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.
Advice and consultation by telephone with a Participating Attorney. Services are available during normal business hours. Calls can relate to any personal legal matter, civil or criminal, except those specifically excluded.
Up to the maximum as shown in the Schedule of Benefits for office consultations with a Participating Attorney on any personal legal problem, civil or criminal, except those specifically excluded.
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 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.
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.
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.
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.
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.
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, even where a Member has Healthcare Coverage under another policy outside this Policy. For a definition of Healthcare Coverage, please see definitions in this policy.
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, 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.
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/herself.
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 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 one closing 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 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 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.
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 court-ordered 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; (2) contested matters in which case the Member 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 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 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.
Guardianship/Conservatorship:
Services required to establish a Member and/or Covered Family Member as the guardian(s) or conservator(s) of another. 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 not 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 Policy/Certificate to which this endorsement is attached. This endorsement is made a part of the Policy/Certificate to which it is attached. This endorsement is subject to all of the provisions and limitations of the Policy/Certificate. If there is a conflict between the Policy/Certificate 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 Policy/Certificate 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% less 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 (6 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)