Schedule of Benefits
Advice and Consultation	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
LegalEASE Helpline	Covered	Not Applicable
Initial Law Office Consultation - one hour per calendar quarter	Covered	Not Applicable
Review of Simple Documents - Review of documentation up to 6 pages	Covered	Not Applicable
Financial Advisor	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Financial Helpline	Covered	Not Applicable
Identity Theft Assistance	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Advice and Consultation	Covered	Not Applicable
Miscellaneous Services	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Legal Services for any non-excluded legal matter not specifically covered in the Schedule up to 10 hours per year	Covered	$60/hour
Discounted Legal Services for any non-excluded legal matter	25% discount on Participating Attorney’s hourly rates	Not Applicable
Consumer Matters	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Document Preparation: Simple Deed Promissory Note Consumer Dispute Correspondence Installment Sales Agreement Simple Affidavit General Power of Attorney: Member & Family Member Lease Agreement - Tenant only Time Share Agreement	Covered	$65 $55 $55 $55 $55 $55 $65 $55
Consumer Dispute	Covered	$595
Small Claims Court Reprsentation	Covered	$300
Construction/Renovation/Home Repair Dispute	Covered subject to Managed Case Rules*	$895 maximum subject to Managed Case Rules*
Mail Order or Internet Purchase Dispute	Covered	$300
Bank Fee Dispute	Covered	$300
First-time Vehicle Buyer	Covered	$300
Vehicle Repair and Lemon Law Litigation	Covered	$300
Cell Phone Contract Dispute Contract review up to 6 pages Representation	Covered	$300
Personal Property Protection	Covered	$300
Warranty Dispute Warranty review up to 6 pages Representation	Covered	$300
Health Care Coverage Dispute and Records Office consultation up to 5 hours Review of Health Care Policy Review/preparation of document up to 5 pages	Covered	$300
Identity Theft Defense	Covered	$850
Estate Planning	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Simple Will or Codicil for: Member Spouse Family Member	Covered	$80
Living Will/Health Care or Advance Directive	Covered	$55
Health Care or Medical Power of Attorney	Covered	$55
Revocable or Irrevocable Living Trust Document	Covered	$310
Funeral Directive	Covered	$55
Hospital Visitation Authorization	Covered	$55
Probate of Small Estate	Covered up to 2 hours with remainder at 25% discount	$120
Veterans Benefits Appeal	Covered	$720
Elder Law	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Will Preparation	Covered	$80
Living Will/Health Care or Advanced Directive	Covered	$55
Durable Financial Power of Attorney	Member co-pay $45 per document	Not Applicable
Health Care or Medical Power of Attorney	Member co-pay $45 per document	Not Applicable
Elder Law Matters	Covered	$425
Residential Matters	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Purchase of Primary Residence	Covered	$490
Sale of Primary Residence	Covered	$365
Refinancing of Primary Residence	Covered	$385
First Time Home-Buyer	Covered	$425
Vacation or Investment Home Purchase/Sale/Refinancing	Covered	$425
Home Equity Loan Assistance	Covered	$360
Property Tax Assessment	Covered	$360
Tenant Dispute	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
Tenant Security Deposit Dispute	Covered	$850
Landlord Dispute with Tenant Pre-litigation activities Trial Representation	Covered up to 10 hours with remainder at 25% discount	$595
Security Deposit Dispute with Tenant	Covered up to 10 hours with remainder at 25% discount	$595
Construction Defect Dispute	Covered	$425
Neighbor Dispute	Covered	$765
Noise Reduction Dispute	Covered	$765
Boundary or Title Dispute	Covered	$595
Zoning Application	Covered	$595
Financial Matters	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Debt Collection Defense  Pre-litigation defense activities  Trial defense	Covered	$425 $850
Garnishment Defense	Covered	$850
Bankruptcy (Chapter 7 or 13)	Covered subject to Managed Case Rules*	$935 maximum subject to Managed Case Rules*
Foreclosure	Covered	$680
Tax Audit	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
Tax Defense	Covered subject to Managed Case Rules*	$850 maximum subject to Managed Case Rules*
Student Loan Refinancing/Collection Defense	Covered	$420
Family	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Separation, Divorce, Civil Annulment Uncontested Separation or Civil Annulment Consent/default Divorce Uncontested Divorce	Covered up to 10 hours with remainder at 25% discount	$595
Contested Divorce, as defined	Covered up to 28.5 hours with remainder at 25% discount	$1,700 maximum subject to Managed Case Rules*
Post-Divorce Proceedings	Covered up to 28.5 hours with remainder at 25% discount	$1,700 maximum subject to Managed Case Rules*
Domestic Partnership Agreement	Covered	$320
Postnuptial Agreement	Covered	$680
Prenuptial Agreement	Covered	$680
Name Change	Covered	$255
Gender Identifier Change	Covered	$240
Egg/Sperm/Embryo Donation Agreement	Covered	$480
Uncontested Guardianship/Conservatorship	Covered	$365
Uncontested Governmental Agency Adoptions	Covered	$365
Uncontested Stepparent Adoptions	Covered	$365
Pre-Birth/Post-Birth Parentage Order	Covered	$320
Protection from Domestic Violence	Covered	$595
Juvenile Court Proceedings	Covered	$470
School Administrative Proceeding	Covered	$425
Immigration Assistance	Covered up to 10 hours with remainder at 25% discount	$595
Parental Responsibility Matters	Covered	$595
Civil	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Civil Litigation Defense	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
Administrative Hearing Representation	Covered subject to Managed Case Rules*	$1,275 maximum subject to Managed Case Rules*
Discounted Contingency Fees	10% discount on state maximum, or a maximum of 29% pre-trial, 36% at trial, or 40% in an appeal	Not Applicable
Mediation	10% discount on Mediator’s hourly rates	Not Applicable
Criminal Defense	LegalEASE Plan Coverage Participating Attorney	LegalEASE Plan Coverage Non-Participating Attorney
Traffic Ticket	Covered	$215
Serious Traffic Matters (resulting in suspension or revocation of license)	Covered	$425
Administrative Proceeding (resulting in Suspension or Revocation of License)	Covered	$255
Misdemeanor Defense	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*
DUI/DWI Defense	Covered subject to Managed Case Rules*	$1,700 maximum subject to Managed Case Rules*

