Definitions
“CLAIMS ADMINISTRATOR” - means Co-ordinated Benefit Plans, LLC; or its subsidiary.
“COMPLEX WILL” - means the Member has a significant net worth and will benefit from tax planning, or the estate is subject to current state or federal estate taxation; or the Member owns a business that will continue in operation after death; or the Member wants to put restrictions on what heirs may do with the property; or the Member 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; or the Member thinks that someone will challenge the will; or the Member wants to exclude any lawful dependents.
“CONTESTED DIVORCE” - refers to a divorce proceeding that requires more than 5 hours of attorney time, involves disputed issues and both parties are represented by an attorney.
“COVERED FAMILY MEMBER” – means the Member’s spouse or domestic partner and Member’s unmarried dependent children, including stepchildren, legally adopted children, children placed in the home for adoption and foster children, up to age 19, and from age 19 up to 26 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.
“COVERED SPOUSE” - means the Member’s lawful spouse or domestic partner at the time the group policy is in effect.
“EFFECTIVE DATE” - means the date a Member’s coverage hereunder begins.
“HEALTHCARE COVERAGE” – means any policy for healthcare that a Member and/or Covered Family Member has in effect over which some type of coverage, benefits, or privacy dispute arising while that policy is in effect as defined by the terms of that policy. Nothing in this group policy/Certificate of Coverage will pay or create any obligation to pay any healthcare benefits to any person for any reason, and any coverage related to this definition in this group policy/Certificate of Coverage must be related to a Member’s and/or Covered Family Member’s dispute under a healthcare coverage policy.
“INTERNET PURCHASE” - A purchase of goods or services whose purchase value is over $200.00 at the time of purchase by a Member and/or Covered Family Member from a website on the worldwide web.
“LEGAL PLAN ADMINISTRATOR” – LegalEASE, its affiliates, officers, directors, employees, and/or agents, including third party organizations and their affiliates, officers, directors, employees, and/or agents, hired by LegalEASE to perform services under this group policy/Certificate of Coverage.
“MEMBER” - refers to the individual who is associated with the Policyholder and who has paid or a premium has been paid on his/her behalf and who meets the eligibility requirements for Covered Services as established by the Policyholder.
“MEMBER SERVICE CENTER” - means the service location established to help make full use of the certificate benefits.
“NON-PARTICIPATING ATTORNEY” - means an attorney not retained by Legal Plan Administrator who is selected and paid by the Member to provide services covered under the Certificate of Coverage 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 Legal Plan Administrator to provide covered legal services at the amount shown in the Schedule of Benefits.
“POLICYHOLDER” - means the organization named in the declarations page.
“WE”, “US”, “OUR” AND “COMPANY” - means the name of the underwriter indicated on the first page of this Certificate of Coverage.
Covered Services
In consideration of payment and receipt by Us of the applicable premium, all Covered Services are available to a Member and all Covered Family Members. Except as noted below, the following Covered Services are provided to the Member when the Member uses a Participating Attorney. The Schedule of Benefits chart shows the reimbursement schedule when the Member uses a Non-Participating Attorney.
Consumer Matters
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 per document, except general power of attorney, which is limited to one use per year per Covered Family Member.
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. (Attorney may not be permitted to attend court hearings in some jurisdictions).
This benefit is limited to one use per year.
Mail Order or Internet Purchase Dispute:
The services of an attorney to review the nature of any mail order or Internet Purchase dispute involving the purchaser prior to the commencement of litigation. This service includes the review or preparation of dispute letters, any purchase documents and/or consultation with the attorney. If litigation is commenced in this matter, the benefit will cover up to the maximum shown on the Schedule of Benefits.
This benefit is limited to one purchase per year.
Bank Fee Dispute:
The services of an attorney to review the nature of any (non-business related) bank fee dispute between the Member and their bank prior to the commencement of litigation. This service includes the review or preparation of dispute letters, any purchase documents and/or consultation with the attorney. If litigation is commenced in this matter, the benefit will cover up to the maximum shown on the Schedule of Benefits.
This benefit is limited to one dispute per year.
First-time Vehicle Buyer:
The services of an attorney for the purchase of a Member’s and/or Covered Family Member’s first vehicle. This service includes the review or preparation of purchase and finance documents and/or consultation by the attorney at or
before closing.
