International Styles

The Definition of Disability

The difficulty of ascertaining what constitutes total and permanent disability is one of the main objections that has been advanced against this clause. Disability may be defined with reference to its effect upon the occupation or profession of the insured or it may be defined with reference to the causes of disability. In the first case the disability that is of consequence to the insured is that which renders him totally and permanently incapable of fulfilling the duties of his own occupation. An injury to the fingers of a concert violinist, for instance, may totally incapacitate him thereafter from carrying on the duties of his profession and he is in this sense totally disabled. The same injury would be of little consequence to a commercial salesman. Loss of speech on the other hand would mean to the latter inability to follow his profession but might scarcely affect the violinist. In this way it might be shown that there are many injuries, diseases, and defects that have vastly different effects on the earning capacity of men in different occupations. If protection is to be obtained against the financial consequences of disability these different results must be considered in defining the clause offering such protection. The usual form of definition requires that "the insured shall furnish due proof that he has become wholly and permanently-disabled by bodily injury or disease such that he is and will be permanently, continuously, and wholly prevented thereby from performing any work for compensation or profit....." This definition does not consider disability from the standpoint of its financial consequences to the insured. Literally interpreted, the violinist is not disabled by an injury to his fingers, since he may now become a salesman. Such interpretation neglects the fact that transitions from one profession to another are difficult and sometimes disastrous to the person concerned. In spite of the fact that all clauses are stated in this way many companies no doubt will not interpret them with such severity as is suggested above. The practice of liberal interpretation is followed in connection with other features of the policy contract in cases where fraud and dishonesty are not present $nd such liberality will certainly be extended to .the, interpretation of the disability clause.

Disability may be further defined with reference to the causes, of disability. From this viewpoint the clause quoted above has much:to commend it. It promises benefits for disability due to bodily injury or disease, and that bodily injury and disease probably cover, the majority of cases is evident from the data on page 296. Bodily injury and disease, therefore, cover all cases with the possible exception of the last or miscellaneous group, the composition of which is unknown. A large majority of clauses define, disability in this way. Some add the following, specific cases, taken probably from the contracts of the accident and health companies;: "The entire and irrecoverable loss of the sight of both eyes, or the severance of both hands above the wrists, or of both feet above the:ankles, or of one entire hand and one entire foot." In a few cases specific mention is made of deafness arid insanity as acceptable cases of disability; dumbness is nowhere: referred to, but is equally important with the above. A very few companies agree to pay benefits upon the occurrence of disability from any cause whatsoever. There is no doubt as to the scope of this definition.

A few companies issue clauses that place limitations upon the causes which will be acceptable for the payment of benefits. Some of these restrictions are of slight consequence, as the following examples show: Disability must not be due (1) to wilful or immoral acts on the part of the insured, (2) to intoxication, (3) to actual or attempted violation of law, or (4) to military or naval service in time of war. A few clauses refuse to accept bodily injury as a cause of disability. In the aggregate this comprises but 4.4 percent, of all disability according to the above data, but the risk of accident disability is, nevertheless, of much importance to the individual. The worst examples of restriction, however, are found in those few clauses which pay benefits only in case disability is due to accidental injury. Disease, which causes a large percentage of all disability, is not covered, and protection is furnished against only 4.4 percent, of the total risk.

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