Limitations apply.

* Managed Case Rules

This Policy excludes benefits for the following:

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 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 this Policy; Legal Plan Administrator or its subsidiaries; Claims Administrator or its subsidiaries; Policyholder; Member’s employer; LegalEASE and it’s 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 Policy.The Policy 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 Policy, 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.

 

 

“CLAIMS ADMINISTRATOR” - means LegalEASE; or its subsidiary.

“COMPLEX WILL” – means:

1. You have a significant net worth and will benefit from tax planning, or
2. the estate is subject to current state or federal estate taxation; or
3. You own a business that will continue in operation after death; or
4. You want to put restrictions on what heirs may do with the property; or

5. You want to leave money to someone in a trust because the person cannot manage his or her own affairs (such as a mentally handicapped child), or
6. 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

7. You think that someone will challenge the will; or
8. You want 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:

1. requires more than 5 hours of attorney time, and
2. involves disputed issues and
3. both parties are represented by an attorney.

“COVERED FAMILY MEMBER” – means

1. Your Covered Spouse
2. Your and Covered Spouse’s unmarried dependent children, including
   1. newborn children from the moment of birth
   2. stepchildren
   3. legally adopted children
   4. children placed in the home for adoption
   5. children who are under Your or Covered Spouse’s sole legal guardianship
   6. foster children up to age 26

“COVERED SPOUSE” – means Your lawful spouse or Domestic Partner at the time the coverage is in effect and for whom the required premium is paid where spouse coverage is optional.

“DOMESTIC PARTNER” – means Your domestic partner as defined by the jurisdiction in which You primarily reside.

“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 Your coverage hereunder begins.

“ELIGIBLE PARENT” – means Your or Covered Spouse’s parents regardless of age. It includes biological parents, step-parents and adoptive parents.

“HEALTH CARE COVERAGE” – means Your coverage under any health care or health insurance policy. It

also means any policy that covers as its primary function any aspect of an individual’s health.

“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.

“INTERNET PURCHASE” - A purchase of goods or services whose cost is over $200.00 at the time You purchase from a website on the Surface Web.

“LEGAL PLAN ADMINISTRATOR” – LegalEASE,

1. its affiliates, officers, directors, employees, and/or
2. agents, including third party organizations and their affiliates, officers, directors, employees, and/or
3. 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. This document only takes effect when the individual becomes incapacitated and can no longer express his or her wishes.

“MEMBER” - refers to the individual who:

1. is associated with the Policyholder,
2. has either paid a premium or had a premium paid on his or her behalf, and

In consideration of payment and receipt by Us of the applicable premium, all Covered Services are available to You and all Covered Family Members, except as specifically noted below. The following Covered Services are provided when You use a Participating Attorney. The Schedule chart shows the reimbursement schedule when You use 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:

Office consultations with an attorney on any personal legal problem, civil or criminal, except those specifically excluded.

 

Review of Simple Documents:

This benefit includes:

1. attorney review,

2. verbal explanations of the meaning or impact of any form or document, or

3. suggestions for changes to a form or proposed document being drafted of up to the maximum number of pages as shown in the Schedule.

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:

1. review and/or prepare documents, or

2. 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 per year.

 

Discounted Legal Services for any Non-Excluded Legal Matter:

This benefit will cover any legal services to:

1. review and/or prepare documents, or

2. any other service required on any legal matters not listed as a Covered Service or Exclusion.

This benefit may not be used to extend the coverage for any other service shown in the Schedule beyond the limits of coverage.

 

Consumer Matters

 

Document Preparation:

Preparation of any of the following documents:

1. Simple Deed for the primary residence only(excluding those reviewed or prepared under the real estate benefit) This benefit is limited to one use per year.

2. Promissory Note

3. Consumer Dispute Correspondence

4. Installment Sales Agreement

5. Simple Affidavit

6. General Power of Attorney This benefit is limited to one use per year per Member/Covered Family Member and can be used for a General, Limited, and/or Durable Financial Power of Attorney.

