Hi In the example of a PCA used by a major insurer on pg 17 of Ch1 total benefit is payable if you, amongst other things, 'are unable to perform at least 3 of the defined personal capabilities below'. There are 9 defined personal capabilities. Is it just me that finds this ambiguous? On first reading I thought benefit was payable if you could not do at least 3 out of 9 so you could do 2 or fewer. However, on a second read through I'm wondering if it means that there are at least 3 you cannot do? As in you can do say 5 or 6 and still claim? Which of these is the correct interpretation? Is this a standard way to express this condition? And, if I can find 2 interpretations to this surely it does not fit in with insurer's desire to have clear policy conditions??
Hi I think it's pretty clear - your latter interpretation is correct. If you fail 3 or more of the 9 tests, you can claim. So, yes, you could still be able to do upto 6 of the other tasks and still claim. I think this wording is fairly common, especially on LTCI policies (see Ch 3) where ADLs are used. It's used for defining claims on IP policies for at least one major insurer. Hope this helps.
Hi Steve Thanks for the reply. I disagree about the clarity of the definition and feel that you may only think it's clear given that you already know what it was supposed to mean. I think it could be interpreted either way but I suppose that would only be an issue if the first interpretation I gave were the intended definition. Thanks again.
