Definitions
“CLAIMS ADMINISTRATOR” - means LegalEASE; 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. The inclusion of a pour-over provision in a will does not, by itself, make a will complex.
“CONTESTED DIVORCE” - refers to a divorce proceeding that requires more than 5 hours of attorney time and involves disputed issues.
“COVERED FAMILY MEMBER” – means the Member’s Covered Spouse and the Member’s and Covered Spouse’s children, including stepchildren, legally adopted children, children placed in the home for adoption , up to the end of the month of the child’s 26th birthday, regardless of student or marital status, and unmarried children who are permanently and totally disabled and, if age 26 or older, for whom proof of disability has been provided.
“COVERED SPOUSE” - means the Member’s lawful spouse or Domestic Partner at the time the coverage is in effect.
“DOMESTIC PARTNER” – means two individuals who, together, each meet all of the following criteria set forth below:
1. Are 18 years of age or older.
2. Are not legally married to, nor the Domestic/Civil Union Partner of, any other person.
3. Are not related by blood closer than permitted under marriage laws of the state in which they reside.
4. Affirm that the consent of ether Domestic Partner to the domestic partnership relationship has not been obtained by force, duress, or fraud.
5. Have entered into a relationship which is the functional equivalent of a marriage, and which includes joint commitment to each other’s welfare and basic living expenses.
6. Intend to continue the Domestic/Civil Union Partner relationship indefinitely, while understanding that the relationship is terminable at the will of either partner.
“DURABLE FINANCIAL POWER OF ATTORNEY” –a legal document that allows an individual to appoint another person to manage the individual’s finances in the event that he/she is unable to do so him/her self.
“EFFECTIVE DATE” - means the date the Member’s coverage hereunder begins.
“ELIGIBLE PARENT” – means the parents of the Member or Covered Spouse, regardless of age, and includes, biological parents, step-parents and adoptive parents.
“HEALTH CARE OR MEDICAL POWER OF ATTORNEY” – A legal document that allows an individual to appoint another person to make medical decisions in the event the individual is unable to do so him/her self.
“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 the Policy.
“LIVING WILL/ HEALTH CARE OR ADVANCE DIRECTIVE” – A legal document that outlines an individual’s preferences for medical treatment and which takes effect only when the individual becomes incapacitated and can no longer express his or her wishes.
“MEMBER” - refers to the individual who (a) is associated with the Policyholder, (b) has either paid a premium or had a premium paid on his or her behalf, and (c) meets the eligibility requirements for Covered Services as defined by the Policyholder.
“MEMBER SERVICE CENTER” - means the service location established to assist Members/Covered Family Members in making full use of the coverage.
“NEIGHBOR” – A person whose residence is located on a property that directly abuts the property on which a Member’s residence is located.
“NON-PARTICIPATING ATTORNEY” - means an attorney not contracted by the Legal Plan Administrator who is selected and paid by the Member to provide covered legal services up to the maximum amount shown under the Non-Participating Attorney column of the Schedule of Benefits.
“PAID IN FULL” - means complete payment in full to a Participating Attorney for covered legal services.
“PARTICIPATING ATTORNEY” - means an attorney contracted by the Legal Plan Administrator to provide covered legal services at the amount shown under the Participating Attorney column of the Schedule of Benefits.
“PERSONAL PROPERTY” – means any property that is not Real Property and which does not produce income.
“POLICY” - means the Group Legal Expense Insurance Policy and the Certificate of Coverage.
“POLICYHOLDER” - means the organization named in the declarations page.
“REAL PROPERTY” – means land and all permanent structures attached thereto.
“WE”, “US”, “OUR” AND “COMPANY” - means Virginia Surety Company, Inc.
Covered Services
In consideration of payment and receipt by Us of the applicable premium, all Covered Services are available to the Member and all Covered Family Members, except as specifically noted below. The following Covered Services are provided 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
LegalEASE Helpline:
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.