7. Lease Agreement (for You/Covered Family Member as a tenant only)

8. Time Share Agreement

 

Consumer Dispute:

Consultation or representation in a dispute relating to consumer goods and services.

 

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).

 

Construction / Renovation / Home Repair Dispute:

Consultation or representation in a dispute involving consumer goods or services related to:

1. construction

2. renovation

3. home repairs

that occurred on the premises of Your primary residence (where You have resided or intends to reside for twenty-seven (27) weeks).

This benefit does not apply to consumer goods and services that are directly or indirectly related to a landlord/tenant dispute.

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:

1. mail order or

2. Surface Web Internet Purchase

dispute involving the purchaser prior to the commencement of litigation. This service includes:

1. the consultation with the attorney and review and/or

2. preparation of purchase documents and/or

3. dispute letters.

 

Bank Fee Dispute:

The services of an attorney to review the nature of any (non-business related) bank fee dispute between You and Your bank prior to the commencement of litigation. This service includes:

1. the consultation with the attorney and

2. review and/or preparation of purchase documents and/or dispute letters.

 

First-time Vehicle Buyer:

The services of an attorney for the purchase of a first vehicle. This service includes:

1. the consultation with the attorney at or before closing and/or

2. review and/or preparation of purchase and finance documents.

This benefit is limited to one vehicle purchase per year and must be Your first vehicle purchase.

 

Vehicle Repair and Lemon Law Litigation:

Services related to Your representation when 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 You have or are required by law to have insurance.

 

Cell Phone Contract Dispute:

Review of the cell phone contract where the attorney will:

1. verbally explain the meaning or impact of any form or document, or

2. make suggestions for changes to a form or document being drafted, of up to maximum number of pages shown on the Schedule.

This benefit does not include:

1. a written analysis or

2. explanation

of any form or document.

In the event of a dispute over the terms of the agreement between the cell phone company and You, this benefit provides for representation in a dispute relating to the cell phone contract only if You have been sued or named in a court action. This service covers:

1. counseling on prosecuting a court action;

2. helping You prepare documents;

3. advising on evidence, documentation and witnesses; and

4. preparing You for trial. The service does not include:

1. the attorney’s attendance or representation at a trial,

2. collection activities after a judgment or

3. any services relating to post-judgment actions.

 

Personal Property Protection:

Services cover counseling over the phone or in the office on any Personal Property issue, including:

1. consumer credit reports,

2. contracts for the purchase of Personal Property,

3. consumer credit agreements or installment sales agreements,

4. pursuing or defending small claims actions.

The benefit includes reviewing personal legal documents and preparing promissory notes, affidavits and demand letters.

 

Warranty Dispute:

Review of the warranty policy or service contract where the attorney will:

1. verbally explain the meaning or impact of any form or document, or

2. make suggestions for changes to a form or document being drafted, up to the maximum number of pages shown on the Schedule.

This benefit does not include:

1. a written analysis or

2. explanation of any form or document.

In the event of a dispute over the terms of the agreement between the warranty company and You, this benefit provides representation in a dispute relating to the warranty or service contract only if You have been sued or named in a court action.

This service covers:

1. counseling on prosecuting a court action;

2. helping You prepare documents;

3. advising on evidence, documentation and witnesses; and

4. preparing You for trial. The service does not include:

1. the attorney’s attendance or representation at a trial,

2. collection activities after a judgment or

3. any services relating to post-judgment actions.

 

Health Care Coverage Dispute and Records:

Up to the maximum as shown in the Schedule for office consultations with an attorney on any Health Care Coverage dispute, civil, involving a:

1. coverage,

2. benefits, or

3. privacy matter

that arose while the health care or health insurance policy was in effect (as defined by the terms of that health care or health insurance policy). For a definition of Health Care Coverage, please see the Definitions section.

This benefit is designed to help You understand:

1. health care law provisions and coverages based on the federal and/or state version of this law AAPACA, and

2. 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:

1. collection defense or

2. other actions

related to medical bills or payments. This benefit also includes:

1. the review of simple health care policy coverage documents and

2. the attorney will verbally explain the meaning or impact of any policy or related document, or

3. make suggestions for dispute letters or documents being drafted, of up to the maximum number of pages as shown in the Schedule.

This benefit does not include a written analysis or explanation of any form or document.

This benefit does include the preparation of any of the following documents, up to the maximum number of pages shown on the Schedule:

1. policyholder dispute correspondence, and

2. simple affidavit.

Partial documents cannot be reviewed or prepared, and if the document ,other than the actual health care coverage policy is more than the maximum number of pages shown in the Schedule, the benefit does not apply.

Nothing in this benefit will pay or create any obligation to pay any health care or health insurance benefits to any person for any reason. Any coverage related to this benefit must be related to Your dispute under a health care or health insurance policy.

 

Identity Theft Defense:

Services related to Your representation regarding potential creditor actions resulting from identity theft, and attorney services as needed to contact:

1. creditors,

2. credit bureaus and

3. 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. For a definition of a Complex Wills, please see the Definitions section.

