does not qualify for PTD.
If you do have more medical evidence which supports her claim, you can appeal to the insurer to review the decision.
Lynda Cox
