Definitions
“PLAN” ATTORNEY” - means an attorney associated with a private law firm, who is licensed to practice law in the Policyholder’s state. These attorneys have been contracted to provide legal advice and simple service by telephone to Policyholders.
“ADMINISTRATOR” - means LegalPlans USA, a licensed adjuster; or a properly licensed subsidiary.
“POLICY TERM” - means a Policy period of one year from the Policyholder’s initial effective date.
“MEMBER SERVICE CENTER” - means the service location established to help make full use of the Policy.
“COMPLEX WILL” - means the Policyholder has a significant net worth and will benefit from tax planning, or the estate is subject to current state or federal estate taxation; the Policyholder owns a business that will continue in operation after death; the Policyholder wants to put restrictions on what heirs may do with the property; the Policyholder wants to leave money to someone in a trust because the person cannot manage his or her own affairs (such as a mentally handicapped child), or wants the property to be managed by a trustee for a period of time past the child’s age of majority, to age 25 or 30, for example; the Policyholder thinks that someone will challenge the will; and/or the Policyholder wants to exclude any lawful dependents.
“EFFECTIVE DATE” - means the date coverage hereunder begins.
“FAMILY MEMBER” - means the Policyholder’s lawful spouse and children, and for whom a premium is paid. Eligible Family Members are the Policyholder’s spouse and Policyholder’s unmarried dependent children, including stepchild, legally adopted child, child placed in the home for adoption and foster child, up to age 19, and from age 19 up to 25 years if they are enrolled in an accredited school or college as full-time student(s) and are primarily dependent upon the Policyholder for support.
“NON-PARTICIPATING ATTORNEY” - means an attorney not retained by Administrator who is selected and paid by the Policyholder to provide services covered under the Policy up to the maximum amount as shown in the Schedule of Benefits.
“PAID IN FULL” - means complete payment to a Participating Attorney for covered legal services.
“PARTICIPATING ATTORNEY” - means an attorney retained by the Administrator to provide covered legal services at the amount as shown in the Schedule of Benefits.
“PLAN SPONSOR” - means an organization which makes coverage hereunder available.
“POLICYHOLDER” - refers to the individual who is named in the declarations page and who has paid the premium for Covered Services in the Policy.
“WE”, “US”, “OUR” AND “COMPANY” - means the name of the underwriter indicated on the declarations page of this Policy.
Covered Services
In consideration of payment and receipt by Us of the applicable premium, all Covered Services are available to a Policyholder and the Policyholder’s spouse and eligible dependents. Except as noted below, the following Covered Services are provided to the Policyholder when the Policyholder uses a Participating Attorney. The Schedule of Benefits chart shows the reimbursement schedule when the Policyholder uses a Non-Participating Attorney.
Advice and Consultation
LegalEASE Helpline:
Advice and consultation by toll-free telephone with a Plan Attorney. Services are available during normal business hours (EST). Calls can relate to any personal civil legal matter, except those specifically excluded.
Financial Helpline:
Consultation by toll-free telephone during normal business hours (EST). Calls can relate to investment strategies, debt matters, or any personal financial planning question.
Initial Law Office Consultations
Up to the maximum as shown in the Schedule of Benefits for office consultations with a Participating Attorney on any personal civil legal problem, except those specifically excluded.
Miscellaneous Law Office Services
Benefits not specifically covered or excluded hereunder to be provided at an amount shown in the Schedule of Benefits.
This benefit is limited to one use per year is subject to Managed Case Rules.
Review of Simple Document
The Plan Attorney will verbally explain the meaning or impact of any form or document, or make suggestions for changes to a form or document being drafted of up to the maximum number of pages as shown in the Schedule of Benefits. This benefit does not include a written analysis of any form or document.
OnLine Legal Access
Internet access to legal information and documents for many common legal situations. This feature is designed for Policyholders and/or Family Members who wish to independently research legal issues either before or after contacting a Plan Attorney. OnLine Legal Access can be activated through the internet by contacting the following website:
www.vsc-legalease.com.
