Definitions
“REIMBURSEMENT ADMINISTRATOR” - means LegalPlans USA, LLC; or its subsidiary.
“CONTESTED DIVORCE” - refers to a divorce proceeding that requires more than 5 hours of attorney time, involves disputed issues and both parties are represented by an attorney.
“COVERED FAMILY MEMBER” - means the Member’s spouse and Member’s unmarried dependent children, including stepchildren, legally adopted children, children placed in the home for adoption and foster children, up to age 19, and from age 19 up to 25 years if they are enrolled in an accredited school or college as full-time student(s) and are primarily dependent upon the Member for support
“COVERED SPOUSE” - means the Member’s lawful spouse at the time the contract is in effect..
“EFFECTIVE DATE” - means the date a Member’s coverage hereunder begins.
“CONTRACTHOLDER” - means the organization named in the declarations page.
“LEGAL PLAN ADMINISTRATOR” – the LegalEASE Group, its affiliates, officers, directors, employees, and/or agents, including third party organizations and their affiliates, officers, directors, employees, and/or agents, hired by the LegalEASE Group to perform services under this Certificate of Coverage.
“MEMBER” - refers to the individual who is associated with the Contractholder and/or Plan Sponsor named on the first page of this Certificate of Coverage and who has paid or a fee has been paid on his/her behalf and who meets the eligibility requirements for Covered Services as defined by the Contractholder.
“MEMBER SERVICE CENTER” - means the service location established to help make full use of the Certificate of Coverage.
“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 Legal Services Contract up to the maximum amount as shown in the Schedule of Services.
“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 Services.
“PLAN SPONSOR” - means an organization other than the Member’s employer which makes coverage hereunder available.
“WE”, “US”, “OUR” AND “COMPANY” - means the name of the plan provider indicated on the first page of the Certificate of Coverage.
Covered Services
In consideration of payment and receipt by Us of the applicable fee, 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 Services chart shows the reimbursement schedule when the Member uses a Non-Participating Attorney.
Consumer Matters
Document Preparation:
Preparation of any of the following documents: simple deed (excluding those reviewed or prepared under the real estate service), promissory note, consumer dispute correspondence, installment sales agreement, general power of attorney, lease agreement (tenant only), time share agreement, and simple affidavit.
This Service is limited to one use per year per document.
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.
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 service 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 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 Covered Spouse only , 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 Spouse and/or Covered Family Member and discuss the legal requirements for signing the will.
This service is limited to one use per year.
Complex Will Preparation: Participating Attorney shall prepare a complex will or codicil for Member or Covered Family Member at a discounted fee paid directly to the attorney as shown in the Schedule of Services.
This service shall be limited to one complex will prepared per year.
Living Will and/or Health Care Power of Attorney:
Preparation of living will and/or health care power of attorney for Member and/or Covered Family Member as authorized by state law. A living will expresses an individual’s wishes as to the use or withdrawal of life support systems. A health care power of attorney appoints another to make medical decisions if the individual is unable to do so him/her self.
This service is limited to one use per year.
Living Trust Document:
Preparation of living trust documents. This service does not include services related to transactions to fund the trust or transfer assets into it.
This service 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 Services.
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 service 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 service 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 service is limited to one use per year.
Financial Matters
Debt Collection Defense:
The defense of any dispute involving personal (non-business related) debt. This service includes correspondence, negotiating with creditors to arrange a repayment schedule, assistance in limiting harassment by bill collectors, and negotiating settlement after a complaint is filed. This service does not include defense against execution of a courtordered judgment or efforts to vacate or set aside a judgment.
This service 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 service 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 service 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 service does not include a defense against criminal charges nor the defense of civil tax litigation in any tax court.
This service 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 Certificate of Coverage provides coverage of contested matters and the service shall be in accordance with the Schedule of Services; or, (3) services relative to post-decree representation. 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-todecree order shall constitute a separate use) and applies to the Member only.
Name Change:
Services required to accomplish a legal name change for a Member and/or Covered Family Member.
This service 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 service does not include fees for a court –appointed attorney for the child/conservatee. This service does
not include contested matters.
This service 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 Services in an uncontested governmental agency or stepparent adoption. An uncontested adoption does not involve significant disputed issues. This service 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. If the amount of an attorney’s time for uncontested adoption exceeds the maximum shown in the Schedule of Services, or if the adoption becomes contested, coverage will terminate and the Member and/or Covered Family Member will be responsible for any additional legal fees.
