Elder Parent Will Preparation:
Each Eligible Parent may receive one Simple Will per year at no charge. The attorney will prepare the document and discuss the legal requirements for signing the will. This benefit does not cover Complex Wills, as defined in the Definitions section.
This benefit is limited to one use per year per Eligible Parent.
Elder Parent Living Will/Health Care or Advance Directive:
Each Eligible Parent may request one Living Will/Health Care or Advance Directive, as they are defined in the Definitions section, per year at no charge. The attorney will prepare the documents as authorized by state law and discuss the legal requirements for signing the Living Will/Health Care or Advance Directive. The titles of the above documents may vary by state. 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 both documents, and can be combined to increase the total allowed benefit.
This benefit is limited to one document/set of documents per year per Eligible Parent.
Elder Parent Durable Financial Power of Attorney:
Each Eligible Parent may request one Durable Financial Power of Attorney, as defined in the Definitions section, per year at the co-pay rate shown in the Schedule of Benefits. The attorney will prepare the documents 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.
This benefit is limited to one use per year.
Elder Parent Health Care or Medical Power of Attorney:
Each Eligible Parent may request one Health Care or Medical Power of Attorney, as they are defined in the Definitions section, per year at the co-pay rate shown in the Schedule of Benefits. The attorney will prepare the documents 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 can not be combined to increase the total allowed benefit.
This benefit is limited to one use per year.
Residential Matters
Real Estate Sale, Purchase or Refinancing of Primary Residence:
The services of an attorney for the sale, or purchase or refinancing of a primary residence (where Member has resided or intends to reside for twenty-seven (27) weeks or more per year). This service includes the review and/or preparation of closing documents and/or attendance by the attorney at closing in situations when it is customary for the attorney to do so. This benefit does not include services performed by or for a title company, or for an attorney acting on behalf of a lending institution. This benefit does not include any fees or costs other than those related to the attorney’s review of the purchase/sale documents.
This benefit is limited to one closing per year.
Tenant Dispute:
Representation of the Member 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.
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 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 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 for up to the maximum shown on the Schedule of Benefits in an uncontested separation or civil annulment; consent or default divorce, uncontested divorce or Contested Divorce. An uncontested separation, divorce or civil annulment does not involve significant disputed issues and the parties resolve any issues prior to any court supervised proceeding. A consent or default divorce does not involve any disputed issues and the opposing party is not represented by counsel. The benefit for uncontested matters does not provide any coverage of an attorney’s fee for: (1) services in excess of the maximum shown on the Schedule of Benefits; the Member must pay the attorney’s fee for services in excess of the maximum; or (2) contested matters in which case the Member must pay the attorney’s fee for services, unless the coverage includes contested matters and the benefit shall be in accordance with the Schedule of Benefits. A contested separation, divorce or civil annulment requires more than five hours of attorney time and involves disputed issues.
This benefit is limited to one use per 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 the Member for up to the maximum listed on the Schedule of Benefits in a contested or uncontested post-divorce proceeding. An uncontested post-divorce proceeding does not involve significant disputed issues and the parties resolve any issues prior to any court supervised proceeding. The benefit for uncontested matters does not provide any coverage of an attorney’s fee for: (1) services in excess of the maximum listed on the Schedule of Benefits; the Member must pay the attorney’s fee for services in excess of the maximum; (2) contested matters in which case the Member must pay the attorney’s fee for services, unless the coverage includes contested matters and the benefit shall be in accordance with the Schedule of Benefits. A contested post-divorce proceeding requires more than five hours of attorney time, involves disputed issues and requires that both parties be represented by an attorney. This benefit includes custody, support, and alimony proceedings.
This benefit is limited to one use per year. This benefit applies to the Member and Covered Spouse only for actions not involving the Member as an opposing party.
Prenuptial Agreement:
This service covers the preparation of an agreement by a Member and his or her fiancé/partner prior to their marriage or legal union (where allowed by law), outlining how property is to be divided in the event of separation, divorce or death of a spouse. Representation is provided only to the Member. The fiancé/partner must have separate counsel or must waive representation.
