Law Commons^™

The Marriage Of Intellectual Property And Insurance Law: An Introduction, Leo P. Martinez

Faculty Scholarship

No abstract provided.

Securitizing Insurance Risks, Tamar Frankel, Joseph W. Laplume

Faculty Scholarship

This Article analyzes and evaluates the legal problems that have arisen in connection with this rapidly developing insurance risk securitization. The first part of the Article deals with legal issues concerning the SPVs that undertake insurance and reinsurance contracts with ceding insurers and the other parties to the transaction. The Article addresses the dilemma in choosing the laws applicable to SPVs, the bonds they issue, and the persons and entities that form part of the securitization transaction. These laws involve state insurance laws, bankruptcy and tax laws, the Investment Company Act of 1940 and the Commodity Exchange Act of 1934, …

Massachusetts' Domestic Partnership Challenge: Hope For A Better Future, Jennifer Levi

Faculty Scholarship

Acknowledging that its decision means that "some household members" may be without a "critical social necessity," the Massachusetts Supreme Iudicial Court (SJC) ruled in Connors v. City of Boston that Boston Mayor Thomas M. Menino's executive order granting health insurance benefits to the domestic partners of city employees could not stand in the face of a Massachusetts state insurance law. In Connors, the SJC simultaneously recognized that although the demographics of Massachusetts households have changed within the more than forty years since the state insurance law, G.L. c. 32B (Chapter 32B), was adopted, that law nevertheless constrains municipalities from extending …

Regulating Risk In A Managed Care Environment: Theory Vs. Practice, The Minnesota Experience, Barbara Colombo, Robert P. Webber

Faculty Scholarship

The purpose of this Article is to illustrate the challenges state regulators face when attempting to translate theory into practice in the context of health care risk regulation. Section I reviews the evolution of the risk-bearing market in health care, recognizing that while risk is an inherent part of everyday life, it takes on a delicate meaning when used in the context of health care. Cost and demographic data will be discussed to provide a compelling rationale for the ongoing forceful movement toward cost containment strategies embodied in managed care strategies, as well as the need to develop the next …

The Tale Of A Tail, James F. Hogg

Faculty Scholarship

The commercial general liability insurance industry shifted, in 1986, from the use of an “occurrence-based” to a “claims-made” policy form. So-called “tail” or “long tail” claims have continued nevertheless, to be asserted under the older “occurrence” policies which required that injury occur during the term of the policy, but not that the claim for such injury be made or brought at any particular time. In seeking state approval to use the new “claims-made” form in 1985-86, the insurance industry represented that the new form would not affect coverage under the old “occurrence” form. Despite that representation, insurers are now asserting, …

Disability And Income Loss Benefits Under The Minnesota No-Fault Act, Michael K. Steenson

Faculty Scholarship

The Minnesota No-Fault Automobile Insurance Act was intended to ensure the “prompt payment of specific basic economic loss benefits to victims of automobile accidents without regard to whose fault caused the accident,” to prevent overcompensation of less seriously injured people by the interposition of tort thresholds, and to encourage appropriate medical and rehabilitation treatment by assuring prompt payment for that treatment. It seems clear that at least some of the initial promise of the Act has not been fulfilled. Payment of basic economic loss benefits, which the legislature intended to be paid promptly, has become bogged down in a quagmire …

Evaluating The Case For Social Security Reform: Elderly Poverty, Paternalism And Private Pensions, Maria O'Brien

Faculty Scholarship

This Article considers the many arguments currently being made in favor of Social Security pension reform and evaluates each of them in terms of the principal Congressional goal of the program-the elimination of elderly poverty-as well as more recent goals that have been articulated by subsequent commentators such as a reduction in government paternalism and the maximization of retirement income. The Article begins with a short history of the public pension program in the United States and considers at length the details of the various reform proposals that currently enjoy support. In addition it examines the enormously regressive tax structure …

Judicial Opinions Involving Health Insurance Coverage: Trompe L'Oeil Or Window On The World?, William M. Sage

Faculty Scholarship

This essay offers a few thoughts about using judicial decisions as the dataset for research into health insurance coverage. Part I offers a general overview of insurance coverage law. Part II considers why students of health insurance coverage gravitate toward studying published opinions. Part III then discusses what is wrong with the approach, and suggests alternatives. Finally, Part IV turns to what may be right with the approach, concluding that judicial opinions in coverage litigation may reveal the functionality (or dysfunctionality) of the coverage process in managed care. Although the basic critique which the essay presents applies to areas other …

Emergency Care And Managed Care - A Dangerous Combination, Diane E. Hoffmann

Faculty Scholarship

No abstract provided.