This service 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 service does not cover any matter that falls outside the jurisdiction of juvenile court or any matter that may be considered a felony.
This service 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 service 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 service 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 service 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 service 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 service does not include defense of moving traffic violations.
This service is limited to one use per year.
Elder Law Services
Your benefits package includes Elder Law Services as described below. These benefits are in addition to plan services described in your Certificate of Coverage.
1) Eligibility of Parents
a) Parents of the Plan Member and the Member’s Spouse, regardless of age, are eligible for benefits under the Elder Law coverage described herein.
b) The benefits specified below extend not only to the Member’s Parents and the Member’s Spouse’s Biological Parents, but their Step-Parents and Adoptive Parents as well.
2) Benefits for Elder Parents
a) Advice and Consultation
1. LegalADVISOR Helpline:
Member may receive advice and consultation by toll-free telephone with a Plan Attorney. Services are available during normal business hours. Calls can relate to any personal legal matter, civil or criminal.
2. Financial Helpline:
Member will receive consultation by toll-free telephone during normal business hours. Calls can relate to investment strategies, debt matters or any personal financial planning question
b) Free Simple Wills & Living Wills
1. Simple Will Preparation: Each Eligible Parent, as defined above, may receive one Simple Will per year at no charge. Plan Attorney will prepare the document and discuss the legal requirements for executing the Will. Simple Will means the will maker does not have a significant net worth and will not benefit from tax planning, or the estate is not subject to current state or federal estate taxation; the will maker does not own a business that will continue in operation after death; the will maker does not want to put restrictions on what heirs may do with the property; the will maker does not 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 does not want 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; the will maker does not think that someone will challenge the will; and/or the will maker does not want to exclude any lawful dependents.
2. Living Will Preparation:
Eligible Parents, as defined above, may request one Living Will per year at no charge. Plan Attorney will prepare the document as authorized by state law and discuss the legal requirements for signing the Living Will. A Living Will expresses an individual’s wishes as to the use or withdrawal of life
support systems.
d) Additional documents may be prepared for a minimal charge:
1. Additional documents may be prepared for a minimal charge, up to once per year per Eligible Parent, as described above:
- Healthcare Directive - $45 fee per document
- Financial Power of Attorney - $45 fee per document
- Durable Power of Attorney - $45 fee per document
- Healthcare Durable Power of Attorney - $45 fee per document
Any 3 or more of the above documents may be prepared for a package cost of $115 per set.
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 covered members.
1) Advice and Consultation
a) Free ½ hour telephonic consultations (4 per year) with a Trained Identity Theft Recovery Specialist (consultations can also be online – member’s choice)
b) Online Assistance in understanding identity theft prevention
c) Unlimited access to complete identity theft legal issue law libraries
2) 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 free consultations with the Recovery Specialist).
b) Free Simple 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) Free Review of necessary recovery legal documents (up to 6 pages each)
Savings Assistance Services
Your benefits package includes a Savings Assistance Plan as described below. These benefits are in addition to plan services described in your Certificate of Coverage.
1. Consultation Services:
a) Plan members are entitled to an initial consultation with one of our Savings Coaches for savings information including how to get started, how much is the right amount, how can I possibly save, how can I create a savings plan, can I save while I am in debt, and similarly related topics.
2. Creation of Savings Plan Assistance:
a) Counselor assistance to help members with creating their own personal savings plan is also included in the Saving Assistance Coverage. This service will include charting projected income and expenses, helping the member understand when savings might work, managing expenses in debt, educational tools to make an informed decision, and advice on selecting savings amounts options. This section of the plan is designed to help members deal with their increasing debt and need to save.
3. Additional Follow-up Services:
a) Plan members may utilize one, free, thirty minute telephone consultation per year.
b) Follow-up consultations and help from Savings Coaches are also available to each plan member.
Mediation Services
Your benefits package includes Mediation Services as described below. These benefits are in addition to plan services described in your Certificate of Coverage.
1. Consultation Services:
a) Plan members receive unlimited access to online information including domestic disputes, divorce or child custody proceedings, consumer problems, medical bill, warranties, loan disputes, workplace employee disputes, auto accidents, etc.
b) Members receive one free thirty minute consultation with a licensed mediator every quarter.
