A version of this conversation happens two or three times a year, and it never starts with risk cover. A dentist in his mid forties comes in for a second opinion on his retirement plan. Somewhere in the second hour he mentions, almost as an aside, that he was off work for six weeks the previous winter after coming off a mountain bike on a Sunday morning. Nothing dramatic. A cervical injury, a course of physiotherapy, and six weeks in which he could not stand over a chair for more than twenty minutes at a time.

He has a lump sum disability benefit of several million rand. It pays nothing, because he is not permanently disabled. He has an income protection policy with a ninety day waiting period. It pays nothing, because he was back at work on day forty two. He has no group scheme, because he is the practice. His rooms, his equipment finance, his hygienist and his receptionist carried on costing exactly what they cost in a normal month.

He is, on paper, thoroughly insured. He receives nothing. The details above are a composite, drawn from conversations we have had more than once. The shape of it is entirely ordinary.

The asset nobody puts a value on

Ask a professional in their forties to list their assets and you will get the practice or the partnership interest, the house, the retirement annuity, perhaps a rental property and a share portfolio. Nobody lists the thing that produced all of it.

The arithmetic is not complicated. A professional aged thirty five earning R1 million a year, with earnings growing at 6% a year to age sixty five, will earn about R79 million over that career in nominal terms before tax. That is a straight compounding calculation on stated assumptions, not a forecast, and you can run it yourself in ten seconds on a spreadsheet. Change the growth rate and the number moves a great deal: at 8% it is over R113 million. The point is not the precision. The point is the order of magnitude. For almost every professional under fifty, the largest asset on the balance sheet is not on the balance sheet at all.

We insure the rooms against fire. We insure the car. We carry professional indemnity cover because the regulator and common sense both insist on it. And then we protect the engine that pays for all of it with whatever benefit happened to come attached to the policy someone sold us in our thirties.

Death is the risk professionals insure. Losing the ability to work is the risk they actually run.

What the claims books say

South Africa has an unusually good public record on this, because the large insurers publish their claims statistics every year. Read across them and the same shape appears.

Bidvest Life, which specialises in income protection, reported in its 2024 claims report that its clients were fifteen times more likely to claim on an income protection benefit than on a death benefit, and forty three times more likely to claim on income protection than on a lump sum permanent disability benefit. Its average temporary disability claim ran for seventy one days. More than half of the claimants, 52%, had claimed before.

The causes are consistent across insurers, and they are not the ones people expect. Momentum’s 2025 income protection claims were led by musculoskeletal conditions at 33%, then cancer at 13%, nervous system conditions at 12% and psychiatric or mental health conditions at 9%. Liberty’s 2025 disability income claims show the same ordering: musculoskeletal 21.1%, cancer 15.2%, cardiovascular 10.3%. Liberty paid R924 million for loss of income due to disability in 2025, up 19.4% on the R773 million it paid the year before. Discovery Life paid R684 million through its Income Continuation Benefit in 2025, and reported that 65% of its individual life payouts went to illness, disability and income loss rather than death.

Backs, necks, shoulders, knees and hands. Not the catastrophes we imagine when we sign the application form.

The professional problem, specifically

PPS is the useful data source here, because it insures graduate professionals and nobody else. In 2025 it paid R4.39 billion in life risk claims across 23 016 claims, up 19.9% on 2024. Its sickness benefit alone paid R983.6 million, across 6.3% more claims than the year before, and permanent incapacity payments rose 6.7% to R1 billion.

The line that should stop a professional reader is this one. In coverage of its 2025 claims, PPS reported that musculoskeletal and connective tissue conditions accounted for 14% of claims and R479.9 million in payments, and that physiotherapists, medical doctors and attorneys submitted the highest number of claims in that category. Stamina, fine motor control, concentration and long hours are not incidental to those jobs. They are the job.

This is the uncomfortable part of professional work that nobody puts in the brochure. The higher the skill, the narrower the physical and cognitive margin you are actually trading on. A surgeon does not need to be unable to work. She needs to lose a small amount of fine motor control. An advocate does not need to be incapacitated. He needs to lose the ability to concentrate for six hours at a stretch. The gap between fully functional and unable to do this particular job is, for a specialist, remarkably thin.

Three places professional cover quietly fails

The occupation definition. South African policies use language along the lines of own occupation, own or similar occupation, and any occupation. There is no industry standard set of definitions, so the wording in your schedule governs, not the label. Under an own occupation definition, the surgeon who can no longer operate has a claim. Under a broader definition, the insurer can point out that she could lecture, do medico legal work, or practise as a general practitioner.