Enterprise Liability And The Emerging Managed Health Care System, William M. Sage

Faculty Scholarship

“Enterprise medical liability” is a term used to describe a system in which health care organizations bear responsibility for medical malpractice in addition to or instead of individual health professionals. Enterprise liability is in many senses a natural outgrowth of the increasing dependence of medical practice on institutional resources and expertise. Proposals for enterprise liability surfaced briefly from the academic literature into the political spotlight during the 1993-94 health care reform debate. At that time, objections to the concept as a basis for medical malpractice liability, even in a restructured health care system, were nearly universal.

Just five years later, …

Some Preliminary Thoughts On The Deregulation Of Insurance To Advantage The Working Poor, Maria O'Brien

Faculty Scholarship

The regulatory framework in which employee benefits products are marketed and consumed by individuals and groups seeking to reduce exposure to covered events creates a set of background rules. These rules influence the way in which insurance products are developed and impact the number of people who will enjoy the protection these insurance products afford. This means that every proposal to regulate an employment related insurance product likely will affect both the quality and quantity of insurance available to consumers. For example, over the past decade, as the public and professionally-interested parties have grappled with the insurance implications of the …

Protections For Erisa Self-Insured Employee Welfare Benefit Plan Participants: New Possibilities For State Action In The Event Of Plan Failure, Mark A. Edwards

Faculty Scholarship

Employees who receive health benefits through ERISA self-insured plans need protection when self-insured plans fail. Because of the breadth of ERISA preemption, states have been unable to assess ERISA self-insured plans for contribution to state insurance guaranty funds, and thus have been unable to include those employees in the protection of those funds. Further, attempts at federal reform to protect these employees have failed to garner support. However, under the recent Travelers, United Wire, and Safeco decisions, it may be possible for states to assess ERISA self-insured funds and their participants through a combination of hospital use surcharges and taxes …

Genetic Discrimination And Health Insurance: An Urgent Need For Reform, Kathy L. Hudson, Karen H. Rothenberg, Lori B. Andrews, Mary Jo Ellis Kahn, Francis S. Collins

Faculty Scholarship

No abstract provided.

Insurance Risk Classification After Mcgann: Managing Risk Efficiently In The Shadow Of The Ada, Maria O'Brien

Faculty Scholarship

A significant part of the health insurance debate which gripped the country during the first two years of President Clinton's administration focused on the critical shortage of employer-sponsored health insurance for disabled, br high risk, employees. Indeed, President Clinton's promise of universal access in connection with the promotion of his health care plan is apparently designed to ensure that the increasingly popular employer practice of excluding high risk employees becomes obsolete. In the meantime, while the merits of the Clinton plan and its competitors are debated, individuals like John McGann-working and insured--continue to discover that like their health, their insurance …

The Good Mother: The Limits Of Reproductive Accountability And Genetic Choice, R. Alta Charo, Karen H. Rothenberg

Faculty Scholarship

No abstract provided.

Bank Powers To Sell Annuities, Tamar Frankel

Faculty Scholarship

The conflict over turf between the banking industry and the insurance agents has heated up again. In the 1993 case Variable Annuity Life Ins. Co. v. Clarke, ¹ the Fifth Circuit held banks have no power to sell fixed annuities issued by insurance companies in cities with more than 5,000 inhabitants. On June 6, 1994, the Supreme Court granted certiorari to review the decision. ³ Both the Clinton Administration and members of Congress are considering steps toward resolving this issue. Concerned that the flight of high-quality borrowers from the banking system has rendered bank lending increasingly risky, the Comptroller of …

Private Insurance, Social Insurance, And Tort Reform: Toward A New Vision Of Compensation For Illness And Injury, Kenneth S. Abraham, Lance Liebman

Faculty Scholarship

The United States does not have a system for compensating the victims of illness and injury; it has a set of different institutions that provide compensation. We rely on both tort law and giant programs of public and private insurance to compensate the victims of illness and injury. These institutions perform related functions, but the relationships among them are far from coherent. Indeed, the institutions sometimes work at cross-purposes, compensating some victims excessively and others not at all.

The absence of a coherent system of compensation is reflected even in suggested reforms of existing institutions. Proposals to reform tort law …

The Economics And Politics Of Emergency Health Care For The Poor: The Patient Dumping Dilemma, Maria O'Brien

Faculty Scholarship

As the numbers of uninsured mount⁴ because of job dislocations, exhaustion of benefits, and unaffordably high premiums, the incidence of "dumping" by private hospitals is, predictably, on the rise. Dumping occurs when a hospital, in violation of federal or state law, transfers an emergency patient to another (usually public) hospital or simply refuses any treatment based on the patient's inability to pay.5 In addition to the completely uninsured, favorite dumping targets include Medicare and Medicaid patients, AIDS patients, and cancer patients whose therapy may cost more than the maximum reimbursement under private insurance.

