Definitions
“CLAIMS ADMINISTRATOR” - means Co-ordinated Benefit Plans LLC; or its subsidiary.
“COMPLEX WILL” - means the Member has a significant net worth and will benefit from tax planning, or the estate is subject to current state or federal estate taxation; or the Member owns a business that will continue in operation after death; or the Member wants to put restrictions on what heirs may do with the property; or the Member wants to leave money to someone in a trust because the person cannot manage his or her own affairs (such as a mentally handicapped child), or wants the property to be managed by a trustee for a period of time past the child’s age of majority, to age 25 or 30, for example; or the Member thinks that someone will challenge the will; or the Member wants to exclude any lawful dependents.
“COVERED FAMILY MEMBER” – means the Member’s spouse and Member’s unmarried dependent children, including stepchildren, legally adopted children, children placed in the home for adoption and foster children, up to age 26 and are primarily dependent upon the Member for support.
“COVERED SPOUSE” - means the Member’s lawful spouse at the time the group policy is in effect.
“EFFECTIVE DATE” - means the date a Member’s coverage hereunder begins.
“HEALTHCARE COVERAGE” – means any policy for healthcare that a Member and/or Covered Family Member has in effect over which some type of coverage, benefits, or privacy dispute arising while that policy is in effect as defined by the terms of that policy. Nothing in this group policy / Certificate of Coverage will pay or create any obligation to pay any healthcare benefits to any person for any reason, and any coverage related to this definition in this group policy / Certificate of Coverage must be related to a Member’s and/or Covered Family Member’s dispute under a healthcare coverage policy.
“INTERNET PURCHASE” - A purchase of goods or services whose purchase value is over $200.00 at the time of purchase by a Member and/or Covered Family Member from a website on the worldwide web.
“LEGAL PLAN ADMINISTRATOR” – LegalEASE, its affiliates, officers, directors, employees, and/or agents, including third party organizations and their affiliates, officers, directors, employees, and/or agents, hired by LegalEASE to perform services under this group policy / Certificate of Coverage.
“MEMBER” - refers to the individual who is associated with the Policyholder and who has paid or a premium has been paid on his/her behalf and who meets the eligibility requirements for Covered Services as defined by the Policyholder.
“MEMBER SERVICE CENTER” - means the service location established to help make full use of the certificate benefits.
“NON-PARTICIPATING ATTORNEY” - means an attorney not retained by Legal Plan Administrator who is selected and paid by the Member to provide services covered under the Certificate of Coverage up to the maximum amount as shown in the Schedule of Benefits.
“PAID IN FULL” - means complete payment to a Participating Attorney for covered legal services.
“PARTICIPATING ATTORNEY” - means an attorney retained by the Legal Plan Administrator to provide covered legal services at the amount shown in the Schedule of Benefits.
“POLICYHOLDER” - means the organization named in the declarations page.
“WE”, “US”, “OUR” AND “COMPANY” - means the name of the underwriter indicated on the first page of this Certificate of Coverage.
Covered Services
The Effective Date of this endorsement is the Effective Date of the Policy/Certificate to which this endorsement is attached. This endorsement is made a part of the Policy/Certificate to which it is attached. This endorsement is subject to all of the provisions and limitations of the Policy/Certificate. If there is a conflict between the Policy/Certificate and the endorsement, the terms of the endorsement will govern. The following is a list of Covered Services available, in addition to the services described in your Policy/Certificate of Coverage.
FINANCIAL ADVISOR
Financial Helpline
Consultation with legal or financial professionals by toll-free telephone during normal business hours. Calls can relate to investment strategies, debt matters, or any personal financial planning question.
LEGAL PROTECTION PLAN
The following Covered Services are covered at a flat rate or discount as shown below, when performed by a Participating Attorney.
Discounted Contingency Fees:
- When state laws set contingency fees: Lesser of 10% less than state law maximum fee or the Participating Attorney’s usual fee.
- When state laws do not set contingency fee: Maximum of 29% if settled before trial, 36% if trial is conducted, or40% after an appellate brief is filed.
Contingency rate discount applies in those cases where attorneys customarily take a case on a contingency fee, (an agreed upon portion of any recovery), depending on the outcome of the case.
MEDIATION
Consultation Services:
Members receive one free thirty minute consultation with a licensed mediator every quarter. Topics include: domestic disputes, divorce or child custody proceedings, consumer problems, medical bill, warranties, loan
disputes, auto accidents.