This benefit is limited to one vehicle purchase per year and must be the first vehicle purchase of either the Member or Covered Family Member.
Vehicle Repair and Lemon Law Litigation:
Services related to the representation of a Member and/or Covered Family Member who is entitled under the applicable state “lemon” law to bring a civil lawsuit (non-business related), up to and including the trial thereof related to a defective car as defined in the applicable state law. This benefit does not include: (1) any lawsuit related to finances or defects that do not specifically fall under the definitions permitted in the applicable state lemon law; (2) lawsuits normally handled on a contingent fee basis; (3) any collection or related defense or action; or (4) matters for which the Member has or is required by law to have insurance.
This benefit is limited to one use per year.
Cell Phone Contract Dispute:
Review of the cell phone contract where the Participating 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 maximum number of pages shown on the Schedule of Benefits. This benefit does not include a written analysis of any form or document.
In the event of a dispute over the terms of the agreement between the cell phone company and the Member or any Covered Family Member, this benefit provides representation in a dispute relating to the cell phone contract if the Member/Covered Family Member is sued or named in a small claims court action. This service covers counseling on prosecuting a small claims court action; helping the Member/Covered Family Member prepare documents; advising on evidence, documentation and witnesses; and preparing the Member/Covered Family Member for trial. The service does not include the Participating Attorney’s attendance or representation at a small claims trial, collection activities
after a judgment or any services relating to post-judgment actions.
This benefit is limited to one use per year.
Warranty Dispute:
Review of the warranty policy or service contract where the Participating 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 up to the maximum number of pages shown on the Schedule of Benefits. This benefit does not include a written analysis of any form or document.
In the event of a dispute over the terms of the agreement between the warranty company and the Member or Covered Family Member, this benefit provides representation in a dispute relating to the warranty or service contract if the Member or Covered Family Member is sued or named in a small claims court action. This service covers counseling on prosecuting a small claims court action; helping the Member/Covered Family Member prepare documents; advising on evidence, documentation and witnesses; and preparing the Member/Covered Family Member for trial. The service does not include the Participating Attorney’s attendance or representation at a small claims trial, collection activities
after a judgment or any services relating to post-judgment actions.
This benefit is limited to one use per year.
Healthcare Coverage Disputes and Records:
Up to the maximum as shown in the Schedule of Benefits for office consultations with a Participating Attorney on any Healthcare Coverage dispute, civil or criminal, even where a Member has Healthcare Coverage under another policy outside this group policy. For a definition of Healthcare Coverage, please see definitions in this Certificate of Coverage.
This benefit is designed to help Members and/or Covered Family Members understand new healthcare law provisions and coverages based on the federal and/or state version of this law PPACA, and to prepare a bona fide defense to any
denials in coverage valued at more than $1,000.00 in covered medical services under the policy in dispute. This benefit is not intended to provide representation in litigation and does not include collection defense or other actions related to medical bills or payments.
This benefit also includes the review of simple healthcare policy coverage documents and the Participating Attorney will verbally explain the meaning or impact of any policy or related document, or make suggestions for dispute letters or
documents 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 but does include the preparation of any of the following
documents up to the maximum number of pages shown on the Schedule of Benefits: policyholder dispute correspondence, and simple affidavit. Partial documents cannot be reviewed or prepared and if the document other
than the actual Healthcare Coverage policy is more than the maximum number of pages shown in the Schedule of Benefits the benefit does not apply.
This benefit is limited to one use per year.
Identity Theft Defense:
Services related to the representation of a Member and/or Covered Family Member regarding potential creditor actions resulting from identity theft, and attorney services as needed to contact creditors, credit bureaus and financial institutions. It also provides defense services for specific creditor actions over disputed accounts.
This benefit is limited to one use per year.
Estate Planning
Will or Codicil Preparation:
Preparation of one simple will or codicil (an amendment to an existing will) for the Member and/or Covered Family Member, including the preparation of a simple testamentary support trust for the dependent children:
Simple Will Preparation: Participating Attorney shall prepare a simple will or codicil for Member and/or Covered Family Member and discuss the legal requirements for signing the will.
This benefit is limited to one use per year per Member/Covered Family Member.
Complex Will Preparation: Participating Attorney shall prepare a complex will or codicil for Member or Covered 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 Member and/or Covered 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.