Dumping is merely a part of …

Mengele's Birthmark: The Nuremberg Code In United States Courts, George J. Annas

Faculty Scholarship

Experimentation on human beings is so difficult to justify that the attempt is seldom even made. Usually its justification is simply assumed, and vague notions of progress or national emergency are suggested as sufficient rationales. The United States, a society dedicated to both progress and human rights, has been profoundly ambivalent about human experimentation. On the one hand, we have consistently argued in our ethical codes that the rights and welfare of research subjects must be protected; on the other hand, we have consistently used perceived emergencies, both national and medical, as an excuse to jettison individual rights and welfare …

Accountable Accountants: Is Third-Party Liability Necessary?, Victor P. Goldberg

Faculty Scholarship

Should accountants be liable to third parties if they conduct an audit in negligent manner? A half century ago, in Ultramares Corporation v. Touche, Niven & Co., Cardozo argued that they should not, unless their performance could be characterized as fraud. In recent years, courts in a minority of jurisdictions have concluded that Cardozo's argument is no longer compelling and they have found that "foreseeable" third parties could bring a tort action for ordinary negligence against the accountants. In addition to being subject to tort actions, accountants may also be liable under federal and state securities laws.

Suits against …

The Fault Concept In Personal Injury Cases In Minnesota: Implications For Tort Reform, Michael K. Steenson

Faculty Scholarship

Legislative tort reform proposals have attempted to restore what is perceived to be an imbalance in the tort-litigation system by limiting tort recoveries. One of the motivating factors behind tort reform proposals is a concern that tort law has deviated from a fault-based system of liability. It is this concern over the structure of the fault system in Minnesota that is the subject of this Article. This Article examines Minnesota Supreme Court opinions of the 20th Century to determine whether the court's decisions deviated from a fault-based system of liability. The focus is on change, accepted and rejected. The purpose …

Insurance Law: Public Policy Permits Insuring Against One's Own Intentional Acts Of Discrimination, Daniel B. Yeager

Faculty Scholarship

No abstract provided.

A Primer On Minnesota No-Fault Automobile Insurance, Michael K. Steenson

Faculty Scholarship

The Minnesota No-Fault Act has undergone substantial change since its enactment in 1974. Recent legislative modifications and judicial constructions of the Act's provisions have served to correct earlier deficiencies, but have raised new and complex problems of interpretation. In light of these developments, Professor Steenson provides an overview that explains how the Act functions. After tracing the history of automobile insurance regulation in Minnesota, Professor Steenson examines in detail the various compulsory and optional insurance coverages under the Act, the proper sources of payment under those coverages, and the limitations imposed by the Act on the right to recover damages …

No-Fault In A Fault Context: Tort Actions And Section 65b.51 Of The Minnesota No-Fault Automobile Insurance Act, Michael K. Steenson

Faculty Scholarship

The passage of the Minnesota No-Fault Automobile Insurance Act has created new problems for the Minnesota lawyer. Some of the most pressing problems concern the effect of the Act on tort actions. This article analyzes the provisions of the No-Fault Act dealing with limitations on tort recovery and suggests solutions to come of the many interpretive problems created by the Act.

Variable Life Insurance, Tamar Frankel

Faculty Scholarship

No abstract provided.

Medical Malpractice Litigation Under National Health Insurance: Essential Or Expendable, George J. Annas

Faculty Scholarship

"Medical malpractice" denotes the basis for a civil action brought by a patient against a physician for injuries resulting from negligence. The current method for compensating victims of these occurrences is primarily a fault-and-liability insurance system. The first principle of tort liability is that the party at fault pays for the damage inflicted upon an innocent victim. Whether a doctor is at fault is determined in an adversary proceeding, with both the doctor and the patient represented by counsel. The triers of fact have the task of ascertaining whether the defendant was at fault, and if so, what compensation he …

1973 Annual Survey Of Michigan Law: Insurance, Kevin H. Tierney

Faculty Scholarship

No abstract provided.

Regulation Of Variable Life Insurance, Tamar Frankel

Faculty Scholarship

On November 29, 1971 the American Life Convention and Life Insurance Association of America filed a petition with the Securities and Exchange Commission (SEC) to exempt certain variable life insurance policies and separate accounts funding them from the provisions of the federal securities acts.¹ The petition had been preceded by informal negotiations by the insurance industry for a decision by the SEC "not to assert jurisdiction" over such policies and accounts.² The Commission's staff declined to recommend primarily because the staff felt that other interested parties ought to be heard before a determination was made which might adversely …

1971 Annual Survey Of Michigan Law: Contracts, Kevin H. Tierney

Faculty Scholarship

No abstract provided.