How to enjoy your LegalWise Benefits
A step by step process on submitting a claim.
In legal matters, some laws have time limits to start or defend a Case. If you miss a deadline, you may lose your right to sue or defend. You must report a matter to us as soon as possible.
We are not responsible if you lose your rights because you did not report a matter in time. You can report a matter on the 24-hour LegalLine, at a Branch or at email@example.com. If your issue is a labour or civil matter (not criminal), our Legal Counsellors will try to resolve it on a reasonable basis.
If we decide that we cannot resolve it, or that it is complicated or requires immediate action, or it is a criminal matter, we will refer you to a LegalWise Network Lawyer or you can consult your own Lawyer.
If you have chosen a LegalWise Network Lawyer, s/he will submit a LegalWise Claim Form (LCF) to us on your behalf. If you choose another Lawyer, you or your Lawyer must submit the LCF to Us. (See Step 3 - Second Option)
PLEASE NOTE: Once we have received the LCF, and before we can decide whether our matter qualifies for Insurance Benefits or not, we may request more information from you or your Lawyer. If it qualifies, we will issue a written Confirmation of Cover to your lawyer, but please note:
We will not pay legal expenses incurred before we have issued a written Confirmation of Cover.
STEP 3 - FIRST OPTION
If you elect to choose a LegalWise Network Lawyer, we have the information about who specializes in particular types of cases. You can request that information from us. LegalWise Network Lawyers have agreed to charge according to the LegalWise Tariffs and to assist you to comply with your obligations under this Agreement.
We cannot process your claim for Insurance Benefits unless we have received the LCF. The LCF is available in Branch, on www.legalwise.co.za or on request. Your LegalWise Network Lawyer will deal directly with us in connection with your benefit claim and there is no risk of being charged above the LegalWise Tariffs, which may happen under Step 3 - Second option.
STEP 3 - SECOND OPTION
If you have chosen a Lawyer who is not a LegalWise Network Lawyer, you must provide us with a LegalWise Claim Form (if we have not received it yet), within 7 days of consulting with that Lawyer.
Please be aware that the Lawyer:
- may not be prepared to charge at the LegalWise Tariffs or,
- may not agree to assist you to comply with our reasonable requests for relevant information.
It is in your own interests to clarify the 2 points above with your Lawyer.
If your Lawyer agrees to co-operate but does not agree to charge at the LegalWise Tariffs, we will adjust the Lawyer's total charges to the LegalWise Tariffs and pay that amount. You will then be personally responsible to pay the shortfall to your Lawyer out of your own pocket.
To contact the Claims Department, you can send an e-mail to firstname.lastname@example.org or call our National Switchboard on 010 271 2255.
OBJECTION PROCESS IF YOUR CLAIM IS REPUDIATED (REJECTED)
1. If we decide that a claim by you does not qualify for any payment, or only qualifies for payment of a portion of your legal expenses, We will inform you (together with Our reasons). It will be within 10 days after being placed in possession of all the information we have reasonably requested. You then have 90 days from the date we inform you, to let us know in writing if you object and do not agree with it.
2. We will reconsider the matter and let you know our decision within 10 days of receiving your objection. If we still decide not to pay what you claim and our decision:
a) is based on the fact that you did not pay a premium due, or due to the fact that the relevant event occurred before the end of the waiting period, our decision is final.
b) is based on any other reason, and you request it in writing, we will pay an Independent External Referee nominated by us, to review it. S/he will review our decision and give us a recommendation.
3. We do not have to follow the recommendation of the external referee, but it will be carefully considered. We will inform you of the referee's recommendation and of our final decision, within 15 days after we receive the recommendation.