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 does not include tax planning or tax advice related to the trust or the Member’s situation before and after the trust is prepared.
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.
Residential Matters
Real Estate Sale, Purchase or Refinancing of Primary Residence:
The services of an attorney for the purchase, sale, or refinancing of a Member’s primary residence (where Member has resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes the review or preparation of closing documents and/or attendance by the Member’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 two closings per year.
Vacation or Investment Home Purchase, Sale or Refinancing:
The services of an attorney for the purchase, sale, or refinancing of a Member’s vacation or investment residence (where Member has not resided or does not intend to reside for twenty-seven (27) weeks or more per year). This service includes the review or preparation of closing documents and/or attendance by the 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 properties are not included. This benefit does not include any fees or costs other than those related to the attorney’s review of the purchase/sale documents.
This benefit is limited to one closing per year.
Tenant Dispute:
Representation of the Member and/or Covered Family Member as a tenant in a dispute with his/her landlord.
This benefit is limited to one use per year.
Tenant Security Deposit Dispute:
The services of an attorney to assist the Member as a tenant in recovering a security deposit from the Member’s residential landlord for the Member’s primary residence; reviewing the lease and other relevant documents; and preparing a demand letter to the landlord for the return of the deposit. This benefit covers preparation for prosecuting a small claims action; helping prepare documents; advising on evidence, documentation and witnesses; and preparing the Member for the small claims trial. The service does not include the Participating Attorney’s attendance or representation at the small claims trial, collection activities after a judgment or any services relating to post-judgment actions.
This benefit is limited to one use per year.
Landlord Dispute with Tenant:
This benefit covers the Member where he/she is a landlord, but where the regular business or livelihood of the Member is that other than a landlord, for matters involving evictions, leases, or disputes with a residential tenant. The service includes advice and representation if a lawsuit is filed up to the maximum shown on the Schedule of Benefits. It does not include representation for a tenant in disputes with other tenants. If a lawsuit must be brought by the landlord, representation will be provided up to the maximum shown in the Schedule of Benefits and the Member will be responsible for paying all fees for any additional services required.
This benefit is limited to one use per year.
Security Deposit Dispute with Tenant:
This benefit covers the Member where he/she is a landlord, but where the regular business or livelihood of the Member is that other than a landlord, in defending against the recovery of a security deposit from the Member’s residential tenant for any residence owned and leased by the Member; reviewing the lease and other relevant documents; and preparing a letter to the tenant specifying what part of the deposit, if any, will not be returned. It also covers assisting the Member in defending a small claims action; helping prepare documents; advising on evidence, documentation and witness; and preparing the Member for the small claims trial. The service does not include the Participating Attorney’s
attendance or representation at the small claims trial, collection activities after a judgment or any services relating to post-judgment actions.
This benefit is limited to one use per year.
Construction Defect Dispute:
The services of an attorney in a dispute relating to the Member’s new home purchased within the past five (5) years up to the maximum shown in the Schedule of Benefits. This benefit includes preparation and assistance for a dispute
related to any defect or damage caused by the construction or related to the construction.
This benefit is limited to one use per year.
Neighbor Dispute:
The services of an attorney in a dispute relating to a Member’s neighbor up to the maximum shown in the Schedule of Benefits. Advice and/or preparation and assistance for a dispute filed in court is also covered, although representation
in small claims court is not covered.
This benefit is limited to one use per year.
Noise Reduction Dispute:
The services of an attorney in a dispute relating to a Member’s enjoyment of his/her home, where any activity related to noise affecting the Member’s enjoyment of their home is prohibited by federal, state or local law, up to the maximum
shown in the Schedule of Benefits. Advice and/or preparation and assistance for a dispute filed in court is also covered, although representation in small claims court is not covered.
This benefit is limited to one use per year.
Financial Matters
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 courtordered judgment or efforts to vacate or set aside a judgment.
This benefit is limited to one use per year.
Bankruptcy:
Representation on behalf of the Member and/or Covered 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.
Foreclosure:
Defense of the Member in an action to foreclose on the Member’s primary residence (where Member has resided or intends to reside twenty-seven (27) weeks or more per year.) This benefit is limited to one use per year.
Tax Audit:
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.
