Pennsylvania Code
Title 31 - INSURANCE
Part IV - Life Insurance
Chapter 88 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE MINIMUM STANDARDS
DEFINITION OF TERMS
Section 88.137 - Total disability

Universal Citation: 31 PA Code ยง 88.137

Current through Register Vol. 54, No. 44, November 2, 2024

(a) For the first 24 months after the commencement of a loss, "total disability" shall be defined as the inability of the insured to perform all the substantial and material duties of his regular occupation. After 24 months of continuous disability, total disability may be defined as the inability of the insured to perform all of the substantial and material duties of any occupation for which he is reasonably suited by reason of education, training, or experience. The definition may require that the insured not in fact be engaged in any occupation for wage or profit.

(b) Total disability may be defined in relation to the inability of the person to perform duties but such inability may not be based solely upon the ability of an individual to:

(1) Perform "any occupation whatsoever" or "any occupational duty."

(2) Engage in any training or rehabilitation program.

(c) The definition may require regular care and attendance by a physician, other than the insured or a member of the insured's immediate family. The definition may require that the total disability be "continuous" or "uninterrupted" for a specified period of time or to a specified age which shall be consistent with the type of coverage afforded.

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