Document Preparation
Preparation of any of the following documents: simple deed (excluding those reviewed or prepared under the real estate benefit), promissory note, consumer dispute, correspondence, installment sales agreement, general power of attorney, lease agreement (tenant only), time share agreement, and simple affidavit.
This benefit is limited to one use per year.
Consumer Dispute
Consultation or representation in a dispute relating to consumer goods and services (not involving real estate construction, landlord/tenant disputes or renovation).
This benefit is limited to one use per year.
Small Claims Court Representation
Consultation and/or representation for a consumer dispute filed in small claims court.
This benefit is limited to one use per year.
Will and Codicil Preparation
Preparation of one simple will or codicil (an amendment to an existing will) for the Policyholder and spouse only, including the preparation of a simple testamentary support trust for the dependent children: Simple Will Preparation: Plan Attorney shall prepare a simple will or codicil for Policyholder and Family
Member and discuss the legal requirements for signing the will.
Complex Will Preparation
Plan Attorney shall prepare a complex will or codicil for Policyholder or Family Member at a discounted fee paid directly to the attorney as shown in the Schedule of Benefits.
Living Will and/or Health Care Power of Attorney
Preparation of living will and/or health care power of attorney for Policyholder and/or Family Member as authorized by state law. A living will expresses an individual’s wishes as to the use or withdrawal of life support systems. A health care power of attorney appoints another to make medical decisions if the individual is unable to do so him/her self.
This benefit is limited to one use per year.
Living Trust Document
Preparation of living trust documents. This benefit does not include services related to transactions to fund the trust or transfer assets into it.
This benefit is limited to one use per year.
Probate of Small Estate
The service of an attorney for the probate of a small estate (an estate that is not subject to current state or federal estate taxation) up to the maximum as shown in Schedule of Benefits.
Real Estate Sale, Purchase or Refinancing of Primary Residence
The services of an attorney for the purchase, sale, or refinancing of a Policyholder’s primary residence (where the Policyholder has resided or intends to reside twenty-seven (27) weeks or more per year). This service includes the review or preparation of closing documents and/or attendance by the Policyholder’s attorney at closing in situations when it is customary to do so. This benefit does not include services performed by or for a title company, or for an attorney acting on behalf of a lending institution. Home equity loans and the sale or purchase of unimproved or rental properties are not included.
This benefit is limited to one closing use per year and is subject to a waiting period, if any, as shown in the Schedule of Benefits.
Landlord/Tenant Disputes
Representation of the Policyholder and/or Family Member as a tenant in a dispute with his/her landlord.
This benefit is limited to one use per year and is subject to Managed Case Rules.
Debt Collection Defense
The defense of any dispute involving personal (non-business related) debt. This benefit includes correspondence, negotiating with creditors to arrange a repayment schedule, assistance in limiting harassment by bill collectors, and negotiating settlement after a complaint is filed. This service does not include defense against execution of a court ordered judgment or efforts to vacate or set aside a judgment.
This benefit is limited to one use per year. Trial defense benefit is subject to Managed Case Rules.
Bankruptcy
Representation on behalf of the Policyholder or Family Member for personal (non-business related) bankruptcy protection under Chapter 7 or 13 of the Internal Revenue Code.
This benefit is limited to one use per year and is subject to a waiting period, if any, as shown in the Schedule of Benefits.
Foreclosure
Defense of the Policyholder in an action to foreclose on the Policyholder’s primary residence (where Policyholder has resided or intends to reside twenty-seven (27) weeks or more per year).
This benefit is limited to one use per year and is subject to Managed Case Rules.
Tax Audits
Includes the services of an attorney (but not accounting services) during a personal (non-business related) tax audit process required by federal and state tax authorities and negotiations relating to it. This benefit does not include a defense against criminal charges nor the defense of civil tax litigation in any tax court.
This benefit is limited to one use per year and is subject to waiting period, if any, as shown in the Schedule of Benefits. This benefit is subject to Managed Case Rules.