This benefit is limited to one use per year.
Name Change:
Services required to accomplish a legal name change for a Member/Covered Family Member.
This benefit is limited to one use per year per Member/Covered Family Member.
Guardianship/Conservatorship:
Services required to establish a Member/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 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 Proceeding:
Services related to the representation of the dependent child of a Member/Covered Family Member in any juvenile court proceeding, provided the child’s interest is not in conflict with the Member’s and/or Covered Family Member’s interest. This benefit does not cover any matter that falls outside the jurisdiction of juvenile court.
This benefit is limited to one use per year.
Immigration Assistance:
This service covers advice and consultation, preparation of affidavits and powers of attorney, review of any immigration documents, and helping the Member prepare for hearings. This service also covers representation in the defense and/or assertion of status relating to immigration policies. This benefit also extends to the Member’s Covered Family Members and non-covered family members, including the Member’s parent, sibling, grandchild(ren), fiancé(e), and other family members acting as a custodian of the Member’s child(ren) who are attempting to become US citizens in the manner prescribed by law.
This benefit is limited to proceedings involving one covered immigration applicant per year.
Civil Matters
Civil Litigation Defense:
Services related to the representation of a Member who is a named defendant in a filed civil lawsuit (non-business related), up to and including the trial thereof. This benefit does not include: (1) any debt collection or family law matters; (2) lawsuits normally handled on a contingent fee basis; or (3) matters for which the Member has or is required by law to have insurance.
This benefit is limited to one use per year.
Discounted Contingency Fees:
Participating Attorneys will handle the matter at a maximum percentage of the gross award. It is the Member’s responsibility to pay this fee and all costs.
• When state laws set contingency fees: Lesser of 10 % less than state law maximum fee or the Participating Attorney’s usual fee.
• When state laws do not set contingency fee: Maximum of 29 % if settled before trial, 36 % if trial is conducted, or 40 % after an appellate brief is filed.
Contingency rate discount applies in those cases where attorneys customarily take a case on a contingency fee, (an agreed upon portion of any recovery), depending on the outcome of the case.
Mediation:
The services of an attorney for representation at a mediation. This benefit does not include the cost of the mediator’s services.
This benefit is limited to one use per year.
Criminal Defense
Traffic Ticket:
Services related to the representation of the Member in defense of any traffic ticket except driving under influence or vehicular homicide, including court hearings, negotiation with the prosecutor, trial, and counseling and preparing Member for self-representation at any hearings if chosen. This benefit does not cover violations related to a commercial driver’s license. This benefit does not apply to Driving Under the Influence (DUI) or Driving While Intoxicated (DWI) violations/citations.
This benefit is limited to one use per year.
Serious Traffic Matter:
Services related to the representation of a Member who is charged by governing authorities with moving traffic violation(s) and conviction could result in suspension or revocation of a state-issued license permitting a person to drive a motor vehicle. This benefit does not cover violations related to a commercial driver’s license. This benefit does not apply to Driving Under the Influence (DUI) or Driving While Intoxicated (DWI) violations/citations. This benefit can not include expungements of misdemeanor convictions. This benefit does not include adjustments to probation or parole.
This benefit is limited to one use per year.
Administrative Proceeding:
Services related to the representation of a Member in an administrative proceeding relating to the suspension or revocation of driving privileges. This benefit does not cover suspension or revocation of a commercial driver’s license.
This benefit is limited to one use per year.
Misdemeanor Defense:
Defense of a Member in connection with criminal misdemeanor charges (not associated with any felony charge).
This benefit is limited to one use per year.
DUI/DWI Defense:
Defense of a Member in connection with Driving Under the Influence (DUI) or Driving While Intoxicated (DWI) violations/citations misdemeanor charges (not associated with any felony charge). This benefit does not include employment related DUI/DWI charges. This benefit does not include misdemeanors relating to a commercial driver’s license. This benefit does not include adjustments to probation or parole.
This benefit is limited to one use per year.
The following is a list of Covered Services available, in addition to the services described in your Certificate of Coverage.
FINANCIAL ADVISOR
Coverage includes a financial counseling Service for Member, and Covered Family Members.