Mediation Counseling Assistance:
Assistance is available to assist Members with understanding mediation and alternative dispute resolution. Examples of some topics are; charting projected lawsuit expenses, understanding when mediation might work, managing legal expenses in
mediation, educational tools to make an informed decision, and advice on selecting mediator or other options. These services are designed to help Members deal with the increase in resolution pace.
Discounted Mediation Services:
Member receives a 10% discount on Participating Attorney’s normal mediation fees. This includes hourly rates and flat fees. However, this does not apply to contingency fees.
IDENTITY THEFT PREVENTION/RECOVERY ASSISTANCE
Coverage includes a basic Identity Theft HelpLine Service as well as a comprehensive Online Identity Theft Prevention and Assistance Service for Member, and Covered Family Members.
Advice and Consultation
Telephone consultations (6 per year) with a Trained Identity Theft Recovery Specialist Additional Benefits
a) Personal Recovery Kit – designed to walk a victim of identity theft step-by-step through the process of recovery (designed to be utilized in conjunction with the consultations with the Recovery Specialist).
b) Recovery Letter preparation by plan attorney – a plan attorney will draft the simple affidavits to submit to specific agencies and organizations needed to establish the theft of your identity and prevent further loss of your identity and credit rating.
c) Review of necessary recovery legal documents (up to 6 pages each)
In consideration of payment and receipt by Us of the applicable premium, all Covered Services are available to a Member and all Covered Family Members. Except as noted below, the following Covered Services are provided to the Member when the Member uses a Participating Attorney. The Schedule of Benefits chart shows the reimbursement schedule when the Member uses a Non-Participating Attorney.
Advice and Consultation
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 a Participating Attorney on any personal legal problem, civil or criminal, except those specifically excluded.
Review of Simple Documents:
The Participating Attorney will verbally explain the meaning or impact of any form or document, or make suggestions for changes to a form or document being drafted of up to the maximum number of pages as shown in the Schedule of Benefits. This benefit does not include a written analysis of any form or document.
Miscellaneous Law Office Services
Legal Services for any Non-Excluded Legal Matter:
This benefit will cover any legal services needed by the Member or Covered Family Member for review or preparation of documents, or any other service required on any legal matters not listed as a covered benefit or exclusion under this Policy.
Consumer Matters
Document Preparation:
Preparation of any of the following documents: simple deed (excluding those reviewed or prepared under the real estate benefit),promissory note, consumer dispute correspondence, installment sales agreement, general power of attorney, lease agreement (tenant only), time share agreement, and simple affidavit.
This benefit is limited to one use per year per document, except general power of attorney, which is limited to one use per year per Covered Family Member.
Consumer Dispute:
Consultation or representation in a dispute relating to consumer goods and services (not involving real estate construction, landlord/tenant disputes or renovation).
This benefit is limited to one use per year.
Small Claims Court Representation:
Consultation and/or representation for a consumer dispute filed in small claims court. (Attorney may not be permitted to attend court hearings in some jurisdictions).
This benefit is limited to one use per year.
Life Insurance Claim:
Assistance to Members in securing life insurance proceeds (not including life insurance provided as an employee benefit) when a Member and/or Covered Family Member is a beneficiary of a life insurance policy.
This service is limited to one use per year.
Estate Planning
Will or Codicil Preparation:
Preparation of one simple will or codicil (an amendment to an existing will) for the Member and/or Covered Family Member, including the preparation of a simple testamentary support trust for the dependent children:
Simple Will Preparation: Participating Attorney shall prepare a simple will or codicil for Member and/or Covered Family Member and discuss the legal requirements for signing the will.
This benefit is limited to one use per year per Member/Covered Family Member.
Living Will and/or Health Care Power of Attorney:
Preparation of living will and/or health care power of attorney for Member and/or Covered Family Member as authorized by state law. A living will expresses an individual’s wishes as to the use or withdrawal of life support systems. A health care power of attorney appoints another to make medical decisions if the individual is unable to do so him/herself.
This benefit is limited to one use per year.
Living Trust Document:
Preparation of living trust documents. This benefit does not include services related to transactions to fund the trust or transfer assets into it. This benefit does not include tax planning or tax advice related to the trust or the Member’s situation before and after the trust is prepared.
This benefit is limited to one use per year.
Probate of Small Estate:
The service of an attorney for the probate of a small estate (an estate that is not subject to current state or federal estate taxation) up to the maximum as shown in Schedule of Benefits.
Residential Matters
Real Estate Sale, Purchase or Refinancing of Primary Residence:
The services of an attorney for the purchase, sale, or refinancing of a Member’s primary residence (where Member has resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes the review or preparation of closing documents and/or attendance by the Member’s attorney at closing in situations when it is customary to do so. This benefit does not include services performed by or for a title company, or for an attorney acting on behalf of a lending institution. Home equity loans and the sale or purchase of unimproved or rental properties are not included.