Separation, Divorce, Annulment
Legal representation of the Policyholder only for up to 10 hours in an uncontested separation, divorce, civil annulment, consent or default divorce. An uncontested separation, divorce or civil annulment does not involve significant disputed issues and the parties resolve any issues prior to any court supervised proceeding. A consent or default divorce does not involve any disputed issues and the opposing party is not represented by counsel. The benefit for uncontested matters does not provide any coverage of an attorney’s fee for: (1) services in excess of 10 hours; the Policyholder must pay the attorney’s fee for services in excess of 10 hours; (2) services relative to post-decree representation; or, (3) contested matters in which case the Policyholder must pay the attorney’s fee for services, unless this Policy provides coverage of contested matters and the benefit shall be in accordance with the Schedule of Benefits. A contested separation, divorce or civil annulment requires more than five (5) hours of attorney time, involves disputed issues and both parties are represented by an attorney.
This benefit is limited to one use per year( representation seeking or defending against interim or subsequent-to-decree order shall constitute a separate use) and applies to the Policyholder only. This benefit is subject to a waiting period, if any, as shown in the Schedule of Benefits. Contested divorce is subject to the Managed Case Rules.
Name Change
Services required to accomplish a legal name change for a Policyholder and/or Family Member.
This benefit is limited to one use per year.
Guardianship/Conservatorship
Services required to establish a Policyholder and/or Family Member as the guardian(s) or conservator(s) of another. This benefit does not include contested matters.
This benefit is limited to one use per year.
Uncontested Adoption
Legal representation for a Policyholder and/or Family Member of up to five (5) hours in an uncontested governmental agency or stepparent adoption. An uncontested adoption does not involve significant disputed issues. This benefit does not include: (1) contested termination of parental rights; (2) fees for a courtappointed attorney for the child; or (3) adoptions(s) made through any agency other than a governmental agency. A contested adoption requires more than five (5) hours of attorney time and involves disputed issues. If the amount of an attorney’s time for uncontested adoption exceeds five (5) hours, or if the adoption becomes contested, coverage will terminate and the Policyholder and/or Family Member will be responsible for any additional legal fees.
This benefit is limited to one use per year.
Juvenile Court Matters
Services related to the representation of the dependent child of a Policyholder and/or Family Member in any juvenile court proceeding, provided the child’s interest is not in conflict with the Policyholder’s and/or Family Member interest. This benefit does not cover any matter that falls outside the jurisdiction of juvenile court.
This benefit is limited to one use per year.
Civil Litigation Defense
Services related to the representation of a Policyholder and/or Family Member who is a named defendant in a covered civil lawsuit, up to and including the trial thereof. This benefit does not include: (1) any debt collection or family law matter; (2) lawsuits normally handled on a contingent fee basis; or (3) matters for which the Policyholder and/or Family Member has or is required by law to have insurance.
This benefit is limited to one use per year and is subject to a waiting period, if any, as shown in the Schedule of Benefits. This benefit is subject to the Managed Case Rules.
Traffic Defense
Services related to the representation of a Policyholder and/or Family Member who is charged by governing authorities with moving traffic violation(s) and conviction could result in suspension or revocation of a Policyholder’s and/or Family Member’s drivers’ license.
This benefit is limited to one use per year.
Administrative Proceeding
Services related to the representation of a Policyholder and/or Family Member in an administrative proceeding related to the suspension or revocation of driving privileges.
This benefit is limited to one use per year.
Savings Assistance Services
Your benefits package includes a Savings Assistance Plan as described below.
These benefits are in addition to plan services described in your Certificate of Coverage.
1. Consultation Services:
a) Plan members are entitled to an initial consultation with one of our Savings Coaches for savings information including how to get started, how much is the right amount, how can I possibly save, how can I create a savings plan, can I save while I am in debt, and similarly related topics.
2. Creation of Savings Plan Assistance:
a) Counselor assistance to help members with creating their own personal savings plan is also included in the Saving Assistance Coverage. This service will include charting projected income and expenses, helping the member understand when savings might work, managing expenses in debt, educational tools to make an informed decision, and advice on selecting savings amounts options. This section of the plan is designed to help members deal with their increasing debt and need to save.