 

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:

1. Living Will

2. Health Care Directive

3. Advance Directive

4. Health Care Power of Attorney

5. 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 You and/or Covered Spouse. 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. This benefit does not include the preparation of:

1. a charitable or charitable remainder trust;

2. special needs trust;

3. tax by-pass or credit shelter trust;

4. asset protection trust;

5. insurance trust;

6. qualified domestic trust (QDOT);

7. qualified terminable interest property trust (QTIP); or

8. blind trust.

This benefit applies to the Member and Covered Spouse only.

 

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 up to the maximum as shown in the Schedule. The estate must not be subject to current state or federal estate taxation. This benefit does not apply when there are applicable state-mandated attorney fees.

 

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. For a definition of a Complex Wills, please see 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 per year at no charge. For a definition of Living Will/Health Care or Advance Directive, please see the Definitions section. The attorney will prepare the document 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. When state law allows the information contained in any two or more of these documents to be combined into one document, then the benefit covers the preparation of only one document, and can be combined to increase the total allowed benefit.

 

Elder Parent Durable Financial Power of Attorney:

Each Eligible Parent may request one Durable Financial Power of Attorney per year at the co-pay rate shown in the Schedule. For a definition of Durable Financial Power of Attorney, please see the Definitions section. The attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Durable Financial Power of Attorney. The titles of the above documents may vary by state.

 

Elder Parent Health Care or Medical Power of Attorney:

Each Eligible Parent may request one Health Care or Medical Power of Attorney per year at the co- pay rate shown in the Schedule. For a definition of Health Care or Medical Power of Attorney, please see the Definitions section. 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. When state law allows the information contained in any two or more these 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.

 

Elder Law Matters:

This service covers counseling You:

1. over the phone or

2. in the office

on any personal issues relating to the Eligible Parents as they affect You. This benefit includes reviewing documents of the Eligible Parents to advise You of the legal effect on You. The documents include:

1. Medicare or Medicaid materials,

2. prescription plans,

3. leases,

4. nursing home agreements,

5. powers of attorney,

6. living wills and

7. wills.

The benefit also includes preparing deeds involving the Eligible Parents when You and/or Covered Spouse is either:

1. the grantor or grantee;

2. and preparing promissory notes involving the parents when You 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 You have resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes:

1. the review and/or preparation of closing documents and/or

2. attendance by the attorney at closing in situations when it is customary for the attorney to do so. This benefit does not include:

1. services performed by or for a title company, or

2. 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 does not include any fees or costs other than those related to the attorney’s review of the purchase/sale documents.

 

First-time Home Buyer:

The services of an attorney for the purchase of a first primary residence (where You have resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes:

1. the review and/or preparation of closing documents and/or

2. attendance by the attorney at closing in situations when it is customary for the attorney to do so. This benefit does not include:

1. services performed by or for a title company, or

2. for an attorney acting on behalf of a lending institution.

Home equity loans and the purchase of unimproved or rental 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.

 

Vacation or Investment Home Purchase, Sale or Refinancing:

The services of an attorney for the:

1. purchase,

2. sale, or

3. refinancing

of a vacation or investment residence (where You have not resided or do not intend to reside for twenty-seven (27) weeks or more per year). This service includes:

1. the review and/or preparation of closing documents and/or

2. attendance by the attorney at closing in situations when it is customary for the attorney to do so. This benefit does not include:

1. services performed by or for a title company, or

2. 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.

 

Home Equity Loan Assistance for Primary Residence:

The services of an attorney for the review and/or preparation of a home equity loan on a primary residence home. This benefit does not include:

1. services performed by or for a title company, or

2. 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 residence (where You have resided or intends to reside for twenty-seven (27) weeks or more per year). This benefit includes:

1. filing the paperwork,

2. gathering the evidence,

3. negotiating a settlement, and

4. attending the hearing necessary to seek a reduction of the assessment.

 

Tenant Dispute:

Representation of You as a tenant in a dispute with his/her landlord. This benefit does not include representation for a tenant in a dispute with other tenants or for a tenant acting in his/her capacity as sublessee or sublessor.

 

Tenant Security Deposit Dispute:

The services of an attorney to assist You as a tenant in:

1. recovering a security deposit from the residential landlord for the primary residence;

2. reviewing the lease and other relevant documents; and

3. preparing a demand letter to the landlord for the return of the deposit. This benefit covers:

1. preparation for prosecuting a small claims action;

2. helping prepare documents;

3. advising on evidence, documentation and witnesses; and

4. preparing You for the small claims trial. The service does not include:

1. the attorney’s attendance or representation at the small claims trial,

2. collection activities after a judgment or

3. any services relating to post-judgment actions.

 

Landlord Dispute with Tenant:

This benefit covers You where You are a landlord , but where Your regular business or livelihood is that other than a landlord, for matters involving:

1. evictions,

2. leases, or

3. disputes

with a residential tenant.

The service includes advice and representation if a lawsuit is filed up to the maximum shown on the Schedule.

This benefit does not include representation for a tenant in disputes with other tenants or for a tenant acting in his/her capacity as sublessee or sublessor. 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. You will be responsible for paying all fees for any additional services required.