Financial Helpline
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.
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 (10 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).
Claim for Benefits
1. Members should call the Member Service Center to confirm the potentially applicable benefit(s) prior to consulting with any attorney. The Member/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 of Benefits.
3. Members and/or Covered Family Members who are requesting services must remain enrolled and continue to pay premium hereunder.
4. Upon completion of a Covered Service, the Member/Covered Family Member may be required by the Participating Attorney to sign a confirmation of completion. Failure to sign the confirmation may result in denial of the claim and the Member/Covered Family Member will be responsible for all legal fees.
5. If the Member/Covered Family Member pays for pre-authorized services provided by a 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/Covered Family Member for Covered Services are subject to the maximum as shown in the Schedule of Benefits.
6. Payment by Us for Covered Services does not preclude the attorney (whether Participating or Non-Participating) from seeking and recovering attorney’s fees from an opposing party, where authorized by law, court rule, or contract, at the attorney’s customary or prevailing rate. If the Member/Covered Family Member receives reimbursement of attorney’s fees, then the Member/Covered Family Member agrees to reimburse Us for payments issued.
Disputes Between Member and Covered Family Member
In the event that the Member and one of the Covered Family Members are involved as adversaries in a dispute that is a Covered Service, only the Member will be covered.
If two or more Covered Family Members are involved in a dispute that is otherwise covered, no coverage will be provided.
If two Members are involved as adversaries in a dispute that is a Covered Service, separate coverage for each Member will be provided.
Exclusions
The following benefits are excluded:
Appellate court proceedings, class actions, interventions, malpractice proceedings, actions in which punitive damages are being sought, derivative actions and amicus curiae filings.
The preparation and filing of individual, partnership or estate tax returns, appellate or administrative proceedings related to tax returns, litigation before the U.S. Tax Court, U.S. Court of Claims or any other federal, state or other courts with respect to tax matters.
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, mediator or 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 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; Plan Sponsor; or any Participating and/or Non-Participating Attorney, if the dispute or proceeding pertains to services provided under the Policy.
The Policy does not allow benefits listed under the Covered Services section to be combined for one legal matter.
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.
Matters relating to: securities, trademark or patent matters; business or commercial interests, including, but not limited to, professional, partnership and/or corporate matters; matters arising out of a Member/Covered Family Member’s role as an officer or director of an organization; matters involving the law or laws of jurisdictions other than the United States and its territories, except as specifically described under Covered Services; any matters involving a government (domestic or foreign) entity or agency except as specifically described under Covered Services; farm related issues.
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.
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.
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
General Provisions
Attorney-Client Relationship
All attorneys are subject to the authority of the state Supreme Court and the state bar association of the state(s) where they are licensed to practice. The Member has the unrestricted right to choose an attorney. The Member’s relationship with an attorney is privileged and strictly confidential. We will not interfere in the attorney-client relationship or in the attorney’s independent exercise of his or her professional judgment. Participating Attorneys are not certified specialists. Participating Attorneys are not agents or employees of either the Legal Plan Administrator or Us.
The Member shall authorize the Participating Attorney to provide the Legal Plan Administrator with information and supporting documentation on the number and type of services provided to the Member.
By using legal services benefits that are provided under the Policy, the Member agrees that neither We, nor the Policyholder, nor any other person involved in the marketing or administration of the Policy, shall have any liability for the acts, errors or omissions of an attorney providing services, in whole or in part.
Non-Participating Attorney Services
If the Member already has an attorney, the Member may prefer to use her/him as a Non-Participating Attorney. To do so, the Member must first contact the Member Service Center and notify the representative of his/her intention to use a Non-Participating Attorney for a Covered Service. The Member Service Center will send the Member a claim form which must be completed and returned in order to request reimbursement. The Member’s reimbursement will be based on the reimbursement schedule shown under the Non-Participating Attorney column of the Schedule of Benefits. If a Member has a Non-Participating Attorney he or she would prefer to work with, the Legal Plan Administrator may elect to offer to negotiate with the attorney on behalf of the Member but cannot guarantee the Non-Participating Attorney will accept the Plan Discounted Rate.