3. Additional Follow-up Services:
a) Plan members may utilize one, free, thirty minute telephone consultation per year.
b) Follow-up consultations and help from Savings Coaches are also available to each plan member.
Identity Theft Prevention/Recovery Assistance
Coverage includes a basic Identity Theft HelpLine Service as well as a comprehensive Online Identity Theft Prevention and Assistance Service for covered members.
1) Advice and Consultation
a) Free ½ hour telephonic consultations (10 per year) with a Trained Identity Theft Recovery Specialist (consultations can also be online – member’s choice)
b) Online Assistance in understanding identity theft prevention
c) Unlimited access to complete identity theft legal issue law libraries
2) Additional Benefits
a) Personal Recovery Kit – designed to walk a victim of identity theft step-by-step through the process of recovery (designed to be utilized in conjunction with the free consultations with the Recovery Specialist).
b) Free Simple Recovery Letter preparation by plan attorney – a plan attorney will draft the simple affidavits to submit to specific agencies and organizations needed to establish the theft of your identity and prevent further loss of your identity and credit rating.
c) Free Review of necessary recovery legal documents (up to 6 pages each)
d) Up to $25,000 Expense Reimbursement for Identity Theft Losses That Cannot Be Recovered
Mediation Services
Your benefits package includes Mediation Services as described below. These benefits are in addition to plan services described in your Certificate of Coverage.
1. Consultation Services:
a) Plan members receive unlimited access to online information including domestic disputes, divorce or child custody proceedings, consumer problems, medical bill, warranties, loan disputes, workplace employee disputes, auto accidents, etc.
b) Members receive one free thirty minute consultation with a licensed mediator every quarter.
2. Mediation Counseling Assistance:
a) Assistance is available to assist members with understanding mediation and alternative dispute resolution. Examples of some topics are; charting projected lawsuit expenses, understanding when mediation might work, managing legal expenses in mediation, educational tools to make an informed decision, and advice on selecting mediator or other options.
b) These services are designed to help members deal with the increase in resolution pace.
3. Additional Mediation Services:
a) Plan members receive a 10% discount on Plan Mediators’ normal fees. This includes hourly rates and flat fees. However, this does not apply to Contingency Fees.
Elder Law Services
Your benefits package includes Elder Law Services as described below. These benefits are in addition to plan services described in your Certificate of Coverage.
1) Eligibility of Parents
a) Parents of the Plan Member and the Member’s Spouse, regardless of age, are eligible for benefits under the Elder Law coverage described herein.
b) The benefits specified below extend not only to the Member’s Parents and the Member’s Spouse’s Biological Parents, but their Step-Parents and Adoptive Parents as well.
2) Benefits for Elder Parents
a) Advice and Consultation
1. LegalADVISOR Helpline:
Member may receive advice and consultation by toll-free telephone with a Plan Attorney. Services are available during normal business hours. Calls can relate to any personal legal matter, civil or criminal.
2. Financial Helpline:
Member will receive consultation by toll-free telephone during normal business hours. Calls can relate to investment strategies, debt matters or any personal financial planning question
b) Free Simple Wills & Living Wills
1. Simple Will Preparation:
Each Eligible Parent, as defined above, may receive one Simple Will per year at no charge. Plan Attorney will prepare the document and discuss the legal requirements for executing the Will.
Simple Will means the will maker does not have a significant net worth and will not benefit from tax planning, or the estate is not subject to current state or federal estate taxation; the will maker does not own a business that will continue in operation after death; the will maker does not want to put restrictions on what heirs may do with the property; the will maker does not want to leave money to someone in a trust because the person cannot manage his or her own affairs (such as a mentally handicapped child), or does not want the property to be managed by a trustee for a period of time past the child’s age of majority, to age 25 or 30, for example; the will maker does not think that someone will challenge the will; and/or the will maker does not want to exclude any lawful dependents. Benefits provided by Legal Access Plans, L.L.C.
