Legal Expense Insurance Policy
Administered by Insuresense Consultants (Pty) Ltd FSP 47115 and underwritten by GENRIC Insurance Company Limited (FSP 43638), an Authorisred Financial Service Provider and Registered Short-term insurer.
Whereas the Insured has applied to GENRIC Insurance Company Limited (“the Insurer”) for the insurance as set out in this policy and agrees that any proposal/application or other information supplied by the Insured or on his \ her behalf for the insurance shall be the basis of this Contract of Insurance, the Insurer agrees to indemnify the Insured subject to the terms, conditions and exclusions of this policy.
In consideration of the payment of the premium by or on behalf of the Insured, the Insurer agrees to provide the Benefits to the Insured arising out of the Insured Matters which occur and are notified to the Administrator, Insuresense, during the period of insurance.
Insured shall mean the person in whose name this policy is issued and includes, as beneficiaries under this policy, his/her life-partner/spouse and 5 (five) of his/her/their biological or legally adopted children under the age of 23 (twenty- three) years who are unmarried, full time students and financially dependent on the Insured.
Insuresense shall mean Insuresense Consultants (Pty) Ltd, registration number 2016/167323/07.
Benefits shall mean the Legal Services provided by Insuresense and/or appointed legal practitioners on behalf of the Insurer to the Insured.
Inception Date shall mean the date of receipt of the first premium.
Legal Services shall mean the proceedings and/or services provided by Insuresense and/or appointed legal practitioners arising from any of the Insured Matters.
Insured Matters shall mean:
• Legal Advice
The Insured shall be entitled to access to a 24-hour legal service centre to obtain legal advice and standard routine legal documents.
• Legal Assistance
Subject to the terms of this policy, the Insured shall be entitled to legal advice, legal representation and litigation services in any legally instituted court or tribunal, pertaining to the following matters:
1. Civil claims instituted by the Member regarding matters set out in this service schedule
2. Civil claims instituted against Member regarding matters set out in this service schedule
Family Law Matters
3. Family violence
5. Protection orders
6. Lobola marriages. Services will be provided only in respect of marriages that came into effect after the 2-month waiting period
7. Religious and Customary Marriages. Services will be provided only in respect of marriages that came into effect after the 2-month waiting period
8. Divorces – Uncontested
9. Amendment of Divorce Orders
10. Enforcement of Divorce Orders
11. Maintenance Applications
12. Enforcement of Maintenance Orders
13. Amendment of Maintenance Orders
14. Failure to pay maintenance – Representation in
15. Recovery of arrear maintenance
16. Prenuptial agreements
17. Disputes in respect of life partners living together
18. Visitation right disputes and/or court orders
19. Paternity testing (Excluding medical expenses)
General Legal Matters
21. Child abuse
22. Children’s rights
23. School related legal disputes
24. Lease agreements – this benefit is limited to tenants only
25. Damage to immovable property
26. Unlawful arrest by SAPS and Metro Police
27. Malpractice by doctors
28. Negligence in hospitals
29. Disputes with medical aid companies
30. Consumer related legal problems
31. Guarantees and Warrantees
32. Defective goods
33. Personal and bodily injuries
34. Problems with the neighbours
35. Sexual harassment
36. Disputes with service providers
37. Homeowner legal problems – limited to primary residence of member
38. Insurance related matters
39. Building disputes – limited to primary residence of member
41. Poor craftsmanship
42. Defamation of character – in printed or electronic media, excluding social media
43. Legal disputes regarding Tax
44. Registration of companies – Limited to 2 Companies per year
45. Status of persons (Curators’ appointment) The event and/or condition that forms the ground for person’s change in status must have happened or developed after the 2-month waiting period
46. Urgent applications
48. Appeals and review proceedings in criminal cases
49. Rescission of civil judgements
50. Wills – limited to advice and drafting of
51. Legal disputes regarding financial services
52. ID Theft
53. Debt related legal problems
54. Garnishee Orders
55. Blacklisting – Removal of your name from the Credit Bureau list
56. Unlawful blacklisting
57. Legal problems with Local Authorities
58. Criminal matters – all criminal offences
59. Bail applications
60. Bail payments up to R5 000 per incident per family member. Legal iQ will conduct a bail application and pay bail money / furnish a guarantee on behalf of the Member in an amount not exceeding R5000 (Five Thousand Rand) per Member per incident. The bail assistance service under this agreement will only be provided in respect of a first bail application related to every specific incident.