Initial Law Office Consultation:
Up to the maximum as shown in the Schedule of Benefits for office consultations with an attorney on any personal legal problem, civil or criminal, except those specifically excluded.
Review of Simple Documents:
This benefit includes attorney review, verbal explanations of the meaning or impact of any form or document, or suggestions for changes to a form or proposed 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.
Miscellaneous Law Office Services
Legal Services for any Non-Excluded Legal Matter:
This benefit will cover any legal services to review and/or prepare documents, or any other service required on any legal matters not listed as a Covered Service or Exclusion.
This benefit is limited to the maximum number of hours shown on the Schedule of Benefits per year.
Discounted Legal Services for any Non-Excluded Legal Matter:
This benefit will cover any legal services to review and/or prepare documents, or any other service required on any legal matters not listed as a Covered Service or Exclusion.
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
• Simple Affidavit
• General Power of Attorney
• Lease Agreement (for the Member/Covered Family Member as a tenant only)
• Time Share Agreement
Consumer Dispute:
Consultation or representation in a dispute relating to consumer goods and services (not directly or indirectly related to real estate construction or renovation, or landlord/tenant disputes).
Small Claims Court Representation:
Consultation and/or representation for a dispute filed in small claims court. (Attorney may not be permitted to attend court hearings in some jurisdictions).
Construction/Renovation/Home Repair Dispute:
Consultation or representation in a dispute involving consumer goods or services related to construction or renovation or home repairs that occurred on the premises of the Member’s primary or secondary residence. This benefit does not apply to consumer goods and services that are directly or indirectly related to a landlord/tenant dispute.
Vehicle Repair and Lemon Law Litigation:
Services related to the representation of a 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 apply to: (1) any lawsuit related to matters that are not specifically listed under the provisions of the applicable state fraud laws; (2) lawsuits normally handled on a contingent fee basis; (3) any action for or defense against a collection or related matter; or (4) matters for which the Member has or is required by law to have
insurance.
Personal Property Protection:
Services cover counseling over the phone or in the office on any Personal Property issue, including consumer credit reports, contracts for the purchase of Personal Property, consumer credit agreements or installment sales agreements. Counseling on pursuing or defending small claims actions is included.
The benefit includes reviewing personal legal documents and preparing promissory notes, affidavits and demand letters.
Identity Theft Defense:
Services related to the representation of a 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.
Estate Planning
Will or Codicil Preparation:
Preparation of one will or codicil (an amendment to an existing will), including the preparation of a simple testamentary support trust for the dependent children:
Will Preparation: Attorney shall prepare a will or codicil and discuss the legal requirements for signing the will. This benefit does not cover Complex Wills, as defined in the Definitions section.
Complex Will Preparation: Attorney shall prepare a Complex Will or codicil.
Living Will/Health Care or Advance Directive/Health Care or Medical Power of Attorney:
This benefit covers the preparation of up to 2 of any of the following documents as defined in the Definitions section per Member/Covered Family Member:
• Living Will
• Health Care Directive
• Advance Directive
• Health Care Power of Attorney
• Medical Power of Attorney
The titles of the above documents may vary by state. When state law allows the information contained in any two or more of the above mentioned documents to be combined into one document, then the benefit covers the preparation of only one document, and cannot be combined to increase the total allowed benefit.
Revocable or Irrevocable Living Trust Document:
Preparation of a revocable or irrevocable living trust for either the Member, Covered Spouse, or a combined living trust document. 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.
Funeral Directive:
Preparation of a funeral directive for the Member/Covered Family Member.
Hospital Visitation Authorization:
Preparation of a hospital visitation authorization for Member/Covered Family Member.
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. This benefit does not apply when there are applicable state-mandated attorney fees.
Medicare/Medicaid/Social Security Proceeding:
This benefit will cover review or help with preparation of documents prior to the representation of a Member and/or Covered Family Member in any federal or state Medicare, Medicaid or Social Security administrative proceeding including matters related to the Member’s or Covered Spouse’s elder parent(s)), provided the elder parent’s interest is not in conflict with the Member’s/Covered Spouse’s interest. This benefit applies to consultation or representation in a dispute relating to any such administrative proceeding and is covered up to the maximum shown in the Schedule of Benefits. Consultation and/or preparation and assistance for any proceeding filed in court is also covered, although the Member will be responsible for all fees incurred for representation needed after the maximum shown on the Schedule of Benefits.