Student Loan Refinancing/Collection Defense:
The services of an attorney up to the maximum shown in the Schedule of Benefits for a student loan refinancing or collection dispute proceeding. This service covers the Member and/or Covered Family Member when there is an issue regarding a student loan in the name of the Member and/or Covered Family Member. This benefit includes negotiation with creditors for a repayment schedule and to limit creditor harassment, and representation in defense of any action
for personal debt collection, tax agency debt collection, foreclosure, repossession or garnishment, all related to one or more school loans in the name of the Member and/or Covered Family Member up to and including trial if necessary.
It does not include vacating a judgment; counter, cross or third party claims; bankruptcy; any action arising out of family law matters including support and post decree issues; or any matter where the creditor is affiliated with the sponsor or
employer.
This benefit is limited to one use per year.
Family Matters
Separation, Divorce, Civil Annulment:
Legal representation of the Member only for up to the maximum shown on the Schedule of Benefits 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 the maximum shown on the Schedule of Benefits; the Member must pay the attorney’s fee for services in excess of the maximum; or (2) contested matters in which case the Member must pay the attorney’s fee for
services, unless this Certificate of Coverage 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
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-todecree order shall constitute a separate use) and applies to the Member and Covered Family Members only for actions not involving the Member as an opposing party.
Prenuptial Agreement:
This service covers the preparation of an agreement by a 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 Member. The fiancé/partner must have separate counsel or must waive representation.
This benefit is limited to one use per year.
Name Change:
Services required to accomplish a legal name change for a Member and/or Covered Family Member.
This benefit is limited to one use per year per Member/Covered Family Member.
Guardianship/Conservatorship:
Services required to establish a Member and/or Covered Family Member as the guardian(s) or conservator(s) of a family member of either the Member or Covered Spouse. This benefit does not include fees for a court-appointed attorney for the child/conservatee.
This benefit is limited to one use per year.
Government Agency/Stepparent Adoption:
Legal representation for a Member and/or Covered Family Member of up to the maximum shown in the Schedule of Benefits in a 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 court appointed attorney for the child; or (3) adoptions(s) made through any agency other than a governmental agency. A contested adoption requires more than five hours of attorney time and involves disputed issues
This benefit is limited to one use per year.
Juvenile Court Matters:
Services related to the representation of the dependent child of a Member and/or Covered Family Member in any juvenile court proceeding, provided the child’s interest is not in conflict with the Member’s and/or Covered Family Member’s interest. This benefit does not cover any matter that falls outside the jurisdiction of juvenile court or any matter that may be considered a felony.
This benefit is limited to one use per year.
Civil Litigation Defense
Civil Litigation Defense:
Services related to the representation of a Member and/or Covered Family Member who is a named defendant in a civil lawsuit (non-business related), up to and including the trial thereof. This benefit does not include: (1) any debt collection or family law matters; (2) lawsuits normally handled on a contingent fee basis; or (3) matters for which the Member/Covered Family Member has or is required by law to have insurance.
This benefit is limited to one use per year.
Incompetency Defense:
Services related to the representation of a Member in the defense of any incompetency action, including court hearings when there is a proceeding to find the Member incompetent.
This benefit is limited to one use per year.
Criminal Defense
Traffic Tickets:
Services related to the representation of the Member and/or Covered Family Member in defense of any traffic ticket except driving under influence or vehicular homicide, including court hearings, negotiation with the prosecutor, trial, and counseling and preparing Member for self-representation at any hearings if chosen. This benefit does cover violations related to a commercial driver’s license.
This benefit is limited to one use per year.
Serious Traffic Matters:
Services related to the representation of a Member and/or Covered Family Member who is charged by governing authorities with moving traffic violation(s) and conviction could result in suspension or revocation of Member’s and/or Covered Family Member’s drivers’ license. This benefit does not cover violations related to a commercial driver’s license.
This benefit is limited to one use per year.
Administrative Proceeding:
Services related to the representation of a Member and/or Covered Family Member in an administrative proceeding relating to the suspension or revocation of driving privileges. This benefit does not cover suspension or revocation of a
commercial driver’s license.
This benefit is limited to one use per year.
Misdemeanor Defense:
Defense of a Member and/or Covered Family Member in connection with criminal misdemeanor charges (not associated with any felony charge).
This benefit is limited to one use per year.