61. Disciplinary Hearings assistance
62. Lodgement of grievances at workplace
63. Internal Appeals
64. CCMA assistance
Motor Related Matters
65. Criminal prosecution relating to Motor vehicle Accidents
66. Traffic Offences – where the fine exceeds R2 500. Bail services as set out in services 59 and 60 above will only be provided following an arrest after the commission of a traffic offence. In respect of any drug or alcohol related offences or in the event of an arrest as a result of failure to appear in court no bail services will be provided
67. Drunken driving
68. Reckless or Negligent driving
69. Culpable Homicide as a result of an accident
70. Problems with panel beaters
71. Problems with tow-in companies
72. RAF (Road Accident Fund) Claims
74. Pothole damages
75. Other damage to your vehicle caused by bad road conditions
Additional Value-adding Services: (Costs for the account of the member)
76. Negotiating discount on attorney’s transfer fees of up to 30% when purchasing/selling immovable property if one of the attorneys on the Legal iQ network is appointed as the transferring attorney.
77. Winding up of deceased estates. Legal iQ will negotiate a special rate on executor’s fees if one of the attorneys on the Legal iQ network is involved in the winding up of a deceased member’s estate.
1. Limit of Liability
The liability of the Insurer in respect of any Benefits, proceeding or series of services and proceedings arising from one original cause for any Insured Matter shall not exceed R200 000 (two hundred thousand rand).
The Insured shall pay by debit or stop order to the Insurer a monthly premium as stated in the policy schedule, including VAT, on the due date. For the purposes of this policy the due date shall mean the date indicated by the Insured as the preferred premium debit order or stop order payment deduction date. In the event of non-payment of the premium at the due date, the Insurer shall double debit the Insured’s account on the next due date.
From the second month after inception of the policy onwards, the insured is awarded a 15 days grace period from the Due Date in which to pay to the premium. Failure to pay the premium within these 15 days will lead to cover being suspended for the remainder of the month. If the premium remains unpaid after this second debit order or stop order deduction, the policy shall be deemed to be cancelled form the last day of the month in which the premium was received and no further Benefits will be provided to the Insured as from that said last day of the month. The Insurer shall not be obliged to accept any premium tendered after the second unpaid debit or stop order but may do so on terms that it, at its sole discretion, may determine.
The Insured hereby requests and authorises the deduction/withdrawal of the premium against his/her bank account or salary, if stop order payment is selected by the Insured and to debit his/her account or salary with the amount equivalent to the monthly premium and continuing until cancelled by him / her in writing. All such deductions against his/her account or salary shall be treated as though he/she has signed and done them personally. If, in the event of the day of the said deduction of the premium falls on a Sunday or recognised South African public holiday, the payment day will automatically be the preceding or next ordinary business day. Further, if there are insufficient funds in his/her nominated bank account, the debit order system may track his/her account and re-present the instruction for payment as soon as sufficient funds are available in his / her account.
3. Waiting Period
This policy commences on the inception date and from such date the Insured is immediately entitled to legal advice. An Insured may utilise the legal services as frequently as required, provided that the service shall be rendered to such Insured on Insured Matters pertaining to personal capacity. Legal representation and litigation services are only available after 2 (two) months continuous and uninterrupted duration of this policy and in respect of divorce matters only after 6 (six) months continuous and uninterrupted duration of this policy, and only in matters where the cause or grounds of a claim arose after the expiration of the 2 (two) mentioned periods, respectively, as set out above. With regard to any legal disputes in respect of agreements, of whatever nature, only agreements that came into effect after the said 2 (two)-month waiting period will be covered under this policy. In any matter, where Insuresense provides litigation and representation services in terms of this policy on behalf of an Insured, and such Insured instructs Insuresense to stop litigation and representation services in that matter before finalisation thereof, then the Insurer will not be liable to provide further litigation or representation services in that same matter.
This policy may be cancelled at any time by the Insured by giving notice in writing to Insuresense in which event the Insured’s and the members’ entitlement to the Benefits will immediately terminate on the date of such cancellation and the member shall have no claim or right to the completion and/or finalisation of cases/matters that are not completed or that are pending on date of cancellation.
The Insurer may give the Insured 31 (thirty-one) days written notice to cancel or terminate this policy in which event a member’s entitlement to any further Benefits under this policy will immediately terminate on the date of such termination. However, the legal expenses already incurred and payable for the completion of pending and/or partly completed proceedings in respect of an Insured Matter occurring before such termination, shall be payable by the Insurer, subject to the applicable limit. Any claim for legal expenses must be submitted to Insuresense within 6 months of the cancellation or termination date, failing which Insursense and / or the Insurer shall have no liability to the Insured in respect of a claim.
If a member’s membership of Capitec Legal is cancelled or terminated, for whatever reason, that member’s entitlement to the Benefits will immediately terminate on the date of such cancellation/termination and the Insured shall have no claim or right to the completion and/or finalisation of cases/matters that are not completed or that are pending on date of cancellation.
