ABOUT THE LEGAL SERVICES
The Plan and Coverage
Responding to the needs of members for flexibility and free choice of attorney, this legal plan is provided by the Fund. The Trustees have adopted a plan that partially covers fees for services through Benefit allowances. This allowance feature enables our members to choose an attorney according to individual needs and as the type of case warrants.
Charges are the responsibility of the members. Reimbursement in accordance with the Fund’s established fee schedule may be requested at the completion of the covered legal matter. You should explore, with your chosen attorney, the estimate of costs involved for any problem for which you seek help, acquiring a working concept of what services are covered. If you need assistance with locating an attorney, we normally suggest contacting the Suffolk County Bar Association.
With a plan of such flexibility, a restriction must be imposed that if a court awards full or partial payment for a member’s legal fees, the Fund’s payment of allowances shall be reduced by the amount awarded. Specifically, the total court award and Fund allowance cannot exceed the amount charged by the attorney. Costs of documents, filing, court fees, etc., are not covered by this plan. Second-opinion fees are also excluded from coverage. No Fund Member is compelled to use this plan of benefits.
NOTE: Further information is available upon request. It you have any questions regarding the coverage, benefits or exclusions, please contact the Fund Office at (631) 319-4099.
LEGAL SERVICES PLAN PROVISIONS
In order to be eligible for benefits you must have completed a Benefit Fund enrollment card and filed it with the Fund Office. When filed at the Fund Office this card confirms whether you are a covered member or an eligible non-member dependent. With this data, the attorney-client relationship will remain exclusively between you and your chosen counselor and yet enable the Fund to properly process your benefit. No employee or Trustee of the Fund can interfere with this relationship.
First, check each listing under the covered benefit you are in need of to determine whether or not you are eligible for it.
Once you have determined the benefit category and that you possibly qualify for the coverage call or write the Benefit Office at 30 Orville Drive, Suite D, Bohemia, NY 11716, telephone number (631) 319-4099 and request a legal voucher. Give as much information as you can to the Fund’s claims examiner so that he or she can make sure that the proper legal voucher is issued.
Payment is not made by the Fund until the legal matter is completed. Members terminating service prior to completion of a matter are NOT eligible for an allowance on that matter.
After legal services are completed, you – not your attorney – should return this form to the Fund, along with a bill detailing the fees charged. Your allowance for services will be sent to you directly once you claim has been approved.
It should be noted that from time to time the Trustees may, in their discretion add to, amend, change, delete or modify existing Benefit Fund rules and regulations and benefit allowances. Should a question arise as to benefit coverage, such question shall be resolved upon review of the Legal Service’s Trust Indentures, plan of benefits and minutes of Trustees meetings. If additional information is desired call the Fund office where more detailed information is available.
Each benefit type identifies exactly who is covered under the following rules:
Covered members include; all employees of Suffolk County covered by the collective bargaining agreement between the County of Suffolk and The Association of Municipal Employees for whom contributions are payable to the Suffolk County Municipal Employees Benefit Fund (herein “the Benefit Fund”); any other employees of the County of Suffolk, including, but not limited to the faculty and administrative staff of the Suffolk County Community College, that may be deemed eligible by the Board of Trustees, for whom contributions are made payable to the Benefit Fund; the judges and court administrative personnel of the County of Suffolk for whom contributions are made payable to the Benefit Fund; employees of towns, villages and subdivisions of municipalities located in the County of Suffolk that maybe deemed eligible by the Board of Trustees, for whom contributions are made payable to the Benefit Fund; employees of other entities, such as the Vanderbilt Museum, that may be deemed eligible by the Board of Trustees, for whom contributions are made payable to the Benefit Fund; employees of The Association of Municipal Employees for whom contributions are payable to the Benefit Fund by the Union and employees of the Benefit Fund for whom contributions are payable to the Benefit Fund.
Spouses and dependents of covered members are covered for certain benefits as specifically hereinafter described in this booklet. Dependents, as defined by the Fund, are your spouse, unmarried dependent children who have not reached their 19th birthday and unmarried dependent children who are full time students at a college or university who have not reached their 25th birthday; an unmarried child, regardless of age, who is incapable of self-sustaining employment by reason of mental retardation or physical handicap who became so prior to the age of nineteen and resides with and wholly depends upon the covered member for support. Dependent children include legally adopted children, stepchildren and foster children who reside with and wholly depend on the covered member for support.
In general, subject to the requirements pertaining to the definition of a covered member, employees are eligible for benefits only so long as they are in an active payroll status. Eligibility for benefits terminates as of the effective date your employment is terminated. Therefore, if you are a covered member at the time that you retain an attorney but are no longer on active payroll status at the time that a legal matter is completed, you are not covered under this plan and the costs are your sole responsibility.
Active payroll status here means the period for which contributions are paid, or should have been paid, for the employee by the employer to the, Benefit Fund.
Members who go on a leave of absence from active employment due to extended illness, job related injury that results in Workers Compensation status, or maternity will remain eligible for benefits for one year commencing with the date of such leave,
All employees covered by the Legal Services and in an active payroll status will be eligible for benefits after completion of two full months of employment following the month in which they were hired. For example, an employee hired on February 15 shall be eligible for benefits on May 1; an employee hired on June 2 shall be eligible for benefits on September 1.
The Fund reserves the right to request any documents necessary to establish eligibility of a member or dependent.
Extension of Dependent Eligibility in Case of Member’s Death
For a period of 90 days after the death of a member, all legal service benefits for a spouse and dependents as defined by the Fund, will continue to the extent that they were entitled to receive such benefit on the date of the decedent’s death. In addition, during this extension period, the consultation benefit is available to the surviving spouse, or if there is none the eldest surviving dependent.
Within 180 days after receipt of notice that your claim has been denied, in whole or in part, you, or your duly authorized representative, may file a written request for a review of your claim by the full Board of Trustees. Such request must set forth the basis for the appeal, and all pertinent data to substantiate your position. In connection with the appeal, you, or your representative, will be given an opportunity to inspect copies of pertinent documents and to review the information upon which the denial was based. The Board of Trustees in their discretion may hold a full hearing of the issues presented by you. The Board will act upon a request for a review within a reasonable period of time after receipt thereof. You will be notified in writing of the action taken by the Board of Trustees. Such notice shall include the specific reasons for the decision and specific references to the Plan provisions on which the decision was based. All such decisions will be final, conclusive and binding.
All appeals must be in writing and addressed to: The Board of Trustees, Suffolk County Municipal Employees Legal Services Fund, 30 Orville Drive, Suite D, Bohemia, NY 11716.