SECTION 3.3012. Policy Definition of Total Disability

(a) A general definition of "total disability" may not be more restrictive than one requiring the individual to be totally disabled from engaging in any employment or occupation for which he or she is or becomes qualified by reason of education, training, or experience, and such individual is not in fact engaged in any employment or 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 an individual's inability to:

(1) perform "any occupation whatsoever" or "any occupational duty"; or

(2) engage in any training or rehabilitation program; however, an insurer may specify the requirement of the inability of the person to perform all of the substantial and material duties pertaining to his or her regular occupation, or words of similar import.

(c) The definition may reasonably require regular care and attendance by a physician, other than the insured or a member of the insured's immediate family.

(d) The definition may require that the total disability be "continuous" or "uninterrupted" for a specified period of time or to a specified age. If the insured's total disability shall continue to such specified age or for such specified period and shall then and thereafter continue, the definition may predicate continuance of benefits on the insured's inability to perform any work or occupation for which he is reasonably trained or qualified by education or experience.

Source Note: The provisions of this §3.3012 adopted to be effective January 26, 1977, 2 TexReg 159.