 

Security Deposit Dispute with Tenant:

This benefit covers You where You are a landlord , but where Your regular business or livelihood is that other than a landlord, in:

1. defending against the recovery of a security deposit from Your residential tenant for any residence owned and leased by You;

2. reviewing the lease and other relevant documents; and

3. preparing a letter to the tenant specifying what part of the deposit, if any, will not be returned. It also covers:

1. assisting You in defending a small claims action;

2. helping prepare documents;

3. advising on evidence, documentation and witnesses; and

4. preparing You for the small claims trial. The service does not include:

1. the attorney’s attendance or representation at the small claims trial,

2. collection activities after a judgment or

3. any services relating to post-judgment actions

 

Construction Defect Dispute:

The services of an attorney in a dispute relating to a defect or damage caused by the construction of Your new primary residence (where You have resided or intends to reside for twenty-seven (27) weeks or more per year), purchased within the past five (5) years up to the maximum shown in the Schedule.

 

Neighbor Dispute: The services of an attorney in a dispute relating to Your Neighbor up to the maximum shown in the Schedule. 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.

This benefit does not include matters involving:

1. a dispute with a condominium/homeowners’/property owners association or

2. a housing cooperative board, or

3. any individual in his/her capacity as a member of a condominium/homeowners’/property owners’

association or

4. a housing cooperative board.

 

Noise Reduction Dispute:

The services of an attorney in a dispute relating to Your enjoyment of Your residence, where any activity related to noise affecting Your enjoyment of Your home is prohibited by:

1. federal,

2. state or

3. local law,

up to the maximum shown in the Schedule. Advice and/or preparation and assistance for a dispute filed in court is also 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 :

1. Your primary residence and

2. where coverage is not available under Your 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.

 

Zoning Application:

Services needed to negotiate and/or litigate the change of zoning or variance for Your primary residence. This benefit applies to You as a named plaintiff or defendant.

This benefit includes:

1. research and review of the law,

2. surveys,

3. advising You,

4. preparing applications, and

5. preparing for and attending the hearing.

This benefit does not include zoning or variance issues related to business assets or property.

 

Financial Matters

 

Debt Collection Defense:

The defense of any dispute involving personal (non-business related) debt. This benefit includes:

1. correspondence,

2. negotiating with creditors to arrange a repayment schedule,

3. assistance in limiting harassment by bill collectors, and

4. negotiating settlement after a complaint is filed. This service does not include:

1. defense against execution of a court-ordered judgment or

2. 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:

1. correspondence,

2. negotiating with the court or opposing party to arrange a repayment schedule,

3. assistance in limiting harassment by bill collectors,

4. negotiating settlement after a complaint is filed, and

5. representation at trial, if necessary.

This service does not include efforts to vacate or set aside a judgment. This service does not include:

1. counter, cross or third-party claims;

2. bankruptcy;

3. any action arising out of family law matters, including support and post-decree matters; or

4. any matter where the creditor is affiliated with the Policyholder.

 

Bankruptcy:

Representation on Your behalf for personal bankruptcy protection under Chapter 7 or 13 of the Internal Revenue Code. This benefit does not include business related bankruptcy.

This benefit applies to the Member/Covered Spouse only.

 

Foreclosure:

Defense of You in an action to foreclose on Your primary residence (where You have resided or intends to reside twenty-seven (27) weeks or more per year.)

 

Tax Audit:

This benefit includes:

1. 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

2. 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 federaltax agency.

This benefit includes:

1. correspondence,

2. negotiating with the creditor tax agency to arrange a repayment schedule,

3. assistance in limiting harassment by bill collectors,

4. negotiating settlement after a complaint is filed, and

5. representation at trial, if necessary. This service does not include:

1. defense against execution of a court-ordered judgment or

2. efforts to vacate or set aside a judgment. This service does not include:

1. counter, cross or third-party claims;

2. bankruptcy;

3. any action arising out of family law matters, including support and post-decree matters; or

4. 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 for a student loan refinancing or collection dispute proceeding..

This benefit includes:

1. negotiation with creditors for a repayment schedule and to limit creditor harassment, and

2. representation in defense of any action for:

   1. personal debt collection,

   2. tax agency debt collection,

   3. foreclosure,

   4. repossession or

   5. garnishment,

all related to one or more school loans up to and including trial if necessary. This benefit does not include:

1. vacating a judgment;

2. counter, cross or third-party claims;

3. bankruptcy, any action arising out of family law matters, including support and post decree issues; or

4. any matter where the creditor is affiliated with the sponsor or employer

 

Family Matters

 

Separation, Divorce, Civil Annulment:

Legal representation of You for up to the maximum shown on the Schedule 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, You 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; or

3. services relative to post-decree representation.

A contested separation, divorce or civil annulment requires:

1. more than five hours of attorney time, and

2. involves disputed issues and

3. requires that both parties be represented by an attorney.

This benefit is limited to two uses per year (representation seeking or defending against interim order shall constitute a separate use). 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 You for up to the maximum listed n the Schedule of Benefits in a contested or uncontested post-divorce proceeding. An uncontested post-divorce proceeding does not involve:

1. significant disputed issues and

2. 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; You must pay the attorney’s fee for services in excess of the maximum;

2. contested matters in which case You 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:

1. more than five hours of attorney time,

2. involves disputed issues and

3. requires that both parties be represented by an attorney. This benefit includes custody, support, and alimony proceedings.