2. Living Will Preparation:
Eligible Parents, as defined above, may request one Living Will per year at no charge. Plan Attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Living Will. A Living Will expresses an individual’s wishes as to the use or withdrawal of life support systems. d) Additional documents may be prepared for a minimal charge
Immigration Services
Your benefits package includes Immigration Services as described below. These benefits are in addition to plan services described in your Certificate of Coverage. The services below are provided for up to one Eligible Family Member, as described below, per year. Eligible Family Members include spouse, children up to any age, parents of member and spouse and siblings of member and spouse.
1. Advice and Consultation:
a) Plan Member or Eligible Family Member will receive up to one-half hour office consultation per issue with a participating attorney on any personal immigration matter.
2. Review of Immigration Documents:
a) A Plan Attorney will review and explain the meaning or impact of any immigration form or document, or make suggestions for changes to a form or document being drafted that is up to six (6) pages.
3. Discounted Rate:
a) Plan Member or Eligible Family Member receives a discounted hourly rate, up to a 25% discount from the Plan Attorney’s normal hourly rate, for additional representation. Flat fees may not be discounted.
4. Preparation for Hearings:
a) Plan Member or Eligible Family Member will receive up to two hours of general preparation for immigration hearings.
5. Preparation of Documents:
a) A Plan Attorney will prepare necessary affidavits and powers of attorney for the Plan Member or Eligible Family Member at no charge.
To access services, Plan Member or Spouse must call the Member Service Center and identify the family member for whom services are requested.
Flat Rate Benefits
Your benefits package includes benefits that will be covered at a flat rate charged to the member as described below. These benefits are in addition to plan services described in your Certificate of Coverage. Eligible Family Members include spouse and unmarried dependent children, including stepchild, legally adopted child, child placed in the home for adoption and foster child, up to age 19, and from age 19 up to 25 years if they are enrolled in an accredited school or college as full-time student(s) and are primarily dependent upon the Member for support.
1. Traffic Ticket Defense Flat Rate of $89:
a) Traffic defense generally includes the preparation of court documents and attendance at on a onetime only court hearing to settle the issue. Does not include court costs, fines, additional hearings or other related expenses. Does not apply in jurisdictions that consider traffic offenses to be criminal matters.
2. Preparation of Prenuptial Agreement Flat Rate of $239:
a) This service covers the preparation of an agreement by a Plan Member and his or her fiancé/partner prior to their marriage or legal union (where allowed by law), outlining how property is to be divided in the event of separation, divorce or death of a spouse. Representation is provided only to the Plan Member. The fiancé/partner must have separate counsel or must waive representation. To access services, Plan Member or Spouse must call the Member Service Center.
Obtaining Policy Benefits
Telephone Advice and Consultation on Legal and Financial Matters
Consultation by toll-free telephone with an attorney. Services are available during normal business hours (EST). Calls can relate to any personal civil legal matter, except those specifically excluded herein.
Financial Helpline:
Consultation by toll-free telephone during normal business hours (EST). Calls can relate to investment strategies, debt matters, or any personal financial planning question.
Claim for Benefits
1. Policyholders must call the Member Service Center to confirm eligibility and coverage prior to consulting with any attorney. The Member Service Center will assign a Participating Attorney to provide services relative to the matter. Failure to notify the Member Service Center within thirty (30) days following consultation with an attorney may result in a denial of benefits.
Policyholders may reach the Member Service Center at 888-416-4313, 5850 San Felipe, Suite 600, Houston, TX 77057.
2. To obtain benefits under the Managed Case Rules:
Policyholders and/or Family Member must secure a confirmation letter from the Member Service Center prior to proceeding with an attorney. The attorney must provide a written estimate of fees reflecting his or her best judgment as to the likely conduct of the case. We will set a maximum attorney fee that takes into account the reasonable level of reimbursement for the proceeding and the proposed litigation strategy. Fees as a result of services in excess of the maximum attorney fee are the responsibility of the Policyholder and/or Family Member.
