Last Class Review

• Uniform Determination of Death – Either

• circulatory and respiratory functions, or

• brain dead– Rebuttable presumption is

death certificate• Suicide

– Sane or insane language covers all suicide

– Unique Maryland difference• Incontestibility: 2 years for

misrepresentations

Last Class Review Continued

• What is the test as to how you can change beneficiaries? Either strict compliance or…– Intent– Affirmative action

• Indirect Hookup Rule• Possible rules to deal with:

– Georgia bright line rule– Factual determination – is the killer getting an indirect

benefit• Definition of “accidental death”

– Is there a means v. results distinction?

Final Point From Last Class

• No pop culture references that don’t come from US.

Occupational Disability Insurance

• Burden of proof: person claiming disability

• Test for “totally disabled”: no longer able to perform the 'material' and 'substantial' responsibilities of his or her job.

• Occupational disability policies are designed to indemnify against loss of capacity to work, not against loss of income.

Occupational Disability

• Shapiro– Dentist– 90% of his time was spent fixing the teeth of

patients– Makes more money doing administrative

dentistry

General Disability

• Test: inability of the insured to engage in his regular occupation or in any gainful occupation for which he is reasonably fitted by education, training or experience.

• What kind of insurance do you have? Turn to the policy.

• Facts of Wooley

Health Coverage Issues

• Defining the terms of “loss”– Shelton

• Medical appropriateness– Fuller

Granuloma

– Granuloma ball-like collection of immune cells which forms when the immune system attempts to wall off substances that it perceives as foreign but is unable to eliminate

Health Care

• Defining the terms of “loss”– Shelton

• What is the definition of sickness?

• Medical appropriateness– Fuller– Shelton vs. Fuller reversal– How do you parse it out?– Defining “not necessary”

• Our health care problem– Mandatory insurance?