This benefit is limited to two uses per year. This benefit applies to the Member and Covered Spouse only for actions not involving the Member as an opposing party.

 

Domestic Partnership Agreement:

The service covers the preparation of a domestic partnership agreement by You and Your 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 You and Your 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 You and Your fiancé/partner prior to their marriage or legal union (where allowed by law), outlining how property is to be divided in the event of:

1. separation,

2. divorce or

3. death

of a spouse. Representation is provided only to You. The fiancé/partner must have separate counsel or must waive representation.

This benefit applies to the Member only.

 

Gender Identifier Change:

Services required to change the gender identifier on government issued documents.

 

Egg/Sperm/Embryo Donation Agreement:

This service covers the preparation of an egg, sperm or embryo donation agreement for a Member.

 

Name Change:

Services required to accomplish a legal name change for You/Covered Family Member.

 

Uncontested Guardianship/Conservatorship:

Services required to establish You/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. rThis benefit does not include contested matters.

 

Uncontested Government Agency/Stepparent Adoption:

Legal representation up to the maximum shown in the Schedule of Benefits in an uncontested:

1. governmental agency or

2. 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:

1. more than five hours of attorney time and

2. 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, then coverage will terminate and You 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.

Protection from Domestic Violence:

Services needed to assist You in obtaining a protective order arising from a domestic violence or abuse matter, including:

1. all required paperwork and

2. attendance at all court appearances. This benefit does not include:

1. representation in suits for damages,

2. defense of any action, or

3. 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 Your/Covered Family Member’s dependent child in any juvenile court proceeding, provided the child’s interest is not in conflict with Your 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.

 

School Administrative Proceeding:

Services needed for Your/Covered Family Member’s dependent child for:

1. consultations, and

2. 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 Your 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:

1. advice and consultation,

2. preparation of affidavits and powers of attorney,

3. review of any immigration documents, and

4. helping You prepare for hearings.

This benefit also extends to Your Covered Family Members and non-covered family members who are attempting to become US citizens in the manner prescribed by law.

 

Parental Responsibility Matters:

Representation of You/Covered Spouse in juvenile court proceedings (except those involving traffic matters) where the State has brought an action against You/Covered Spouse relating to his or her parental responsibilities for a Covered Family Member.

 

Civil Matters

 

Civil Litigation Defense:

Services related to representation when You are named as 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 You have or are required by law to have insurance; (4) post judgment matters; (5) matters with criminal penalties; or (6) litigation of a job- related incident. This benefit does not include services relating to counter, third-party or cross claims. This benefit does not include matters involving a dispute with:

1. a condominium/ homeowners’/property owners association or

2. a housing cooperative board, or

3. any individual in their capacity as a member of a condominium/ homeowners’/property owners’

association or a housing cooperative board.

 

Administrative Hearing Representation:

Services needed to defend You from civil proceedings before a:

1. municipal,

2. county,

3. state, or

4. 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 Your responsibility to pay this fee and all costs.

1. When state laws set contingency fees: Lesser of 10% less than state law maximum fee or the

Participating Attorney’s usual fee.

2. 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 representing You in defense of any traffic ticket except driving under influence or vehicular homicide, including:

1. court hearings,

2. negotiation with the prosecutor,

3. trial, and

4. counseling and preparing You for self-representation at any hearings if chosen.

This benefit does not cover violations related to a commercial driver’s license. This benefit does not apply to Driving Under the Influence (DUI) or Driving While Intoxicated (DWI) violations/citations.

 

Serious Traffic Matter:

Services related to representing You when You are:

1. charged by governing authorities with moving traffic violation(s) and

2. 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. This benefit does not apply to Driving Under the Influence (DUI) or Driving While Intoxicated (DWI) violations/citations. This benefit cannot include expungements of misdemeanor convictions. This benefit does not include adjustments to probation or parole.

 

Administrative Proceeding:

Services related to representing You in an administrative proceeding relating to the:

1. suspension or

2. revocation

of driving privileges.

This benefit does not cover suspension or revocation of a commercial driver’s license.

 

Misdemeanor Defense:

Defense of You in connection with criminal misdemeanor charges (not associated with any felony charge). This benefit does not include defense of moving traffic violations. This benefit does not include juvenile matters. This benefit cannot be used for expungements of misdemeanor convictions. This benefit does not include employment related misdemeanors. This benefit does not include misdemeanors relating to a commercial driver’s license. This benefit does not include adjustments to probation or parole.

 

 

Coverage includes a financial counseling Service for Member, and Covered Family Members.

 

Consultation with legal or financial professionals by toll-free telephone during normal business hours. Calls can relate to investment strategies, debt matters, budgeting or any personal financial planning question.

 

 

 

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.

 

Telephone consultations (10 per year) with a Trained Identity Theft Recovery Specialist.

 

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).

 

 

 

1. You should call the Member Service Center to confirm the potentially applicable benefit(s) prior to consulting with any attorney. You/Covered Family Member must provide all information requested with respect to the circumstances of an insured event or service provided. 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.

