Last Class Review

1
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

2
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?

3
Final Point From Last Class

• No pop culture references that dont come from
  US.

4
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.

5
Occupational Disability

• Shapiro
• Dentist
• 90 of his time was spent fixing the teeth of
  patients
• Makes more money doing administrative dentistry

6
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

7
Health Coverage Issues

• Defining the terms of loss
• Shelton
• Medical appropriateness
• Fuller

8
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

9
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?