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LegalGUARD
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FAQ Page

Who is the LegalGUARD Plan administered by?

The Legal Plan is administered by LegalEASE or the LegalEASE Group. LegalEASE has exclusive discretion to make all determinations regarding attorney's fees and what constitutes covered services, adoption of administration rules; to make factual determinations and interpret the plan, correct defects, supply omissions and reconcile inconsistencies to the extent necessary to effectuate the plan and such action will be conclusive upon the Plan, participants, policyholders, their dependents and beneficiaries; decide upon questions of eligibility and participation, prescribe procedure and election forms, to accept, modify or reject elections, and to settle any lawsuits against the Plan or Plan Administrator. All contributions collected from policyholders electing this coverage are paid to LegalEASE.

What are my payment options?

Premiums are paid by credit card. Visa, Mastercard, and American Express are accepted.

How will my legal plan show on my credit card statement?

The transaction will appear on the Policyholder’s monthly statements as “The LegalGUARD Plan”.

How do I purchase a legal plan?

To purchase a legal plan, click “GET A LEGAL PLAN QUOTE” and follow the instructions.

What are waiting periods?

Some plans have waiting periods built in to offer a lower priced plan to the consumer. Only some benefits within the plan will have waiting periods and are normally six (6) months from the effective date of the plan. Not all plans have waiting periods.

When does coverage begin?

Eligibility for coverage begins on the first day of the next month, if plan premium is paid.

When does coverage end?

Termination and Cancellation of Coverage provided to the Policyholder shall terminate upon the first of the following to occur:

  • Cancellation or termination of the policy
  • The Policyholder fails to remit premium when due, subject to the statutory grace period

Coverage provided to a Covered Family Member of a Policyholder shall terminate upon the first of the following to occur:

  • The Policyholder’s coverage is cancelled or terminated; or
  • The family member ceases to qualify as a Covered Family Member as defined.

When coverage for a Policyholder and/or Covered Family Member terminates and a matter is unresolved when coverage is terminated, then any further legal work between the Policyholder and/or Covered Family Member and the Participating Attorney shall be outside the scope and coverage of the Plan. 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 Policyholder 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.

What about plan confidentiality and attorney client relationships?

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 Policyholder’s relationship with an attorney is privileged and strictly confidential. LegalEASE will not interfere in the attorney-client relationship, nor in the attorney's independent exercise of his or her professional judgment..

The Policyholder 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 Policyholder. The Policyholder’s use of the Plan and the legal services is confidential. Plan administrators will have access only to limited information needed for orderly administration of the Plan.

If the Policyholder has a complaint about the legal services received or the conduct of an attorney, call LegalEASE Member Services. The complaint will be reviewed and the Policyholder will receive a response within two business days of their call.

Where can I use my benefits?

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

Can I still retain my own attorney?

The Policyholder has the right to retain at their own expense any attorney authorized to practice law in the state.

Do you offer refunds?

In the event that the premium mode is other than monthly and the policy is terminated or the Policyholder elects to terminate the coverage, a pro-rata premium refund will be made in accordance with the insurance laws of the Policyholder's state.

How do I access my benefits?

Finding an attorney is easy. Simply contact Member Services and use the Concierge Matching Service. Specialists are available to assist you from 7:00am to 7:30pm central time.

A team of specialists will help determine what type of attorney is needed, where an attorney is needed, and what dates or deadlines are important. They will also find out about any preferences the Policyholder may have. The goal is to provide a better attorney and save the Policyholder time. Specialists can also answer questions about plan benefits.

Once the specialist has gathered all the information about the legal need, the matching begins. Our teams contact providers for the Policyholder in their preferred locations to confirm availability and make sure they can assist with the specifics of the legal issue before the initial visit. On average, LegalEASE speaks to 7 attorneys before finding the right match.

What if I already have an attorney?

If the Policyholder already has an attorney, and prefers to use her/him as a Non-Participating (Out-of-Network) Attorney, first contact the Member Service Center. Notify the representative of the intention to use a Non-Participating Attorney for a Covered Service. The Member Service Center will send a claim form to request reimbursement. The reimbursement will be based on the reimbursement schedule as shown in the Schedule of Benefits of the Plan. If the Policyholder already has an attorney at the time of purchasing the plan, the Legal Plan Administrator can offer to negotiate with the attorney on behalf of the Policyholder, but does not guarantee the Plan Discounted Rate will be accepted by the attorney or offered by the LegalGUARD.