 

3. You 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, You/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 You/Covered Family Member will be responsible for all legal fees.

 

5. If You/Covered Family Member pay for pre-authorized services provided by a Non-Participating Attorney, You must:

(a) submit a reimbursement form (provided by Member Service Center) accompanied by an original itemized bill,

(b) proof of payment and

(c) supporting documentation

sufficient to demonstrate the work completed in the matter within sixty (60) days after incurring the legal fees. Benefits provided to You/Covered Family Member for Covered Services are subject to the maximum as shown in the Schedule.

 

6. Payment by Us for Covered Services does not preclude the attorney (whether Participating or Non- Participating) from seeking and recovering attorney’s fees from an opposing party, where authorized by:

(a) law,

(b) court rule, or

(c) contract

at the attorney’s customary or prevailing rate.

If You/Covered Family Member receive reimbursement of attorney’s fees, then You/Covered

Family Member agree to reimburse Us for payments issued.

 

 

In the event that You and one of the Covered Family Members are involved as adversaries in a dispute that is a Covered Service, only You 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.

 

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; any matters involving a government (domestic or foreign) entity or agency; farm related issues; matters involving commercial or rental property transactions, including the purchase, sale or lease of investment or income-producing property. A multi-family residence, whether or not used by the Member/Covered Family Member as his or her primary residence, is deemed an 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 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 Non-Participating 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.

 

 

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. You have the unrestricted right to choose an attorney. Your relationship with an attorney is privileged and strictly confidential. We will not interfere in:

(a) the attorney-client relationship or

(b) 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.

 

You shall authorize the Participating Attorney to provide the Legal Plan Administrator with:

(a) information and

(b) supporting documentation

on the number and type of services provided to You.

 

By using legal services benefits that are provided under the Policy, You agree that neither:

(a) We,

(b) nor the Policyholder,

(c) nor any other person

involved in the marketing or administration of the Policy, shall have any liability for the:

(a) acts,

(b) errors or omissions

of an attorney providing services, in whole or in part.

 

 

If You already have an attorney, You may prefer to use her/him as a Non-Participating Attorney. To do so, You must first contact the Member Service Center and notify the representative of Your intention to use a Non-Participating Attorney for a Covered Service. The Member Service Center will send You a claim

 

form which must be completed and returned in order to request reimbursement. Your reimbursement will be based on the reimbursement schedule shown under the Non-Participating Attorney column of the Schedule. If You have a Non-Participating Attorney You would prefer to work with, the Legal Plan Administrator may elect to offer to negotiate with the attorney on Your behalf, but cannot guarantee the Non-Participating Attorney will accept the Plan Discounted Rate.

 

 

All benefits will be subject to subrogation and coordination of benefit rules. For the purpose of subrogation, We may require You/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, You/Covered Family Member must cooperate in providing the assignment.

 

 

You or Covered Family Member may call the Member Service Center to obtain a definition or explanation of any term used herein.

 

 

The coverage period is automatically renewable upon receipt of appropriate premium unless terminated in accordance with the terms hereof.

 

 

The coverage territory includes the United States and United States territories.

 

 

In the event that:

(a) the premium mode is other than monthly and

(b) the Group Policy is terminated or

(c) You elect to terminate the coverage,

a pro-rata premium refund will be made in accordance with the insurance laws of the Policyholder’s state.

 

 

If You/Covered Family Member are 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.

 

 

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.

 

 

We will not provide coverage if You/Covered Family Member have:

(a) intentionally concealed or misrepresented any material fact or circumstances or

(b) 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.

 

 

The Group Policy provides the Policyholder a grace period of thirty-one (31) days after the premium for covered Members’ due date to remit the premium that is due and unpaid. During the grace period, the Group Policy will continue in effect. If the premium for covered Members remains unpaid at the end of the grace period, the Policy will terminate. Termination will be effective at 12:01 a.m. on the thirty- second (32nd) day following the due date for which premium for covered Members remains unpaid. The Policyholder shall remain liable for the pro-rata portion of all premiums that accrue for the period the Group Policy is in effect.

 

 

The Group Policy may be amended or changed at any time by the Company upon written notice thereof and signed by a duly authorized representative. No agent, broker or sales representative may make any change in the Group Policy or waive any of its provisions. No statement made by any person modifies any term of the Group Policy.

 

Notice to any agent or knowledge possessed by any agent or by any other person shall not:

(a) affect a waiver or

(b) change any part of the Group Policy or

(c) stop Us from asserting any right under the terms of the Group Policy

nor shall terms of the Group Policy be waived or changed except as stated above.

 

 

You may continue this insurance by electing the option of portability when You no longer qualify as:

(a) an employee of the Policyholder or

(b) as a Member of the group

to which the Group Policy is issued.

You must apply for portability within thirty-one (31) 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 Your 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 You under the Group Policy.

 

 

Upon Your death, 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 You being called to active duty for a period of more than thirty (30) consecutive days for the purposes of:

(a) military service or

(b) responding to a declared national emergency

coverage for the Covered Family Members will continue, without the payment of premium, for:

(a) the length of Your absence and

(b) for so long as You remain eligible for benefits through the Policyholder.