Social Security Administration Benefit Appeal:
Up to the maximum as shown in the Schedule of Benefits for office consultations on any appeal to the Social Security Administration of denied social security benefits or supplemental security income (SSI).
This benefit is designed to help prepare an appeal to any denials valued at more than $1,000.00 in social security benefits or SSI 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 social security benefits or SSI.
This benefit also includes the review of simple Social Security Administration documents and verbal explanations of the meaning or impact of any policy or related documents, and suggestions for appeal 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 or explanation 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: appeal correspondence and simple affidavit. Partial documents cannot be reviewed or prepared, and if the document other than the actual decision document from the Social Security Administration is more than the maximum number of pages shown in the Schedule of Benefits, the benefit does not apply.
Nothing in this benefit will pay or create any obligation to pay any social security benefits or SSI to any person for any reason, and any coverage related to this benefit must be related to an appeal of a denial of social security benefits.
Veterans Benefits Appeal:
This benefit includes legal services for a Member in an administrative proceeding or appeal for denied Veterans benefits.
Elder Matters
Elder Parent Will Preparation:
Each Eligible Parent may receive one Simple Will per year at no charge. The attorney will prepare the document and discuss the legal requirements for signing the will. This benefit does not cover Complex Wills, as defined in the Definitions section.
Elder Parent Living Will/Health Care or Advance Directive:
Each Eligible Parent may request one Living Will/Health Care or Advance Directive, as they are defined in the Definitions section, per year at no charge. The attorney will prepare the documents as authorized by state law and discuss the legal requirements for signing the Living Will/Health Care or Advance Directive. The titles of the above documents may vary by state.
Elder Parent Durable Financial Power of Attorney:
Each Eligible Parent may request one Durable Financial Power of Attorney, as defined in the Definitions section, per year at no charge. The attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Durable Financial Power of Attorney.
Elder Parent Health Care or Medical Power of Attorney:
Each Eligible Parent may request one Health Care or Medical Power of Attorney, as they are defined in the Definitions section, per year at no charge. The attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Health Care or Medical Power of Attorney. The titles of the above documents may vary by state.
Elder Law Matters:
This service covers counseling the Member over the phone or in the office on any personal issues relating to the Eligible Parents as they affect the Member. This benefit includes reviewing documents of the Eligible Parents to advise the Member of the legal effect on the Member. The documents include Medicare or Medicaid materials, prescription plans, leases, nursing home agreements, powers of attorney, living wills and wills. The benefit also includes preparing deeds involving the Eligible Parents when the Member and/or Covered Spouse is either the grantor or grantee; and preparing promissory notes involving the parents when the Member and/or Covered Spouse is either the payor or payee.
Residential Matters
Real Estate Sale, Purchase or Refinancing of Primary Residence:
The services of an attorney for the sale, purchase or refinancing of a primary residence (where Member has resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes the review and/or preparation of closing documents and/or attendance by the attorney at closing in situations when it is customary for the attorney 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.
First-time Home Buyer:
The services of an attorney for the purchase of a first primary residence (where Member has resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes the review and/or preparation of closing documents and/or attendance by the attorney at closing in situations when it is customary for the attorney 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 purchase of unimproved or rental properties are not included.
Vacation or Investment Home Purchase, Sale or Refinancing:
The services of an attorney for the purchase, sale, or refinancing of a 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 and/or preparation of closing documents and/or attendance by the attorney at closing in situations when it is customary for the attorney 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.
Home Equity Loan Assistance for Primary Residence, or Second or Vacation Home:
The services of an attorney for the review and/or preparation of a home equity loan on a primary residence , or second or vacation home. This benefit does not include services performed by or for a title company, or for an attorney acting on behalf of a lending institution.