There is a cruel logic buried in the published ombud reasoning on this. The alternative occupation test asks whether you are reasonably suited to other work by education, training and experience. In the case studies published by the former Ombudsman for Long-term Insurance, claimants with limited education and long manual work histories succeeded precisely because there was genuinely nothing else they could do. A professional is the mirror image of that claimant. Everything that makes you employable at your income also makes you employable at somebody else’s, at a fraction of it. Your qualifications work against you at claims stage. This is the single most important clause in a professional’s policy and it is the one most likely to be wrong.

Everything that makes you employable at your income also makes you employable at somebody else’s, at a fraction of it.

The waiting period. Bidvest Life’s most striking published figure is not about causes at all. Of the income protection claims it paid in 2023 on a seven day waiting period, 42% were for periods of disability of thirty days or less. Every one of those claims would have paid nothing on a thirty day waiting period. The most common reason it declines an income protection claim is not non disclosure. It is that the period off work was shorter than the waiting period the client chose.

For a salaried professional with thirty days of accumulated sick leave, a thirty day wait is a reasonable trade. For a partner in a firm or the owner of a practice, whose overheads run whether or not anyone is in the building, ninety days is a very different proposition to seven.

Lump sum standing in for income. A lump sum disability benefit pays on permanent impairment. A great deal of what actually stops professionals working is not permanent. Bidvest Life reported that 36% of its Extended Income Protection claims were for non permanent conditions that would not have qualified under lump sum disability definitions at all. The two benefits do different jobs. Holding one and assuming it covers the other is how our dentist ended up with several million rand of cover and nothing to show for six weeks off.

Two smaller traps worth naming. Insurers aggregate benefits across policies and across any employer group scheme, so a professional holding both may not receive the sum of the two. And being medically boarded by an employer is not the same event as an insurer accepting a disability claim; they are separate processes with separate tests, and one does not compel the other.

Sick leave runs out faster than anyone expects

Under section 22 of the Basic Conditions of Employment Act, an employee is entitled to paid sick leave equal to the number of days they would normally work in six weeks, over a thirty six month cycle. On a five day week that is thirty days, for three years, and the Act contains no provision for carrying unused days forward. In the first six months of employment the entitlement is one day for every twenty six days worked.

Thirty days across three years is not a safety net. It is a gesture.

And it applies only to employees. A sole practitioner, or a partner in a partnership, is not an employee and has no statutory sick leave at all. A professional who practises through an incorporated company and draws a salary from it is technically an employee of that company, so the entitlement exists on paper, but the money comes out of a business whose revenue has just stopped. The legal position differs. The economics do not.

Sizing it properly

Two things about the tax position matter for how much cover you should hold, and both are frequently misremembered.

Since 1 March 2015, premiums on income protection policies have not been deductible for personal income tax; section 23(r) of the Income Tax Act prohibits the deduction. In exchange, the benefit is received tax free under section 10(1)(gI). Correct as at the date of writing, and worth confirming with your tax adviser before you act on it.

The consequence is that you are replacing after tax income, not gross income. The old market rule of thumb of 75% of gross earnings dates from the period before the change and is now the wrong anchor. Cover is generally set against after tax income today, and several insurers will write up to 100% of it. Working off the old number is how professionals end up materially underinsured while believing they are covered.

The wider picture is not encouraging. The 2025 ASISA insurance gap study, conducted with True South and reflecting the position at the end of December 2024, found that South Africa’s 16.1 million formally employed income earners held enough life and disability cover to provide only 39% of the income their families would need. The disability portion of the shortfall alone is R29.2 trillion. The average earner needs around R3 million of disability cover and holds R1.2 million. Closing that gap would mean cutting household spending by 37% or finding roughly R9 800 a month. ASISA puts the cost of closing the disability gap at about 3% of earnings.

Two details in that study matter more for professionals than the headline. Nearly two thirds of the disability cover in force in South Africa sits in employer group schemes, which means the averages badly overstate what a self employed practice owner actually holds. And more than 85% of earners have no critical illness cover at all.

What this asks of you

The quiet point

Our dentist goes back to work, and gets properly covered: a seven day waiting period, an own occupation definition, cover sized against what he actually takes home rather than what he invoices. The remarkable thing in every version of that conversation is not that someone was underinsured. It is that they were expensively insured and still exposed, and that nobody had ever sat down and read the schedule with them.

Insurance sold well is a product. Insurance advised well is a piece of engineering: definition, waiting period, benefit term, escalation, and how it sits alongside everything else you own. The difference only becomes visible on the day you need it, which is precisely the wrong day to discover it.

If you would like someone to read your policy schedule and tell you plainly what it does and does not do, that is a conversation we are always happy to have. It does not need to end in a product, and quite often it does not.

This article is general information and not financial advice. It does not take your personal circumstances into account. Figures are drawn from the ASISA and True South Insurance Gap Study 2025, and the published 2024 and 2025 claims disclosures of PPS, Momentum, Liberty, Discovery Life and Bidvest Life. Tax and legislative positions are stated as at September 2026 and may change.