3. Policyholders actively receiving services under this Policy must remain enrolled and continue to pay premium hereunder. All Policy benefits will be subject to subrogation.
4. Upon completion of a Covered Service, the Policyholder and/or Family Member will be required by the Participating Attorney to sign a confirmation of completion.
5. If the Policyholder and/or Family Member pays for pre-authorized services provided by a NonParticipating Attorney, the Policyholder must submit a reimbursement form (provided by Member Service Center) accompanied by an original itemized bill within sixty (60) days after incurring the legal fees. Benefits provided to the Policyholder and/or Family Member for covered services subject to the maximum as shown in the Schedule of Benefits.
6. If coverage terminates while a submitted claim for Covered Services is ongoing, coverage will continue for that claim only until the earlier of: (a) settlement of the claim; (b) ninety (90) days from the original termination date; (c) the final disposition of the claim adverse to the Policyholder/Family Member; (d) the Policyholder/Family Member is found to have committed the alleged wrongful act; or (e) the limits of liability are exhausted.
Disputes Between Policyholder and Family Member
In the event that the Policyholder and one of the Family Members are involved as adversaries in a dispute that is a Covered Service, the Policy will cover the Policyholder only.
If two or more Family Members are involved in a dispute that is otherwise covered under the Policy, the Policy will provide no coverage.
If two Policyholders are involved as adversaries in a dispute that is a Covered Service, the Policy will provide separate coverage for each Policyholder.
Exclusions
The Policy excludes benefits for the following:
Appellate court proceedings, class actions, interventions, derivative action and amicus curiae filings.
Legal services relating to criminal matters (i.e. misdemeanor or felony).
The preparation and filing of individual, partnership or estate tax returns, appellate or administrative proceedings related to tax returns, litigation before the U.S. Tax Court, U.S. Court of Claims or any other federal, state or other courts with respect to tax matters.
Matters relating to securities, trademark or patent matters; business or commercial interests, including, but not limited to, professional, partnership and/or corporate matters; matters involving the law or laws of jurisdictions other than the United States and its territories and Canada; any matters involving government (domestic or foreign) entity or agency; farm related issues; matters involving commercial or rental property transactions, including the purchase, sale or lease of investment or income-producing property. A two-family house, whether or not used by the Policyholder as his or her primary residence, is deemed an investment or income-producing property.
Legal services which are fully paid for or provided at no cost by any governmental agency, organization or insurance company.
Matters that the attorney deems frivolous, spurious, harassing, or unethical (collectively referred to as “frivolous”) or otherwise prohibited by the Model Rules of Professional Conduct of the state in which the attorney is licensed.
Costs associated with covered legal services, including but not limited to, all fines, court costs, penalties, sanctions, expert witness fees, bonds, bail bonds, opposing attorney fees, exhibits, deposition costs, filing fees, transcripts, postage, telephone, photocopying, recording fees, messengers, judgements, jury fees, court reporter fees, investigative costs and all other incidental and out-of-pocket legal and litigation costs.
Any services on behalf of a Family Member against the interests of the Policyholder.
Any employment-related matter. This includes, but is not limited to, any dispute involving the Policyholder’s employer or its affiliates, their officers or directors, any employee benefit plans, credit unions, programs or arrangements sponsored by the Policyholder’s employer, or cases involving workers’ compensation, unemployment compensation, sex harassment, age discrimination, etc.
Any dispute or proceeding against the following persons or entities, their officers, directors, employees, or agents: any person or entity involved in the sale of the Policy; Administrator or its subsidiaries; Policyholder’s employer; Virginia Surety Company, Inc. it’s parent, subsidiaries or any affiliated or successor company, plan underwriter or reinsurer; Plan Sponsor; or any Participating and/or Non-Participating Attorney, if the dispute or proceeding pertains to services provided under the Policy.
Except regarding LegalEASE Helpline and Financial Helpline services, the Policy will not provide benefits in connection with pre-existing matters, which includes any matter where the Policyholder and/or Family Member is on notice as to a pending legal dispute or has previously contacted an attorney.