COVERED SERVICES ENDORSEMENT
The Effective Date of this endorsement is the Effective Date of the Family Advisor ContracVCertificate to which this endorsement is attached. This endorsement is made a part of the Family Advisor ContracVCertificate to which it is attached. This endorsement is subject to all of the provisions and limitations of the Family Advisor ContracVCertificate. If there is a conflict between the Family Advisor ContracVCertificate and the endorsement, the terms of the endorsement will govern.
The following is a list of Covered Services available, in addition to the services described in your Family Advisor ContracVCertificate of Coverage.
FINANCIAL ADVISOR
Financial Helpline
Consultation with legal or financial professionals by toll-free telephone during normal business hours. Calls can relate to investment strategies, debt matters, or any personal financial planning question.
LEGAL PROTECTION PLAN
The following Covered Services are covered at a flat rate or discount as shown below, when performed by a Participating Attorney.
Discounted Contingency Fees:
- When state laws set contingency fees: Lesser of 10%Iess than state law maximum fee or the Participating Attorney's usual fee.
- When state laws do not set contingency fee: Maximum of 29% if settled before trial, 36% if trial is conducted, or 40% after an appellate brief is filed.
Contingency rate discount applies in those cases where attorneys customarily take a case on a contingency fee, (an agreed upon portion of any recovery), depending on the outcome of the case.
MEDIATION
Consultation Services:
Members receive one free thirty minute consultation with a licensed mediator every quarter.
Topics include: domestic disputes, divorce or child custody proceedings, consumer problems, medical bill, warranties, loan disputes, auto accidents.
Mediation Counseling Assistance:
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.
These services are designed to help Members deal with the increase in resolution pace.
Discounted Mediation Services:
Member receives a 10% discount on Participating Attorney's normal mediation fees. This includes hourly rates and flat fees. However, this does not apply to contingency fees.
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 Member and Covered Family Members
Advice and Consultation
Telephone consultations (10 per year) with a Trained Identity Theft Recovery Specialist
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 consultations with the Recovery Specialist).
b) 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) Review of necessary recovery legal documents (up to 6 pages each)
Obtaining Benefits
Claim for Benefits
1. Members 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.
2. To obtain benefits under the Managed Case Rules:
Members and/or Covered 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 Member and/or Covered Family Member.
3. Members actively receiving services must remain enrolled and continue to pay premium hereunder. All benefits will be subject to subrogation and coordination of benefit rules.
4. Upon completion of a Covered Service, the Member and/or Covered Family Member will be required by the Participating Attorney to sign a confirmation of completion. Failure to sign the confirmation may result in denial of the claim and the Member/ Covered Family Member will be responsible for all legal fees.
5. If the Member and/or Covered Family Member pays for pre-authorized services provided by a Non-Participating Attorney, the Member must submit a reimbursement form (provided by Member Service Center) accompanied by an original itemized bill, proof of payment and supporting documentation sufficient to demonstrate the work completed in the matter within sixty (60) days after incurring the legal fees. Benefits provided to the Member and/or Covered Family Member for Covered Services are subject to the maximum as shown in the Schedule of Benefits.
Complaint Resolution Procedure
If, at any point, a Member has a complaint about the services provided either by the Member Service Center or the Participating Attorney a complaint may be registered by calling (888) 416-4313. The matter will be escalated to the Quality Assurance Team for resolution. In the event that a satisfactory resolution is not reached, the Member has the option to file a complaint for review by The Florida Bar concerning attorney conduct pursuant to the plan.
Disputes Between Member and Covered Family Member
In the event that the Member and one of the Covered Family Members are involved as adversaries in a dispute that is a Covered Service, only the Member will be covered.
If two or more Covered Family Members are involved in a dispute that is otherwise covered, no coverage will be provided.
If two Members are involved as adversaries in a dispute that is a Covered Service, separate coverage for each Member will be provided.
Exclusions
The following benefits are excluded:
Appellate court proceedings, class actions, interventions, derivative action and amicus curiae filings.
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 except as specifically described under Covered Services; any matters involving a government (domestic or foreign) entity or agency except as specifically described under Covered Services; farm related issues; matters involving commercial or rental property transactions, including the purchase, sale or lease of investment or income-producing property.
Legal services that 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, attorney fees, exhibits, deposition costs, filing fees, transcripts, postage, telephone, photocopying, recording fees, messengers, judgments, 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 Covered Family Member against the interests of the Member.