This benefit is limited to one closing per year.
Tenant Dispute:
Representation of the Member and/or Covered Family Member as a tenant in a dispute with his/her landlord.
This benefit is limited to one use per year.
Financial Matters
Debt Collection Defense:
The defense of any dispute involving personal (non-business related) debt. This benefit includes correspondence, negotiating with creditors to arrange a repayment schedule, assistance in limiting harassment by bill collectors, and negotiating settlement after a complaint is filed. This service does not include defense against execution of a court-ordered judgment or efforts to vacate or set aside a judgment.
This benefit is limited to one use per year.
Bankruptcy:
Representation on behalf of the Member and/or Covered Family Member for personal (non-business related) bankruptcy protection under Chapter 7 or 13 of the Internal Revenue Code.
This benefit is limited to one use per year.
Foreclosure:
Defense of the Member in an action to foreclose on the Member’s primary residence (where Member has resided or intends to reside twenty-seven (27) weeks or more per year.)
This benefit is limited to one use per year.
Tax Audit:
Includes the services of an attorney (but not accounting services) during a personal (non-business related) tax audit process required by federal and state tax authorities and negotiations relating to it. This benefit does not include a defense against criminal charges nor the defense of civil tax litigation in any tax court.
This benefit is limited to one use per year.
Family Matters
Separation, Divorce, Civil Annulment:
Legal representation of the Member only for up to the maximum shown on the Schedule of Services in an uncontested separation, divorce, civil annulment, consent or default divorce. An uncontested separation, divorce or civil annulment does not involve significant disputed issues and the parties resolve any issues prior to any court supervised proceeding. A consent or default divorce does not involve any disputed issues and the opposing party is not represented by counsel. The service 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 Services; the Member must pay the attorney’s fee for services in excess of the maximum; or, (2) contested matters in which case the Member must pay the attorney’s fee for services, unless this Legal Services Contract provides coverage of contested matters and the service shall be in accordance with the Schedule of Services. A contested separation, divorce or civil annulment requires more than five hours of attorney time, involves disputed issues and both parties are represented by an attorney.
This service is limited to one use per year (representation seeking or defending against interim or subsequent-to-decree order shall constitute a separate use) and applies to the Member and Covered Family Members only for actions not involving the Member as an opposing party.
Name Change:
Services required to accomplish a legal name change for a Member and/or Covered Family Member.
This benefit is limited to one use per year.
Guardianship/Conservatorship:
Services required to establish a Member and/or Covered Family Member as the guardian(s) or conservator(s) of another. This benefit does not include fees for a court –appointed attorney for the child/conservatee.
This benefit is limited to one use per year.
Government Agency/Stepparent Adoption:
Legal representation for a Member and/or Covered Family Member of up to the maximum shown in the Schedule of Benefits in a governmental agency or stepparent adoption. An uncontested adoption does not involve significant disputed issues. This benefit does not include: (1) contested termination of parental rights; (2) fees for a court-appointed attorney for the child; or (3) adoptions(s) made through any agency other than a governmental agency. A contested adoption requires more than five hours of attorney time and involves disputed issues.
This benefit is limited to one use per year.
Juvenile Court Matters:
Services related to the representation of the dependent child of a Member and/or Covered Family Member in any juvenile court proceeding, provided the child’s interest is not in conflict with the Member’s and/or Covered Family Member’s interest. This benefit does not cover any matter that falls outside the jurisdiction of juvenile court or any matter that may be considered a felony.
This benefit is limited to one use per year.
Civil Litigation Defense
Civil Litigation Defense:
Services related to the representation of a Member and/or Covered Family Member who is a named defendant in a civil lawsuit (non-business related), up to and including the trial thereof. This benefit does not include: (1) any debt collection or family law matters; (2) lawsuits normally handled on a contingent fee basis; or (3) matters for which the Member/Covered Family Member has or is required by law to have insurance.
This benefit is limited to one use per year.
Criminal Defense
Serious Traffic Matters:
Services related to the representation of a Member and/or Covered Family Member who is charged by governing authorities with moving traffic violation(s) and conviction could result in suspension or revocation of Member’s and/or Covered Family Member’s drivers’ license. This benefit does not cover violations related to a commercial driver’s license.
This benefit is limited to one use per year.