Property Tax Assessment:
The services of an attorney for review and advice on a property tax assessment on a primary or secondary residence (. This benefit includes filing the paperwork, gathering the evidence, negotiating a settlement, and attending the hearing necessary to seek a reduction of the assessment.
Tenant Dispute:
Representation of the Member as a tenant in a dispute with his/her landlord.
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. This benefit does not include representation for a tenant in disputes with other tenants. If a lawsuit is required in order for the landlord to recover his or her damages, then 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.
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 witnesses; and preparing the Member for the small claims trial. The service does not include the attorney’s attendance or representation at the small claims trial, collection activities after a judgment or any services relating to post-judgment actions.
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. For a definition of Neighbor, please see the Definitions section. Advice and/or preparation and assistance for a dispute filed in court is covered, although representation in small claims court is not covered.
Boundary or Title Dispute:
Services needed to negotiate and/or litigate matters arising from boundary or Real Property title disputes involving the Member’s primary or secondary or vacation residence and where coverage is not available under the Member’s homeowner or title insurance policies. This benefit includes filing to remove a mechanic’s lien. This benefit does not include boundary or title issues related to business assets or property. This benefit does not include boundary or title issues arising from the assertion of Eminent Domain.
Easement Agreement:
Services needed to prepare a temporary easement agreement for the Member’s primary or secondary residence. This benefit does not include issues related to business assets or property.
Zoning Application:
Services needed to negotiate and/or litigate the change of zoning or variance for the Member’s primary or secondary or vacation residence. This benefit applies to the Member as a named plaintiff or defendant. This benefit includes research and review of the law, surveys, advising the Member, preparing applications, and preparing for and attending the hearing. This benefit does not include zoning or variance issues related to business assets or property.
Building Codes:
Services needed to dispute a permit denial of defend a building code violation via civil proceedings before a municipal, county, state, or federal administrative board, agency or commission. It includes the hearing before an administrative board or agency regarding an adverse governmental action. It does not apply where services are available or are being provided by virtue of an insurance policy.
Real Estate Dispute:
The services of an attorney for the representation of the Member as a plaintiff or defendant in a dispute regarding contracts or obligations for the construction, purchase, or sale of the Member’s primary or secondary residence.
This benefit does not include disputes regarding contracts or obligations for the purchase or sale of unimproved land. This benefit does not include the review or preparation of real estate construction contracts or closing documents, or attendance by the Member’s attorney at closing.
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.
Garnishment Defense:
The defense of any dispute involving wage or earnings garnishment to collect on a court-ordered judgment related to personal (non-business related) goods or services. This benefit includes correspondence, negotiating with the court or opposing party to arrange a repayment schedule, assistance in limiting harassment by bill collectors, negotiating settlement after a complaint is filed, and representation at trial, if necessary. This service does not include efforts to vacate or set aside a judgment. This service does not include counter, cross or third-party claims; bankruptcy; any action arising out of family law matters, including support and post-decree matters; or any matter where the creditor is affiliated with the Policyholder.
Bankruptcy:
Representation on behalf of the Member for personal (non-business related) bankruptcy protection under Chapter 7 or 13 of the Internal Revenue Code.
Foreclosure:
Defense of the Member in an action to foreclose on the Member’s primary or secondary residence.
Tax Audit:
Includes the services of an attorney (but not accounting services) during a personal (non-business related) tax audit 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.
Tax Defense:
The defense of any dispute involving the collection of personal (non-business related) debt by a state or federal tax agency. This benefit includes correspondence, negotiating with the creditor tax agency to arrange a repayment schedule, assistance in limiting harassment by bill collectors, negotiating settlement after a complaint is filed, and representation at trial, if necessary. This service does not include defense against execution of a court-ordered judgment or efforts to vacate or set aside a judgment. This service does not include counter, cross or third-party claims; bankruptcy; any action arising out of family law matters, including support and post-decree matters; or any matter where the creditor is affiliated with the Policyholder.
