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?