Administrative Proceeding:
Services related to the representation of a Member and/or Covered Family Member in an administrative proceeding relating to the suspension or revocation of driving privileges. This benefit does not cover suspension or revocation of a commercial driver’s license.
This benefit is limited to one use per year.
Misdemeanor Defense:
Defense of a Member and/or Covered Family Member in connection with criminal misdemeanor charges (not associated with any felony charge).
This benefit is limited to one use per year.
Obtaining Services
Claim for Benefits
1. Members must call the Member Service Center to confirm eligibility and coverage prior to consulting with any attorney. The Member Service Center will assign a Participating Attorney to provide services relative to the matter. Failure to notify the Member Service Center within thirty (30) days following consultation with an attorney may result in a denial of benefits.
2. To obtain benefits under the Managed Case Rules:
Members and/or Covered Family Member must secure a confirmation letter from the Member Service Center prior to proceeding with an attorney.The attorney must provide a written estimate of fees reflecting his or her best judgment as to the likely conduct of the case.We will set a maximum attorney fee that takes into account the reasonable level of reimbursement for the proceeding and the proposed litigation strategy. Fees as a result of services in excess of the maximum attorney fee are the responsibility of the Member and/or Covered Family Member.
3. Members actively receiving services must remain enrolled and continue to pay premium hereunder. All benefits will be subject to subrogation and coordination of benefit rules.
4. Upon completion of a Covered Service, the Member and/or Covered Family Member will be required by the Participating Attorney to sign a confirmation of completion. Failure to sign the confirmation may result in denial of the claim and the Member/ Covered Family Member will be responsible for all legal fees.
5. If the Member and/or Covered Family Member pays for pre-authorized services provided by a Non-Participating Attorney, the Member must submit a reimbursement form (provided by Member Service Center) accompanied by an original itemized bill, proof of payment and supporting documentation sufficient to demonstrate the work completed in the matter within sixty (60) days after incurring the legal fees. Benefits provided to the Member and/or Covered Family Member for Covered Services are subject to the maximum as shown in the Schedule of Benefits.
6. Upon receipt of the submitted claim a satisfaction survey will be sent to the Member. In the event that a survey form is not received, Members may contact the Member Service Center at (888) 416-4313 to request a form.
Complaint Resolution Procedure
If, at any point, a Member has a complaint about the services provided either by the Member Service Center or the Participating Attorney a complaint may be registered by calling (888) 416-4313. The matter will be escalated to the Quality Assurance Team for resolution. In the event that a satisfactory resolution is not reached the Member has the option to file a complaint with the Massachusetts Division of Insurance
Any dispute or controversy arising between the Insurer and any Attorney or Member whose Certificate (group)/Policy (individual) has been canceled or to whom the Insurer has refused to issue a Policy/Certificate or between any Attorney and a Member may request a hearing in writing to the Massachusetts Division of Insurance commissioner within thirty (30) days after such dispute or controversy arises. The commissioner or his designee will hear such party or parties within (30) thirty days after receipt of the written request, and will give written notice of the time and place of the hearing no sooner than fifteen (15) days from the date. The hearing will be an adjudicatory hearing as defined in chapter thirty A. The commissioner or his designee will issue a decision within thirty (30) days after the hearing.
You may contact the Division of Insurance to obtain information on companies, rights or complaints at (877)-563-4467. Or visit the website to obtain a complaint form at
http://www.mass.gov/doi.
In addition, a Member may also submit a complaint for review by the Board of Bar Overseers. 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
Disputes Between Member and Covered Family Member
In the event that the Member and one of the Covered Family Members are involved as adversaries in a dispute that is a Covered Service, only the Member will be covered.
If two or more Covered Family Members are involved in a dispute that is otherwise covered, no coverage will be provided.
If two Members are involved as adversaries in a dispute that is a Covered Service, separate coverage for each Member will be provided.
Exclusions
The following benefits are excluded:
Appellate court proceedings, class actions, interventions, derivative action and amicus curiae filings.
The preparation and filing of individual, partnership or estate tax returns, appellate or administrative proceedings related to tax returns, litigation before the U.S. Tax Court, U.S. Court of Claims or any other federal, state or other courts with respect to tax matters.
Matters relating to securities, trademark or patent matters; business or commercial interests, including, but not limited to, professional, partnership and/or corporate matters; matters involving the law or laws of jurisdictions other than the United States and its territories; 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. A two-family house, whether or not used by the 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 (collectively referred to as “frivolous”) or otherwise prohibited by the Model Rules of Professional Conduct of the state in which the attorney is licensed.