What if I want to use benefits that are subject to Managed Case Rules?
  • Policyholders 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.
  • To obtain benefits that are subject to Managed Case Rules:

    • Policyholders 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 Policyholder and/or Covered Family Member.
  • If the Policyholder is actively receiving services, the Policyholder must remain enrolled and continue to pay premium hereunder. All benefits will be subject to subrogation and coordination of benefit rules.
  • Upon completion of a Covered Service, the Policyholder 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 Policyholder/ Covered Family Member will be responsible for all legal fees.
  • If the Policyholder and/or Covered Family Member pays for pre-authorized services provided by a Non-Participating Attorney, 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 must be submitted. Benefits provided to the Policyholder and/or Covered Family Member for Covered Services are subject to the maximum as shown in the Schedule of Benefits.
What if other coverage is available to me?

If the Policyholder is entitled to receive legal representation provided by any other organization such as an insurance company or a government agency, or if the Policyholder is entitled to legal services under any other legal plan, coverage will not be provided under this Plan. However, if the Policyholder is eligible for legal aid or Public Defender services, the Policyholder will still be eligible for benefits under the Plan, so long as the eligibility requirements are met.

What if I am involved in a legal dispute with Covered Family Members?

In the event that the Policyholder and one of the Covered Family Members are involved as adversaries in a dispute that is a Covered Service, only the Policyholder 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 you are involved with another Policyholder’s dispute that is a Covered Service, separate coverage for each Policyholder will be provided.

What if the court awards attorney's fees as part of a settlement?

If the Policyholder and/or Covered Family Member are awarded attorney's fees as a part of a court settlement, the Plan must be repaid from this award to the extent that it paid the fee for your attorney.

What if I am denied eligibility?

LegalEASE verifies eligibility based on premium remitted by the Policyholder. When you call for services, you will be advised if you are ineligible. If you are not satisfied with the final determination of eligibility, you have the right to formal review and appeal. See the procedures outlined in the next section.

What if I am denied coverage?

If denied coverage by LegalEASE or by any Plan Attorney, you may appeal by sending a letter to:

LegalEASE
Director of Administration
5850 San Felipe Street, Suite 600
Houston, Texas 77057

The Director will issue LegalEASE Legal Plan's final determination within 60 days of receiving your letter. This determination will include the reasons for the denial with reference to the specific Plan provisions on which the denial is based, and if applicable, a description of any additional information that might cause LegalEASE Legal Plans to reconsider the decision, and an explanation of the review procedure.

How do I appeal?

If you, your beneficiary or your authorized representative feel that an error has been made concerning your eligibility to participate in the Plan you, your beneficiary or your authorized representative may request reconsideration under the Plan. All requests for reconsideration must be submitted in writing to the Plan Administrator at the following address:

Attn: Plan Administrator
c/o LegalEASE
5850 San Felipe Street, Suite 600
Houston, Texas 77057

The Plan Administrator will review your claim and respond to you with a determination. The decision of the Plan Administrator is final and binding.

When will I receive the policy?

The policy is automatically generated after purchasing. The Policyholder may request a paper copy to be sent to their address.

Does the policy automatically renew?

Yes, the policy does automatically renew.

How long do I have to file a claim/reimbursement?

For claims with an in-network attorney, there are no reimbursements or claims to file. The attorney will contact LegalEASE directly.

For claims with an out-of-network attorney, the Policyholder or a covered family member must submit a reimbursement form (provided by the Member Service Center), an original itemized bill, proof of payment and supporting documentation sufficient to demonstrate the work completed; within 60 days of incurring the legal fees.

What should I include with my out-of-network claim/reimbursement?

For a claim/reimbursement with an out-of-network attorney, the Policyholder should include:

  • A signed confirmation of completion
  • Claim/reimbursement form
  • Original itemized bill
  • Proof of payment
  • Support documentation sufficient to demonstrate the work completed
How do I get a claim/reimbursement form?

Contact Member Services. A claim/reimbursement form will be generated and sent to the Policyholder.

How do I submit a claim/reimbursement form?

Mail:

Claims/Reimbursements Department
LegalEASE
5850 San Felipe Street, Suite 600
Houston, Texas 77057

Fax: (713) 785-1189

How can I check the status of a claim/reimbursement?

Contact Member Services to check the status of a claim/reimbursement.