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 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 up to and including trial if necessary.
This benefit 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.
The LegalEASE plan provides 10 hours of financial counseling as follows:
Debt Management Counseling (assistance rendered to the named insured and/or his/her insured spouse).
Up to 10 paid-in-full hours of counseling to:
Negotiate, settle or reduce one or more debts; paid-in-full coverage for members/dependents
- Assistance with problems involving a minimal number of creditors
- Advice, negotiations, office work and court representation; paid-in-full coverage
- Consultation over the telephone with a counselor; paid-in-full coverage
Debt Consolidation Counseling for members and dependents (assistance rendered to the named insured and/or his/her insured spouse to help consolidate a number of debts into a formal consolidation plan).
Up to 10 hours paid-in-full of counseling for:
- Assistance with problems involving a large number of creditors; paid-in-full coverage
- Negotiation agreements; paid-in-full coverage
- Consultation over the telephone with a counselor; paid-in-full coverage
- Development of a formal consolidation plan; paid-in-full coverage
Debt Resolution Counseling (Counseling rendered to the named insured and/or his/her insured spouse regarding creating, analyzing and planning a budget to resolve debt issues.)
Up to 10 hours paid-in-full of counseling for:
- Budget preparation for member/family (no charge); paid-in-full coverage
- Debt/asset organization assistance; paid-in-full coverage
- Modifications to budget; paid-in-full coverage
- Determination of specific budget goals; paid-in-full coverage
Family Matters
Separation, Divorce, Civil Annulment:
Legal representation of the Member for up to the maximum shown on the Schedule of Benefits in an uncontested separation or civil annulment; consent or default divorce, uncontested divorce or Contested 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 the coverage includes 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 and involves disputed issues.
This benefit is limited to one use per case. This benefit provides coverage for multiple cases per year.
This benefit applies to the Member and Covered Family Members only for actions not involving the Member as an opposing party.
Post-Divorce Proceedings:
Legal representation of the Member for up to the maximum listed on the Schedule of Benefits in a contested or uncontested post-divorce proceeding. An uncontested post-divorce proceeding does not involve significant disputed issues and the parties resolve any issues prior to any court supervised
proceeding. The benefit for uncontested matters does not provide any coverage of an attorney’s fee for: (1) services in excess of the maximum listed 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 the coverage includes contested matters and the benefit shall be in accordance with the Schedule of Benefits. A contested post-divorce proceeding requires more than five hours of attorney time, involves disputed issues and requires that both parties be represented by an attorney. This benefit includes custody, support, and alimony proceedings.
This benefit is limited to one use per case. This benefit provides coverage for multiple cases per year.
Domestic Partnership Agreement:
The service covers the preparation of a domestic partnership agreement by a Member and his or her partner. Representation is provided only to the Member. The spouse/partner must have separate counsel or must waive representation.
Postnuptial Agreement:
This service covers the preparation of an agreement by a Member and his or her spouse/partner after 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 spouse/partner must have separate counsel or must waive representation.
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.
Name Change:
Services required to accomplish a legal name change for a Member/Covered Family Member.
Gender Identifier Change:
Services required to change the gender identifier on government issues documents.
Egg/Sperm/Embryo Donation Agreement:
This service covers the preparation of an egg, sperm or embryo donation agreement for a Member.
Surrogacy Representation:
Legal representation up to the maximum shown in the Schedule of Benefits in a surrogacy or artificial conception where the Member/Covered Spouse is the intended parent, subject to state law. This service can be used for consultation, contract preparation and negotiation, representation in dispute resolution and court proceedings required to establish parental rights. This benefit does not include representation for the surrogate mother, donor or any party other than the Member/Covered Spouse.
This benefit does not apply where state laws do not address surrogacy or where surrogacy is not legal.
Guardianship/Conservatorship:
Services required to establish a Member/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.
Government Agency/Stepparent Adoption:
Legal representation 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.