5. Policy Changes/ Amendments
The Insurer or Insuresense may, at its sole discretion, amend the premium, Benefits and any of the terms of this policy by giving 31 (thirty-one) days’ notice of such changes to the Insured at his/her postal address or via fax, sms or e-mail message.
6.1. If the Insured is not married, only a partner who is engaged in a relationship of living together with the Insured as a life-partner, shall be entitled to the Benefits. In Legal proceedings brought by or contemplated against Insureds by other Insureds and where the Insureds who are parties to the proceedings, are members of the same household, only the Insured in whose name the policy is issued will be entitled to the Benefits.
6.2. On the occurrence of an Insured Matter which may result in a claim under this policy, the Insured shall, at his/her own expense, give notice thereof to Insuresense as soon as reasonably possible and submit to Insuresense all details they may reasonably require.
6.3. On receipt of notification of an Insured Matter, Insuresense will, at its sole discretion and subject to the terms of this policy, determine the nature, extent and procedures of all legal services covered in terms of this policy and the Insurer will be entitled to conduct such legal services using the appointed legal resources and practitioners of Insuresense or those appointed by Insuresense. Only legal practitioners appointed by Insuresense will be entitled to render services to the Insured and the Insured authorises Insuresense, in terms of this policy, to appoint such legal practitioners. Only Insuresense may terminate the mandate of such appointed practitioners. The Insurer or Insuresense will not be liable for any fees directly or indirectly incurred by any Insured or for payment of bail monies where such Insured, of his/her own accord contracted the services of a legal practitioner and Insuresense and / or the Insurer shall not be compelled, at any stage of such proceedings, to take over any such cases.
6.4. The Insured grants power of attorney to Insuresense to obtain any document or information pertaining to the provision of legal service. All or any privilege that emanates between the Insured and the appointed legal practitioner will include Insuresense. The Insured authorises Insuresense to have access to and receive copies of all privileged documents or information. The Insured further authorises Insuresense and/or the appointed legal practitioner to exchange privileged documents and information in order to provide legal services to the Insured.
6.5. The Insured may not make any confessions or admissions or accept liability in any matter in respect of which the Legal Services are provided, prior to consulting with Insuresense or its appointed legal practitioner. Any statements made by the Insured without prior consultation with Insuresense or its appointed legal practitioner prior to making of such statements, shall not be binding on the Insurer or Insuresense and the appointed legal practitioner, and the Insured irrevocably indemnifies the Insurer, Insuresense and the appointed legal practitioner of any liability of whatever nature resultant to such statements.
6.6. All Benefits are provided at the sole discretion of Insuresense and subject to the terms of this policy and any of the legal services may be provided on a contingency basis. If the Insured does not accept the advice of Insuresense and / or the appointed legal practitioner, or appoints his/her own attorney, or uses alternative legal products, and/or, in the sole opinion of Insuresense or its appointed legal practitioner, regarding any matter to be adjudicated in terms of this policy, there is no reasonable prospect of success, or where, in the sole opinion of Insuresense, a reasonable settlement offer is submitted by the Insured’s opponent and is rejected by the Insured, the Insurer or Insuresense in these instances will not be liable to provide or render any further Benefits under this policy.
6.7. The Insured shall not be entitled to any Benefits under this policy if the Insured does not comply with any of the Claim conditions and procedures as set out in this policy. Where the Insuresense appointed attorney conducts a matter on a contingency fee basis and the Insured, at any stage of the proceedings regarding such matter, terminates this policy and/or the services of that attorney, the Insured will be liable for the attorney’s fees on a scale attorney-client and it is agreed that the amount as set out in the attorney’s taxed account will be a liquid amount for purposes of summary judgement in this regard.
6.8. The Insurer and Insuresense do not provide sureties of whatever kind. Where legal costs are awarded or settled in the favour of the Insured, that amount of costs is payable immediately and on demand to Insuresense and it is further agreed that the amount as set out in the court order will be a liquid amount for purposes of summary judgement. The Insurer reserves the right to off-set such awarded/settled costs against any Benefits paid by the Insurer.