Subrogation and Coordination of Benefits
All benefits will be subject to subrogation and coordination of benefit rules. For the purpose of subrogation, We may require the Member/Covered Family Member to assign all rights of recovery of legal fees to the extent that payment is made by Us. The Member is entitled to complete reimbursement for recovery of legal fees paid by the Member before the Company is entitled to recovery or subrogation proceeds. If an assignment is sought, the Member/Covered Family Member must cooperate in providing the assignment.
Legal Terminology
The Member or Covered Family Member may call the Member Service Center to obtain a definition or explanation of any term used herein.
Coverage Period
The coverage period is automatically renewable upon receipt of appropriate premium unless terminated in accordance with the terms hereof.
Premium Refund Provision
In the event that the premium mode is other than monthly and the Group Policy is terminated or the Member elects to terminate the coverage, a pro-rata premium refund will be made in accordance with the insurance laws of the Policyholder’s state.
Secondary Coverage
If the Member/Covered Family Member is entitled to receive legal services or reimbursement for legal services from any other person or organization, the coverage available under the Policy would be considered excess as defined in the National Association of Insurance Commissioners Model Coordination of Benefits Provisions.
Termination and Cancellation of Coverage
Coverage provided to the Member shall terminate upon the first of the following to occur:
a. The date notice is received or the date the Policyholder requests cancellation. The
Policyholder may cancel the Policy by sending written notification by mail, fax or e-mail;
surrendering the Policy; or providing verbal notice. If the Policyholder provides verbal notice,
We will require the Policyholder to provide written confirmation of cancellation.
b. The date notice is received or the date the Member requests cancellation. The Member may
cancel the coverage by sending written notification by mail, fax or e-mail; surrendering the
Certificate of Coverage; or providing verbal notice. If the Policyholder provides verbal
notice, We will require the Member to provide written confirmation of cancellation.
c. Cancellation or termination of the Group Policy;
d. If applicable, the Member fails to re-enroll;
e. The Member is no longer associated with Policyholder; or
f. 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.
After the Group Policy has been in effect for sixty (60) days or more, it may be cancelled for one of
the following reasons:
a. Nonpayment of premium by Policyholder for covered Members;
b. The Group Policy was obtained through material misrepresentation;
c. Policyholder violated the material terms and condition of the Group Policy;
d. The risk originally accepted has measurably increased;
e. Loss of reinsurance by the Company;
f. Continuation of the Group Policy would be in violation of the law;
g. Company elects to discontinue underwriting the Group Policy for this class of risk.
The Company shall provide written notice of cancellation to the Policyholder and Member at least
forty-five (45) days prior to the effective date of such cancellation. If the Company cancels for nonpayment
of premium, the Company shall provide written notice of cancellation to the Policyholder
and Member at least ten (10) days prior to the effective date of such cancellation. All notices shall
state the reason for cancellation.
Illegal Activity, Misrepresentation and Fraud
We will not provide coverage if the Member/Covered Family Member has intentionally concealed or misrepresented any material fact or circumstances or been involved in any illegal activity related to the Policy or claim. We will not provide coverage if doing so would be in violation of any United States economic or trade sanction.
Premium Remittance
The Policyholder shall remit premium to the Company no later than the 10th calendar day following the month for which Group Policy coverage is provided.
Grace Period
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.
Amendment of the Policy
The Group Policy may be amended or changed by the Company on the anniversary date upon twenty
(20) days 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 affect a
waiver or change any part of the Group Policy or 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.
Change in Premium
We shall provide the Policyholder written notice of any change in premium thirty (30) days prior to the anniversary date of the Group Policy. Any such change shall apply to the Policyholder on the anniversary date of the Group Policy. The Policyholder is responsible for notifying the Members of the change in premium.
Conformed to Statute
Any terms herein that conflict with the statutes of the jurisdiction where issued are amended to conform to the statutes.
Assignment of Benefits
The benefits provided herein are not assignable.
Entire Contract
The Group Policy, including the endorsements, if any, constitutes the entire contract of insurance.