Non-Government Agency Adoption:
Legal representation up to the maximum shown in the Schedule of Benefits in an uncontested agency (non-government) 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 a governmental agency. A contested adoption requires more than five hours of attorney time and involves disputed issues. If the amount of an attorney’s time for uncontested adoption exceeds the maximum shown in the Schedule of Benefits, or if the adoption becomes contested, coverage will terminate and the Member will be responsible for any additional legal fees.
International Adoption:
Legal representation up to the maximum shown in the Schedule of Benefits in an international adoption. This benefit does not include: (1) contested termination of parental rights; (2) fees for a court-appointed attorney for the child; or (3) immigration services for the child. If the amount of an attorney’s time for exceeds the maximum shown in the Schedule of Benefits, then coverage will terminate and the Member will be responsible for any additional legal fees.
Pre-Birth/Post-Birth Parentage Order:
This service covers the preparation of a pre-birth or post-birth parentage order for the Member.
Child Custody/Support Proceeding Involving Never-Married Parents:
Legal representation up to the maximum shown in the Schedule of Benefits in a child custody/support proceeding. This service covers the Member and/or Covered Family Member, when there is an issue of child custody/support of a child parented by a person with the Member/Covered Family Member, but never married to the Member/Covered Family Member. This service covers representation to obtain a support order, including all required paperwork and attendance at all court appearances.
The service does not include representation in suits for damages, defense of any action, representation for the opposing parent, or any paternity proceeding. If the amount of an attorney’s time for an uncontested or contested child custody/support proceeding exceeds the maximum shown in the Schedule of Benefits, then coverage will terminate and the Member will be responsible for any additional legal fees.
This benefit is limited to one use per case. This benefit provides coverage for multiple cases per year.
Paternity Proceeding:
Legal representation up to the maximum shown in the Schedule of Benefits in a paternity proceeding, whether the Member is bringing or defending this action. This service covers representation to obtain a court order, including all required paperwork and attendance at all court appearances. The service does not include representation in suits for damages, defense of any action, or representation for the opposing parent. If the amount of an attorney’s time for an uncontested or contested paternity proceeding exceeds the maximum shown in the Schedule of Benefits, then coverage will terminate and the Member will be responsible for any additional legal fees.
Protection from Domestic Violence:
Services needed to assist the Member in obtaining a protective order arising from a domestic violence or abuse matter, including all required paperwork and attendance at all court appearances. This benefit does not include representation in suits for damages, defense of any action, or representation of the offender. This benefit provides coverage for Covered Family Members only for matters not in conflict with the Member’s and/or Covered Family Member’s interest.
Juvenile Court Proceeding:
Services related to the representation of the dependent child of a Member/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.
Special Needs Education Representation:
Services needed to negotiate an education program subject to availability through the local school district for a special-needs dependent child of a Member. This benefit includes consultations, review or preparation of documents and attendance at meetings or hearings. This benefit does not cover any matter that falls outside the jurisdiction of the school in which the dependent child is officially enrolled.
School Administrative Proceeding:
Services needed for a dependent child of a Member/Covered Family Member for consultations, and review or help with preparation of documents prior to the representation of the dependent child in any school administrative proceeding (not including expulsion), 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 the school in which the child is officially enrolled. This benefit does not contemplate any attendance or representation by the attorney at or prior to any administrative hearing or appearance.
Immigration Assistance:
This service covers advice and consultation, preparation of affidavits and powers of attorney, review of any immigration documents, and helping the Member prepare for hearings. This benefit also extends to the Member’s Covered Family Members and non-covered family members, including the
Member’s parent, sibling, grandchild(ren), and other family members acting as a custodian of the Member’s child(ren) who are attempting to become US citizens in the manner prescribed by law.
This benefit is limited to proceedings involving one covered immigration applicant per year.
Parental Responsibility Matters:
Representation of the Member/Covered Spouse in juvenile court proceedings (except those involving traffic matters) where a the State has brought an action against the Member/Covered Spouse relating to his or her parental responsibilities for a Covered Family Member. Civil Matters
Civil Litigation Defense:
Services related to the representation of a Member who is a named defendant in a filed 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 has or is required by law to have insurance
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.