 

 

Any terms herein that conflict with the statutes of the jurisdiction where issued are amended to conform to the statutes.

 

 

You have the right to request a Division of Insurance hearing on any dispute or controversy arising between Us or Legal Plan Administrator and Member or between any attorney and Member within thirty days after such dispute or controversy arises make written request to the insurance commissioner for a hearing. The insurance commissioner or his designee shall hear the party or parties within thirty days after receipt of the request. Written notice of the time and place of the hearing will be given no less than 15 days after receipt of the request. Within thirty days after the hearing the insurance commissioner or his designee shall issue a decision. The Consumer Section of the Division of Insurance mailing address is 1000 Washington St., Suite 810, Boston, MA 02118. The phone number is 1-617-782-8750. The website is https://www.mass.gov/file-an-insurance-complaint.

 

A Legal Expense Member Survey form will be distributed to all Members after they have received a covered legal service. This form will be used by LegalEASE to help evaluate and improve services. This form can be faxed to LegalEASE using the number shown on the form. The use of the covered person’s name is optional.

 

You have the right to complain to the Board of Bar Overseers concerning attorney conduct in the providing of legal services. The Board of Bar Overseers investigates and evaluates complaints against Attorneys. Complaints are initially handled by the Attorney and Consumer Assistance Program (ACAP) of the Office of the Bar Counsel. Complaint forms can be obtained by calling the Attorney and Consumer Assistance Program (ACAP) at (617) 728-8750. Please note that complaints cannot be accepted via electronic mail due to confidentiality requirements. Completed complaint forms, or questions regarding the process, should be directed to following address:

 

Office of the Bar Counsel 99 High Street

Boston, Massachusetts 02110

(617) 728-8750

 

 

The benefits provided herein are not assignable.

 

• Experience in the Legal Matter Needed
• Quality Time Spent in Consultations
• Years of Legal Training and Experience
• Up-to-date Legal Training Each Year
• Lawyers Who are Service-Oriented
• Lawyers Who Have a Solid Local Reputation in their Communities
• Exceptional Backgrounds
• Years of Courtroom and Trial Experience

• To comply at all times with the Rules of Civil Procedure and Criminal Procedure and the Rules of Professional Conduct applicable to the jurisdiction.
• To return member's calls promptly, within one business day, and communicate with members such that a member and the member's family do not voice substantiated concerns over promptness or frequency of your or your firm's communication.
• To not enter continuances, adjournments, or the like without the member's comfort and consent.
• To not arrange for substitutions or stand-ins unless the member has been previously advised and that the member understands that you remain responsible for the case and to contact you if there is any concern or if proceedings do not go as planned.
• To always respect a member, their needs and family.
• To maintain a professional office, in staffing and appearance.
• To fully explain yourself such that a member has an understanding for the reasons behind your recommendations and suggestions, even if a member may not hire your firm.
• To not complete any additional work that will result in a fee to the member, where not covered by the member's plan, until a fee arrangement is fully understood by the member and there is a written agreement.
• To help each member individually and ensure that everything you do is in the interest of the member.
• To notify LegalEASE if there is or may be the possibility of a conflict of interest or violation of ethical codes.
• To notify LegalEASE if there may be a misunderstanding or potential service issue where there may be a complaint without breaking any client confidences.
• To direct any grievances or concerns, such as process procedure or billing, to Legal Access and not a member.
• To not refer any member to another attorney without the knowledge and consent of Legal Access if you cannot assist.
• To take responsibility and uphold the highest standards of customer service delivered by any and all firm staff or employees that have interaction with members.
• To communicate and cooperate with LegalEASE on any concern, inquiry or issue and return any communication from Legal Access within one business day.

 

We are here to serve you...

 

We believe people deserve to have a sense of safety and security, a peace of mind, when it comes to being protected in legal matters that they may not be the experts in. To have access to legal professionals that can ease and solve their legal burdens. We are here to serve you.

 

How we do it is by providing an in-depth pool of resources to accommodate all your legal needs. Legal Access and LegalEASE have broad experiences with employees in small, medium and large companies in the public and private sectors, local, state and federal government offices, unions, employee assistance plans, work-life companies, and organizations, when it comes to solving your legal matters.

 

What we do is provide value by creating unparalleled access to a network of skilled attorneys to cover your legal needs with options in convenient plans. We are a diversified employee benefits company engaged in administration, network development, technology management and insurance, based in Houston, Texas. Since 1971, we have grown from five attorneys in Los Angeles providing services to a modest amount of companies into a company with the strongest attorney network across America. We provide assistance to members over half of a million times each year throughout the United States and the world.

 

Legal Access Companies consists of several companies and brands to best meet customer needs, including but not limited to: Legal Plans USA, Legal Access Plans, LegalEASE, and LAMG. Legal Access Plans has a wide array of products across several market segements, including worksite, employee assistance and worklife. LegalEASE is the group's primary insurance brand and focuses primarily in the worksite market. LegalEASE products are underwritten and presented by Virginia Surety Company, part of the Warranty Group.