6.9. The Insurer or Insuresense will not be liable to provide any Benefits in the following instances:
• any claim that is false or fraudulent;
• any claim where the Insured acts without the consent of or contrary to the advice of the Insurer or Insuresense regarding the claim and the Benefits which will be provided;
• prior to the issuing of written confirmation of the Insurer or Insuresense that the claim has been accepted;
• where the Insured fails to give proper instructions and/or assistance regarding its claim within a reasonable time to the Insurer or Insuresense or the legal practitioners appointed by Insuresense;
• where the Insured misrepresented any facts or did not disclose to Insuresense, the Insurer or the appointed legal practitioner all facts relevant to a claim;
• where the Insured is responsible for anything which, in the reasonable opinion of the Insurer or Insuresense, prejudices the Insured’s prospects of success in the prosecution, defence or settlement of the proceedings;
• if, in the sole opinion the Insurer or Insuresense, regarding any matter to be adjudicated in terms of this policy, there is no reasonable prospect of success, or where, in the sole opinion of Insuresense, a reasonable settlement offer is submitted by the opponent and is rejected by the Insured;
• any claims lodged after the Insured’s maximum case Benefit has been reached.
6.10. If the Insurer rejects any claim in terms of the policy the Insured has 90 (ninety) days from the date of such rejection letter to dispute this decision with the Insurer. If the dispute is not satisfactorily resolved and the Insured has not commenced legal action within 6 (six) months after this period, all Benefits afforded under this policy in respect of any such claim shall be forfeited.
Legal Services are provided only in respect of matters that fall within the Jurisdiction of South African Courts and where South African Law applies.
8. Value-Added Tax
This document, together with proof of payment of the premium, constitutes an alternative to a tax invoice, debit note or credit note as contemplated in sections 20(7) and 21(5) of the Value Added Tax Act N0 89 of 1991. All sums insured and premiums are inclusive of VAT at 15%.
Misrepresentation, misdescription or non-disclosure in any material particular shall render this policy void and the Insured shall forfeit all Benefits.
1. This policy excludes:
1.1. The payment of any fine, penalty, tax, levy, any witness fee, any costs pertaining to expert witnesses and expert witness reports, travelling or subsistence costs, any payment or reimbursement of money to the Insured of whatever nature, including costs and expenses in respect of services under this policy provided on a contingency fee basis.
1.2. Indemnification of the Insured against payment of claims or damages awarded against the Insured in legal proceedings.
1.3. Any order in legal proceedings, made in respect of legal expenses, in favour of the Insured’s opponent in such proceedings.
1.4. Insured Matters that occurred outside the borders of Republic of South Africa.
1.5. Litigation and representation services regarding events or circumstances which had commenced or occurred or where the cause or grounds of action in respect of those events or circumstances arose prior to inception of the policy or within the Waiting Periods as well as agreements that were entered into by the Insured prior to the inception date of this policy or within the 2-month Waiting Period.
1.6. Matters related to the Insured’s business trade or profession and that are based on the generation of income other than income derived as an employee.
1.7. Matters related to the professional sporting activities of the Insured.
1.8. Claims instituted after 90 days from the date of an insured event or on which the Insured became aware of an occurrence of an insured event or a claim against him that falls within the ambit of an insured event.
1.9. Legal Services that are purely administrative in nature.
1.10. This policy of insurance and all actions, whether actual or contemplated, brought against the Insurer and/or Insuresense and /or the Intermediary in respect of the policy by the Insured.
1.11. Any Matters relating to:
1.11.1. Debt review, counselling or rehabilitation.
1.11.2. Insolvencies and administration of insolvent estates.
1.11.3. Investment and pension/provident fund disputes.
1.11.5. Water and electricity account problems and matters relating to electricity outages or claims based on consequential damage arising from electricity outages.
1.11.6. Disputes with telecommunication service providers.
1.11.7. Loss of or damage to any vehicle as a result of an accident – except where the loss or damage was caused by potholes.
1.11.8. The service and / or repair, of whatever nature and resulting from whatever cause, of a vehicle
1.11.9. Application of rules by Body Corporates and Home Owner Associations.
1.11.10. Events that are, in the sole opinion of Insuresense, trivial and / or should be adjudicated in the small claims Court.
1.11.11. SABC licences.
1.11.13. Adoptions in respect of family and blood relatives of an the Insured.
1.11.14. Land claims.
1.11.15. Constitutional Court proceedings.
1.11.16. Any act or activity pertaining to political activity/riot, civil commotion, labour riot/strike/lockout or public disorder.
1.11.17. Labour matters, the cause or grounds of which originate during the Insured’s membership of a Trade Union.
1.11.18. Protection orders regarding disputes between the Insured and immediate family members, his / her spouse or life-partner.
1.11.19. All matters not specifically included in the definition of Insured Matters
1.11.20. Ionising radiation or contamination by radioactivity from an irradiated nuclear fuel or any nuclear waste from the combustion of nuclear fuel
1.11.21. The radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or nuclear component thereof.
1.11.22. War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, riot, rebellion, revolution, insurrection, military or usurped power, or confiscation or nationalisation or compulsory purchase, requisition, destruction of or restrictions or controls placed on or damage to property by or under the order of any government or public or local authority.