Administrative Hearing Representation:
Services needed to defend the Member from civil proceedings before a municipal, county, state, or federal administrative board, agency or commission. It includes the hearing before an administrative board or agency regarding an adverse governmental action. It does not apply where services are available or are being provided by virtue of an insurance policy. It does not include family law matters, post judgment matters or litigation of a job-related incident.
Discounted Contingency Fees:
Participating Attorneys will handle the matter at a maximum percentage of the gross award. It is the Member’s responsibility to pay this fee and all costs.
• 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:
The services of an attorney for representation at a mediation. This benefit does not include the cost of the mediator’s services.
Criminal Defense
Traffic Ticket:
Services related to the representation of the 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.
Serious Traffic Matter:
Services related to the representation of a Member who is charged by governing authorities with moving traffic violation(s) and conviction could result in suspension or revocation of a state-issued license permitting a person to drive a motor vehicle. This benefit does not cover violations related to a commercial driver’s license.
Administrative Proceeding:
Services related to the representation of a 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.
Habeas Corpus Proceeding:
Services related to the representation in a Habeas Corpus proceeding.
Misdemeanor Defense:
Defense of a Member in connection with criminal misdemeanor charges (not associated with any felony charge).
DUI/DWI Defense:
Defense of a Member in connection with Driving Under the Influence (DUI) or Driving While Intoxicated (DWI) violations/citations misdemeanor charges (not associated with any felony charge). This benefit does not include employment related DUI/DWI charges. This benefit does not include misdemeanors relating to a commercial driver’s license. This benefit does not include adjustments to probation or parole.
Restraining Order Assistance:
Services needed to obtain a temporary restraining order during regular court hours. This benefit includes consultations, review or preparation of documents. This benefit applies only to the Member and/or Covered Family Members for actions not involving the Member or other Covered Family Members as an opposing party.
Major Trial Supplement
In addition to any coverage as shown in the Schedule of Benefits, representation in any non-excluded trial matter that lasts more than three full court days will be covered as shown on the Schedule of Benefits. Payments to the attorney for any covered trial begin on day four of the covered trial and will be paid for legal fees only at a maximum amount shown on the Schedule of Benefits per half day of trial up to the maximum shown on the Schedule of Benefits. Nothing in this Trial Supplement covers any payment for any amount related to the covered trial except actual legal fees for the attorney’s time. This benefit excludes any case taken by an attorney on a contingent fee basis.
This benefit is limited to one use per year.
Obtaining Benefits
Claim for Benefits
1. Members should call the Member Service Center to confirm the potentially applicable benefit(s) 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 confirm coverage for matters to which Managed Case Rules apply reference Managed Case Rules in the Schedule of Benefits.
3. Members and/or Covered Family Members who are requesting services must remain enrolled and continue to pay premium hereunder.
4. Upon completion of a Covered Service, the Member/Covered Family Member may 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/Covered Family Member pays for pre-authorized services provided by a NonParticipating 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/Covered Family Member for Covered Services are subject to the maximum as shown in the Schedule of Benefits.
6. Payment by Us for Covered Services does not preclude the attorney (whether Participating or NonParticipating) from seeking and recovering attorney’s fees from an opposing party, where authorized by law, court rule, or contract, at the attorney’s customary or prevailing rate. If the Member/Covered Family Member receives reimbursement of attorney’s fees, then the Member/Covered Family Member agrees to reimburse Us for payments issued.
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, malpractice proceedings, actions in which punitive damages are being sought, derivative actions 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 arising out of a
Member/Covered Family Member’s role as an officer or director of an organization; matters involving the law or laws of jurisdictions other than the United States and its territories 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.
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 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 awarded as part of a judgment, exhibits, deposition costs, filing fees, transcripts, postage, telephone, photocopying, recording fees, messengers, judgments, jury fees, court reporter fees, investigative costs, arbitrator fees, 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, and age discrimination.