General Provisions
Attorney-Client Relationship
All attorneys are subject to the authority of the State Supreme Court and the State Bar of the state where they are licensed to practice. The Policyholder’s relationship with an attorney is privileged and strictly confidential.
We will not interfere in the attorney-client relationship, nor in the attorney’s independent exercise of his or her professional judgment. Attorneys are not certified specialists.
Policyholder shall authorize Participating Attorney to provide the Administrator with anonymous statistical reports on the number and type of services provided to Policyholder.
By using legal services benefits for which are provided under the Policy, the Policyholder agrees that neither
We nor any other person involved in the marketing or administration of the Policy shall have any liability for the acts, errors or omissions of an attorney providing services, in whole or in part, under the Policy.
Non-Participating Attorney Services
If the Policyholder already has an attorney, the Policyholder may prefer to use her/him as a Non-Participating Attorney. To do so, the Policyholder must first contact the Member Service Center and notify the representative of his/her intention to use a Non-Participating Attorney for a Covered Service. The Member
Service Center will send the Policyholder a claim form to request reimbursement from the Policy. The Policyholder’s reimbursement will be based on the reimbursement schedule as shown in the Schedule of Benefits.
Legal Terminology
The Policyholder may call the Member Service Center to obtain a definition or explanation of any term used herein.
Coverage Period
The coverage period is automatically renewable upon receipt of the appropriate premium unless terminated in accordance with the terms hereof.
Coverage Territory
The coverage territory includes the United States.
Premium Refund Provision
In the event that the premium mode is other than monthly and the Policy is terminated or the Policyholder elects to terminate the coverage, a prorata premium refund will be made in accordance with the insurance laws of the Policyholder’s state.
Termination and Cancellation of Coverage
Coverage provided to a Policyholder shall terminate upon the first of the following to occur:
a. Cancellation or termination of this Policy;
b. If applicable, the Policyholder fails to renew; or
c. The Policyholder fails to remit premium when due, subject to the statutory grace period. Coverage provided to Family Member of a Policyholder shall terminate upon the first of the following to occur:
a. The Policyholder’s coverage is cancelled or terminated; or
b. The Family Member ceases to be an eligible Family Member of the Policyholder’s coverage.
If coverage terminates while a submitted claim for Covered Services is ongoing, coverage will continue for that claim only until the earlier of: (a) settlement of the claim; (b) ninety (90) days from the original termination date; (c) the final disposition of the claim adverse to the Policyholder/Family Member; (d) the Policyholder/Family Member is found to have committed the alleged wrongful act; or (e) the limits of liability are exhausted.
Any further legal work between said Policyholder and/or Family Member and the Plan Attorney shall be outside the scope and coverage of the Policy. The Plan Attorney shall not be obligated to provide any benefits under the Policy and any further legal work shall be based upon an independent and separate fee agreement entered into, if at all, between the former Policyholder and/or Family Member and the attorney. If such an agreement is not entered into, then the Plan Attorney may withdraw from any further representation in accordance with applicable law and State Bar standards.
If this Policy has been in effect for sixty (60) days or less, the Company may cancel this Policy by providing written notice to the Policyholder at least twenty (20) days prior to the effective date of cancellation.