Any employment-related matter. This includes, but is not limited to, any dispute involving the Member’s employer or its affiliates, their officers or directors, the Member’s employee benefit plans, credit unions, programs or arrangements sponsored by an 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, marketing, administration or other processes related to the group policy; Legal Plan Administrator or its subsidiaries; Claims Administrator or its subsidiaries; Policyholder; Member’s employer; Nationwide Mutual Insurance Company and its parents, 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 group policy/Certificate of Coverage.
The Certificate of Coverage will not provide benefits in connection with pre-existing matters, which includes any matter where the Member and/or Covered Family Member is on notice as to a pending legal dispute or has previously contacted an attorney, except when prior coverage under another Legal Plan provided by the Policyholder can be demonstrated.
Where there are specific hours or dollar amounts provide in this Certificate of Coverage, or where a maximum is set under the Managed Case Rules, the Member will be responsible for all attorney fees incurred over the maximum. Additional exclusions related to each benefit are included in the Covered Services.
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 Member’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.
The Member shall authorize the Participating Attorney to provide the Legal Plan Administrator with information and supporting documentation on the number and type of services provided to the Member.
By using legal services benefits that are provided under the group policy/Certificate of Coverage, the Members agree that neither We, nor the Policyholder, nor any other person involved in the marketing or administration of the group policy, shall have any liability for the acts, errors or omissions of an attorney providing services, in whole or in part.
Non-Participating Attorney Services
If the Member already has an attorney, the Member may prefer to use her/him as a Non-Participating Attorney. To do so, the Member 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 Member a claim form to request reimbursement. The Member’s reimbursement will be based on the reimbursement schedule as shown in the
Schedule of Benefits. If a Member already has an attorney at the time he/she becomes a Member, the Legal Plan Administrator can offer to negotiate with the attorney on behalf of the Member, but will not guarantee the Plan Discounted Rate will be accepted by the attorney or offered by the Legal Plan Administrator.
Legal Terminology
The Member or Covered Family Member may call the Member Service Center to obtain a definition or explanation of any term used herein.
Coverage Territory
The coverage territory includes the United States and United States territories.
Premium Refund Provision
In the event that the premium mode is other than monthly and the group policy is terminated or the Member elects to terminate the coverage, a gross unearned premium refund will be made within fifteen (15) working days after the effective date of cancellation.
Termination and Cancellation of Coverage
Coverage provided to the Member shall terminate upon the first of the following to occur:
a. Cancellation or termination of the group policy;
b. If applicable, the Member fails to re-enroll;
c. The Member is no longer associated with Policyholder; or
d. The Member fails to remit premium when due, subject to the statutory grace period.
The Company shall provide written notice of non-renewal or notification of the renewal premium at least forty-five (45) days in advance to Member.
If Policy is cancelled within the first ninety (90) days for reasons other than nonpayment of premium, The Company will give twenty (20) days written notice of cancellation or termination accompanied by the reasons for cancellation or termination. The Company will not give written notice of reason for cancellation if there has been:
a. Material misstatement;
b. Material misrepresentation;
c. Failure to comply with underwriting requirements established by Company;
d. Nonpayment of premium by Policyholder for covered Members.
Coverage provided to a Covered Family Member of a Member shall terminate upon the first of the following to occur:
a. The Member’s coverage is cancelled or terminated; or
b. The family member ceases to qualify as a Covered Family Member as defined.
When coverage for a Member and/or Covered Family Member terminates and a matter is unresolved when coverage terminated, then any further legal work between said Member and/or Covered Family Member and the Participating
Attorney shall be outside the scope and coverage of the group policy/Certificate of Coverage. The Participating Attorney shall not be obligated to provide any benefits and any further legal services shall be based upon an independent and separate fee agreement entered into, if at all, between the former Member and/or Covered Family Member and the attorney. If such an agreement is not entered into, then the Participating Attorney may withdraw from any further representation in accordance with applicable law and State Bar standards.
Conformed to Statute
Any terms of the group policy/Certificate of Coverage that 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 group policy/Certificate of Coverage are not assignable.
Right to Retain an Attorney
The Member has the right to retain, at his or her own expense, except when the Policy provides otheriwise, any attorney authorized to practice law in this state.
Contact Information
For questions regarding claims or coverage under this Certificate, contact LegalEASE at (888) 416-4313.