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 Policy; Legal Plan Administrator or its subsidiaries; Claims Administrator or its subsidiaries;
Policyholder; Member’s employer; Virginia Surety Company, Inc. and it’s parents, subsidiaries or any affiliated or successor company, plan underwriter or reinsurer; or any Participating and/or NonParticipating Attorney, if the dispute or proceeding pertains to services provided under the Policy.
Except for consultation, the Policy will not provide benefits in connection with pre-existing matters, which includes any matter where the Member/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 provided in the Policy, or where a maximum is set under the Managed Case Rules, the Member will be responsible for all attorney fees incurred which exceed 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 association of the state(s) where they are licensed to practice. The Member has the unrestricted right to choose an attorney.
The Member’s relationship with an attorney is privileged and strictly confidential. We will not interfere in the attorney-client relationship or in the attorney’s independent exercise of his or her professional judgment. Participating Attorneys are not certified specialists. Participating Attorneys are not agents or employees of either the Legal Plan Administrator or Us.
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 Policy, the Member agrees that neither We, nor the Policyholder, 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.
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 which must be completed and returned in order to request reimbursement. The Member’s reimbursement will be based on the reimbursement schedule shown under the Non-Participating Attorney column of the Schedule of Benefits. If a Member has a NonParticipating Attorney he or she would prefer to work with, the Legal Plan Administrator may elect to offer to negotiate with the attorney on behalf of the Member, but cannot guarantee the Non-Participating Attorney will accept the Plan Discounted Rate.
Subrogation and Coordination of Benefits
All benefits will be subject to subrogation and coordination of benefit rules. For the purpose of subrogation, We may require the Member/Covered Family Member to assign all rights of recovery of legal fees to the extent that payment is made by Us. If an assignment is sought, the Member/Covered Family Member must cooperate in providing the assignment.
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 pro-rata premium refund will be made in accordance with the insurance laws of the Policyholder’s state.
Secondary Coverage
If the Member/Covered Family Member is entitled to receive legal services or reimbursement for legal services from any other person or organization, the coverage available under the Policy would be considered excess as defined in the National Association of Insurance Commissioners Model Coordination of Benefits Provisions.
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.
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 in the Definitions section.
When coverage for a Member/Covered Family Member terminates and a matter is unresolved when coverage terminated, then any further legal work between said Member/Covered Family Member and the
Participating Attorney shall be outside the scope and coverage of the Policy. The Participating Attorney shall not be obligated to provide any benefits under the Policy and any further legal services shall be based upon an independent and separate fee agreement entered into, if at all, between the former
Member/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.
Illegal Activity, Misrepresentation and Fraud
We will not provide coverage if the Member/Covered Family Member has intentionally concealed or misrepresented any material fact or circumstances or been involved in any illegal activity related to the Policy or claim. We will not provide coverage if doing so would be in violation of any United States economic or trade sanction.
Portability
The Member may continue this insurance by electing the option of portability when the Member no longer qualifies as an employee of the Policyholder or as a Member of the group to which the Group Policy is issued. The Member must apply for portability within sixty (60) days of this disqualifying event and make arrangements for premium payment. Portability coverage will take effect, subject to payment of the initial premium, as of the date the Member’s coverage under the Group Policy terminates. Credit will be given for any applicable Waiting Period based upon the number of months coverage was in force for the Member under the Group Policy.
Waiver of Premium
Upon the death of the Member, coverage for the surviving Covered Family Members continues for the remainder of the current Group Policy term. We waive further premium payments during this time.
Upon the Member being called to active duty for a period of more than thirty (30) consecutive days for the purposes of military service or of responding to a declared national emergency, coverage for the
Covered Family Members will continue, without the payment of premium, for the length of the Member’s absence and for so long as the Member remains eligible for benefits through the Policyholder.
Conformed to Statute
Any terms herein that conflict with the statutes of the jurisdiction where issued are amended to conform to the statutes.
Assignment of Benefits
The benefits provided herein are not assignable.