2. Mediation Counseling Assistance:
a) 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.
b) These services are designed to help members deal with the increase in resolution pace.
3. Additional Mediation Services:
a) Plan members receive a 10% discount on Plan Mediators’ normal fees. This includes hourly rates and flat fees. However, this does not apply to Contingency Fees.
Obtaining Services
Reimbursement for Services
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 coverage.
2. To obtain services 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 under this Legal Services Contract must remain enrolled and continue to pay fees hereunder. All services 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 reimbursement 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 NonParticipating Attorney, the Member must submit a reimbursement form (provided by Member Service Center) accompanied by an original itemized bill, proof of payment and supporting documentation sufficient to demonstrate the work completed in the matter within sixty (60) days after incurring the legal fees. Services provided to the Member and/or Covered Family Member for Covered Services are subject to the maximum as shown in the Schedule of Services.
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 services are excluded:
Appellate court proceedings, class actions, interventions, derivative action and amicus curiae filings.
The preparation and filing of individual, partnership or estate tax returns, appellate or administrative proceedings related to tax returns, litigation before the U.S. Tax Court, U.S. Court of Claims or any other federal, state or other courts with respect to tax matters.
Matters relating to securities, trademark or patent matters; business or commercial interests, including, but not limited to, professional, partnership and/or corporate matters; matters involving the law or laws of jurisdictions other than the United States and its territories and Canada except as specifically described under Covered Services; any matters involving a government (domestic or foreign) entity or agency except as specifically described under Covered Services; farm related issues; matters involving commercial or rental property transactions, including the purchase, sale or lease of investment or income-producing property. 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 contract / Certificate of Coverage;
Legal Plan Administrator or its subsidiaries; Reimbursement Administrator or its subsidiaries; Contractholder; Member’s employer; Nationwide Mutual Insurance Company 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 contract / Certificate of Coverage.
The Certificate of Coverage will not provide services 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 Contractholder can be demonstrated.
Where there are specific hours or dollar amounts provide in this Schedule of Services, 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 service 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 that are provided under this Certificate of Coverage, the Members agree that neither We, nor the Contractholder, nor any other person involved in the marketing or administration of the group contract, 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 form to request reimbursement. The Member’s reimbursement will be based on the reimbursement schedule as shown in the Schedule of Services. 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 unless otherwise identified in Schedule A attached hereto.
Refund Provision
In the event that the payment mode is other than monthly and the group contract is terminated or the Member elects to terminate the coverage, a pro-rata refund will be made in accordance with the laws of the Contractholder’s state.
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 contract;
b. If applicable, the Member fails to re-enroll;
c. The Member is no longer associated with Contractholder; or
d. The Member fails to remit payment 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.
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 Certificate of Coverage. The Participating Attorney shall not be obligated to provide any services under the Certificate of Coverage 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.
Portability
The Member may continue coverage under this Legal Services Contract by electing the option of portability when the Member no longer qualifies as an employee of the Contractholder or as a member of the group to which this Legal Services Contract is issued. The Member must apply for portability within thirty-one (31) days of this disqualifying event and make arrangements for payment. Portability coverage will take effect, subject to receipt of the initial payment, as of the date the Member’s coverage under this group Legal Services Contract terminates. Credit will be given for any applicable Waiting Period based on the number of months coverage was in force for the Member under this Legal Services Contract.
Conformed to Statute
Any terms of the Legal Services Contract 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 Legal Services Contract are not assignable.
Miscellaneous
To obtain information or make a complaint:
You may call The LegalEASE Group’s toll-free telephone number for information or to make a complaint at 1-888-416-4313.
You may also write to The LegalEASE Group at:
5151 San Felipe, Suite 2300
Houston, TX 77056
You may contact the Texas Department of Licensing and Regulation to obtain information on companies, coverages, rights or
complaints at 1-800-803-9202.
You may write the Texas Department of Licensing and Regulation at:
P.O. Box 12157
Austin, Texas 78711
Payment or Reimbursement Disputes:
Should you have a dispute concerning your payment or about a reimbursement, you should contact The LegalEASE Group first. If the dispute is not resolved, you may contact the Texas Department of Licensing and Regulation. Legal service contract companies and their sales representatives are regulated by the Texas Department of Licensing and Regulation.