Last Class Review
• Uniform Determination of
– 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
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
• 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
Occupational Disability
• Shapiro
– Dentist
– 90% of his time was spent fixing the teeth of
– Makes more money doing administrative
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 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
Shelton vs. Fuller reversal
How do you parse it out?
Defining “not necessary”
• Our health care problem
– Mandatory insurance?

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