Permanent and total disability means that an individual has some physical or mental
impairment, disease, or loss, from which recovery or marked improvement cannot be
expected, and which substantially precludes him from engaging in useful occupation
within the range of his mental capacity and educational skill.
The term “disability” encompasses one or more organic or functional impairments that interfere with the
individual's faculties, such as senses, reasoning, mobility, and the like. These impairments
may be physical or mental. They may exist from birth, be acquired during the lifetime
of an individual, or result from accident. They may be obvious or they may be such
that they can be revealed only by medical examination. They may be static or progressive.
They may exist singly or in combination.
“Permanently” refers to the duration of the impairment or combination of impairments. A conditon
of permanent disability is deemed to exist when a medical report and social history
are available showing a physical or mental impairment, disease or loss, verifiable
by medical findings, which is not likely to improve or which will continue throughout
the lifetime of the individual.
The term “permanent” is to be defined, however, in a practical manner rather than in an absolute sense.
It is not to be used necessarily in the sense of “everlasting” or “unchangeable” but in the sense of “continuing” rather than “temporary” or “transient”. It does not rule out the possibility of improvement, rehabilitation or even recovery
from the impairment. Individuals sometimes will respond favorably to treatment after
an unfavorable prognosis or after the condition becomes arrested. The discovery of
new drugs or other advances in medical treatment is always a potential which may change
a “permanent” situation.
Any condition considered by the Medical Review Team as not likely to respond to any
known therapeutic procedures shall be deemed to be permanent. Furthermore, any condition
considered as likely to remain static or to become worse, unless therapeutic measures
are carried out, shall be deemed to be “permanent” so long as treatment is unavailable, inadvisable, impractical, or the individual
reasonably refuses treatment. An impairment, such as injury or illness, however, from
which complete recovery can be expected in a period of less than nine to twelve months
cannot be considered to fall within the interpretation of permanent disability.
“Totally” is related to the degree of disability. A condition of “total disability” is deemed to exist when medical report and social history are available showing a
major impairment resulting in limitation of function which substantially precludes
the individual from engaging in useful occupation within his physical and mental competence.
“Totally”, therefore, as “permanently” is not defined here as an absolute term. The impairment must be of major importance,
but it is to be considered in relation to the person's ability to get along in his
life's situation in the light of this impairment.
As functioning members of society, adults ordinarily are expected to take care of
themselves and their families. For some people this means engaging in gainful employment.
For others, it means the maintenance of a home and caring for children. In order to
function in such roles, an individual must be able to perform a variety of activities.
The individual's capacity for functioning as a normal adult will be determined by
relating the activities, which he can actually carry out, to the activities necessary
for an employed person, homemaker, or a person responsible for his own personal care.
The definition is intended to exclude any individual who is able to carry on a substantial
amount of activity, such as that required of a person keeping house for himself and
others, or a person who is even partially employable. It is not intended to exclude
the individual who can perform minor activities which are primarily of therapeutic
value for him, but which may possibly provide some small irregular earnings. Neither
is it intended to exclude the person who can manage only the minimum of activities
necessary to living alone and caring for himself.