Costs associated with covered legal services, including but not limited to, all fines, court costs, penalties, sanctions, expert witness fees, bonds, bail bonds, attorney fees, exhibits, deposition costs, filing fees, transcripts, postage, telephone, photocopying, recording fees, messengers, judgments, jury fees, court reporter fees, investigative costs and all other incidental and out-of-pocket legal and litigation costs.
Any services on behalf of a Covered Family Member against the interests of the Member.
Any employment-related matter. This includes, but is not limited to, any dispute involving the Member’s employer or its affiliates, their officers or directors, the Member’s employee benefit plans, credit unions, programs or arrangements sponsored by an employer, or cases involving workers’ compensation, unemployment compensation, sex harassment, age discrimination, etc.
Any dispute or proceeding against the following persons or entities, their officers, directors, employees, or agents: any person or entity involved in the sale, marketing, administration or other processes related to the group policy; Legal Plan Administrator or its subsidiaries; Claims Administrator or its subsidiaries; Policyholder; Member’s employer; Nationwide Mutual Insurance Company and 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 group policy / Certificate of Coverage.
The Certificate of Coverage will not provide benefits in connection with pre-existing matters, which includes any matter where the Member and/or Covered Family Member is on notice as to a pending legal dispute or has previously contacted an attorney.
Where there are specific hours or dollar amounts provide in this Certificate of Coverage, or where a maximum is set under the Managed Case Rules, the Member will be responsible for all attorney fees incurred over the maximum. Additional exclusions related to each benefit are included in the Covered Services.
General Provisions
Attorney-Client Relationship
All attorneys are subject to the authority of the State Supreme Court and the State Bar of the state where they are licensed to practice. The Member’s relationship with an attorney is privileged and strictly confidential. We will not interfere in the attorney-client relationship, nor in the attorney’s independent exercise of his or her professional judgment. Attorneys are not certified specialists.
The Member shall authorize the Participating Attorney to provide the Legal Plan Administrator with information and supporting documentation on the number and type of services provided to the Member.
By using legal services benefits that are provided under the group policy / Certificate of Coverage, the Members agree that neither We, nor the Policyholder, nor any other person involved in the marketing or administration of the group policy, shall have any liability for the acts, errors or omissions of an attorney providing services, in whole or in part.
Non-Participating Attorney Services
If the Member already has an attorney, the Member may prefer to use her/him as a Non-Participating Attorney. To do so, the Member must first contact the Member Service Center and notify the representative of his/her intention to use a Non-Participating Attorney for a Covered Service. The Member Service Center will send the Member a claim form to request reimbursement. The Member’s reimbursement will be based on the reimbursement schedule as shown in the Schedule of Benefits. Reimbursement for a Non-Participating Attorney will not be less than the negotiated amount for a Participating Attorney. If a Member already has an attorney at the time he/she becomes a Member, the Legal Plan Administrator can offer to negotiate with the attorney on behalf of the Member, but will not guarantee the Plan Discounted Rate will be accepted by the attorney or offered by the Legal Plan Administrator.
Legal Terminology
The Member or Covered Family Member may call the Member Service Center to obtain a definition or explanation of any term used herein.
Coverage Territory
The coverage territory includes the United States and United States territories.
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 last day of the period for which premium was paid on behalf of a Member, if a premium is not paid when due, subject to the Grace Period provision.
Coverage provided to a Covered Family Member of a Member shall terminate upon the first of the following to occur:
a. The Member’s coverage is cancelled or terminated; or
b. The family member ceases to qualify as a Covered Family Member as defined.
When coverage for a Member and/or Covered Family Member terminates and a matter is unresolved when coverage terminated, then any further legal work between said Member and/or Covered Family Member and the Participating Attorney shall be outside the scope and coverage of the group policy / Certificate of Coverage. The Participating Attorney shall not be obligated to provide any benefits and any further legal services shall be based upon an independent and separate fee agreement entered into, if at all, between the former Member and/or Covered Family Member and the attorney. If such an agreement is not entered into, then the Participating Attorney may withdraw from any further representation in accordance with applicable law and State Bar standards.
Grace Period
The Policy provides the Policyholder a grace period of thirty-one (31) days after the premium due date to remit the premium that is due and unpaid on behalf of a covered Member. During the grace period, the 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 this Policy is in effect.
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.
Conformed to Statute
Any terms of the group policy / Certificate of Coverage that are in conflict with the statutes of the jurisdiction where issued, are amended to conform to the statutes.
Assignment of Benefits
The benefits provided under this group policy / Certificate of Coverage are not assignable.
Entire Contract
This Policy, including the application and endorsements, if any, constitutes the entire contract of insurance.
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