Chris is an insured bricklayer who severed his left hand in an automobile accident. Although his primary duty cannot be performed, Chris is also a substitute high school teacher. He collects a full disability income check every month. How does his policy define total disability?
The Correct Answer Is:
c. Own occupation
Correct Answer Explanation: c. Own occupation
Chris’s insurance policy defines total disability as “own occupation.” This means that Chris is considered totally disabled if he is unable to perform the duties of his specific occupation as a bricklayer, even if he is able to work in another capacity, such as being a substitute high school teacher.
In Chris’s case, even though he is able to work as a substitute teacher after his accident, he is still considered totally disabled according to his policy because he is unable to perform his primary duty as a bricklayer. This distinction is important because it ensures that Chris continues to receive his full disability income check every month.
Now, let’s go over why the other options are not correct:
This option is not relevant to the scenario provided. Recurrent disability typically refers to a situation where the insured person experiences periods of disability followed by periods of recovery, with the disability recurring over time.
Since Chris’s disability is permanent (he severed his left hand), the concept of recurrent disability does not apply here.
b. Any occupation:
This option would imply that Chris is only considered totally disabled if he is unable to perform any occupation for which he is reasonably suited by education, training, or experience.
However, in Chris’s case, he is still able to work as a substitute high school teacher, which means he could potentially perform other occupations. Therefore, “any occupation” does not accurately describe Chris’s situation.
This option is also not applicable in this scenario. Presumptive disability typically refers to a situation where certain severe conditions or injuries automatically trigger a disability benefit, regardless of whether the insured can still perform their occupation.
Chris’s situation does not fall under the category of a presumptive disability, as it is based on the nature of his specific injury and its impact on his ability to work as a bricklayer.
In conclusion, Chris’s insurance policy defines total disability as “own occupation,” which means he is considered totally disabled because he cannot perform his primary duty as a bricklayer, even though he can work in a different capacity as a substitute high school teacher.
This distinction is crucial for ensuring that Chris continues to receive his full disability income check every month. This distinction enables Chris to receive the necessary financial support to navigate the challenges posed by his severe injury and maintain a stable source of income during his recovery.