Own-Occupation Definition

The inability to engage in substantial gainful activity (SGA) because of a medically determinable impairment expected to last at least 12 months or result in death — Social Security uses a strict, all-or-nothing definition of disability: the worker must be unable to engage in substantial gainful activity (SGA) due to a medically determinable physical or mental impairment that has lasted or is expected to last at least 12 continuous months or to result in death. The standard considers the worker's age, education, and work experience, and it is much stricter than private disability insurance's own-occupation definition. Temporary injuries and partial impairments do not qualify; loss of a limb is not automatically disabling if the person can still perform SGA.

National insurance concept

Total disability means the insured cannot perform the duties of their occupation or any occupation, depending on the definition; partial disability means the insured can work but at reduced capacity or income — Total disability is defined by the inability to perform occupational duties: under an own-occupation definition, the duties of the insured's own occupation; under an any-occupation definition, the duties of any occupation for which the insured is reasonably suited. Partial or residual disability exists when the insured can work but at a reduced level or reduced income, allowing a proportional benefit. The duration of the disability does not define the distinction; the degree of incapacity to work does, and the policy language determines which standard the insured must meet to qualify for full benefits.

National insurance concept