After this Policy has been in effect for sixty (60) days or more, it may be cancelled for one of the following reasons:
a. Nonpayment of premium;
b. Conviction of a crime arising out of acts increasing the hazard insured against;
c. Discovery of fraud or material misrepresentation in the obtaining of the Policy or in the presentation of a claim thereunder:
d. Discovery of an act or omission, or a violation of any Policy condition, that substantially and materially increases the hazard insured against, and which occurred subsequent to inception of the current Policy period;
e. Material physical change in the property insured, occurring after issuance or last annual renewal anniversary date of the Policy, which results in the property becoming uninsurable in accordance with the Company’s objective, uniformly applied underwriting standards in effect at the time the Policy was issued or last renewed; or material change in the nature or extent of the risk, occurring after issuance or last annual renewal anniversary date of the Policy, which causes the risk of loss to be substantially and materially increased beyond that contemplated at the time the Policy was issued or last renewed;
f. A determination by the Superintendent of Insurance that continuation of the present premium volume would jeopardize the insolvency or be hazardous to the interests of policyholders of the Company, its creditors or the public;
g. A determination by the Superintendent of Insurance that the continuation of the Policy would violate, or would place the Company in violation of any provision of the insurance laws of this state; or
h. Where the Company has reason to believe, in good faith and with sufficient cause, that there is a probable risk or danger that the insured will destroy, or permit to be destroyed, the insured property for the purpose of collecting the insurance proceeds, provided, however, that:
(i) A notice of cancellation on this ground shall inform the insured in plain language that the insured must act within ten (10) days if review by the Department of Insurance of the ground for cancellation is desired;
(ii) Notice of cancellation on this ground shall be provided simultaneously by the Company to the Department of Insurance; and
(iii) Upon written request of the insured made to the Department of Insurance within ten (10) days from the insured’s receipt of notice of cancellation on this ground, the Department shall undertake a review of the ground for cancellation to determine whether or not the Company has satisfied the criteria for cancellation specified in this subparagraph; if after such review the Department finds no sufficient cause for cancellation on this ground, the notice of cancellation on this ground shall be deemed null and void.
The Company shall provide written notice of cancellation to the Policyholder at least fifteen (15) days prior to the effective date of such cancellation.
Premium Remittance
Policyholder shall remit premium to Company no later than the 10th calendar day following the month for which Policy coverage is provided.
Grace Period
The Policy provides Policyholder a grace period of thirty-one (31) days after the premium due date to remit the premium that is due and unpaid. During the grace period, this Policy will continue in effect. If the premium for covered Members remains unpaid at the end of the grace period, the Policy will terminate. Termination will be effective at 12:01 a.m. on the thirty-second (32nd) day following the due date for which premium remains unpaid. Policyholder shall remain liable for the prorata portion of all premiums that accrue for the period this Policy is in effect.
Amendment of the Policy
The Policy may be amended or changed at any time by the Company upon written notice thereof and signed by a duly authorized representative. No agent, broker or sales representative may make any change in this Policy or waive any of its provisions.
Notice of Policy Provisions
Notice to any agent or knowledge possessed by any agent shall not effect a waiver or change any part of the Policy or stop Us from asserting any right under the terms of the Policy; nor shall terms of the Policy be waived or changed except as stated above.
Change in Premium
We shall provide the Policyholder thirty (30) days prior written notice of any change in premium.
Arbitration
The issuance of this coverage takes place in and substantially affects interstate commerce. Any dispute, controversy, or cause of action by the Policyholder arising out of or relating in any way to, this insurance, or to the sale or solicitation of this insurance, shall be settled by arbitration under the provision of the Federal Arbitration Act, 9 U.S.C., section 1, et seq. Such arbitration shall be governed by the rules of the American Arbitration Association. The arbitration shall be conducted at our home office or such other location as We and the Policyholder agree. The arbitration panel shall consist of three arbitrators, one selected by Us, one selected by the Policyholder and one selected by the arbitrators previously selected. If We, a Policyholder, or a third party have any dispute that is directly or indirectly related to a dispute governed by this arbitration provision, the Policyholder and We agree to consolidate all such disputes.
The arbitration shall be binding upon the Policyholder and Us. Any award may not be set aside in later litigation except upon the limited circumstances set forth in the Federal Arbitration Act. The Policyholder and
We give up the right to seek remedies in Court, including the right to a jury trial. Judgment upon the award rendered may be entered in any Court having jurisdiction thereof. The arbitration expenses shall be borne by the losing party or in such proportion as the arbitrators shall decide.
Policy Conformed to Statute
Any terms of the Policy which are in conflict with the statutes of the jurisdiction where issued, are amended to conform to the statutes.
Assignment of Benefits
The benefits provided under this Policy are not assignable.
Entire Contract
This Policy and endorsement(s), if any, constitutes the entire contract of insurance.