Legal Expense - Power Workers Union

Legal Expense

Legal Expense Coverage Specifications Executive Summary

The Power Workers’ Union Protection Plan provides reimbursement of legal expenses incurred in defending you in relation to family law matters and against most criminal charges and civil law suits.

What types of legal actions are covered?

  • Suits heard in courts such as the Superior, Provincial and Small Claims Courts
  • Other civil suits
  • Family law (e.g. divorce, separation).
  • Criminal charges, including impaired driving charges.
  • Charges related to Provincial Offences, e.g. Highway Traffic Act offences.

What types of legal expense are covered?

  • Defence costs, including lawyers’ fees and disbursements made to defend you in a legal proceeding (including matrimonial proceedings where the member is a defendant)
  • Costs (including disbursements) and legal fees involving a counterclaim (including third party claims) brought directly as part of the defence of a claim against the member.
  • Mutual separation or mutual divorce agreement or matrimonial matters (i.e. both parties have agreed to terms of the separation or divorce and are simply seeking court approval of same):
    • In respect only of mutual separation or mutual divorce agreements or matrimonial legal proceedings only where the separation or divorce leading to the legal proceeding occurred on or after February 26, 2011, the member is entitled to coverage of costs and defence costs if he or she is or would be either the plaintiff or defendant in the proceedings
    • In respect only of separation or mutual divorce agreements or matrimonial legal proceedings where the separation or divorce leading to the legal proceeding occurred before February 26, 2011, the member is entitled to coverage of costs and defence costs only if he or she is the defendant or respondent proceedings.

Can I choose my own lawyer to defend me?

  • Yes, you can, subject to the approval by the insurance company.
  • You MUST contact the Call Centre (1-877-393-0338) at the outset of your case to arrange for approval of your lawyer and to arrange for payment of fees. You must NOT pay any money to your lawyer yourself. ALL billing and payment will be carried out between the lawyer and the PWUPP.

 

In CRIMINAL MATTERS, Frank Addario, Bill Thompson, Rebecca McConchie and Megan Savard in Toronto have acted for the Union and its members (including the PWU member charged and acquitted in the Barrett Chute incident) and have been pre-approved by the insurance company.  Their contact information is as follows:

Frank Addario-Office: (416) 649-5055; Cell (416) 720-9824
Bill Thompson-Office: (416) 649-5057; Cell (289) 314-6167
Andrew Guaglio: (416) 649-5057; Cell (416) 844-8988
Samara Secter: (416) 649-5063; Cell (647) 289-5933
Megan Savard: (416) 649-5056; cell (647) 973-2652
James Foy: (416) 646-1019 Cell: (416) 996-6573

In addition, other lawyers, who acted on behalf of the defendants or witnesses in the Barrett Chute criminal case, are as follows:

Mark Ertel (Ottawa) – Office (613) 236-0535; Cell (613) 299-0350
Patrick McCann (Ottawa) – Office (613) 236-1410; Cell (613) 863-1410

In CIVIL MATTERS, the following law firm has been pre-approved and regularly does civil work for the PWU:

Paliare Roland Rosenberg and Rothstein
250 University Avenue #501
Toronto, ON M5H 3E5

For assistance and referral to the appropriate lawyer, please contact:
Deanna Watters, Law Clerk to Ian Roland
Tel: (416) 646-7429; Fax: (416) 646-4301

In her absence, please contact the following:
Parlet Blake, Assistant to Ian Roland
Tel. (416) 646-7419; Fax: (416) 646-4301
email: parlet.blake@paliareroland.com

What types of legal expense are NOT covered?

Legal fees are only covered if the proximate cause is on or after inception date of the policy, being February 26th, 2007. Even if your bills are incurred after this date, the policy will not cover a claim if the criminal act, negligence, or other events (which necessitated the legal fees) occurred before February 26th, 2007.

  • Costs other than legal defence costs. This means that if you start a law suit against someone else (including a family claim against a spouse), your legal fees for that suit are NOT covered. Legal defence coverage protects you against the cost of defending yourself against an eligible claim made against you. The only exception to this is in the case of mutualseparation or mutual divorce agreements or matrimonial legal proceedings:
    • In respect only of mutual separation or mutual divorce agreements or matrimonial legal proceedings commenced on or after February 26, 2011,the member is entitled to coverage of costs and defence costs if he or she is or would be either the plaintiff or defendant in the proceedings. Proceedings are “mutual” only if both parties have agreed to all trems of the seperation or divorce prior to the commencement of the proceedings.
    • However, for mutual separation or mutual divorce agreements or matrimonial legal proceedings commenced prior to February 26, 2011, the member is only entitled to coverage of costs and defence costs only if he or she is the defendant or respondent proceedings.
  • Expenses that are predictable or that you choose to incur – e.g. wills, powers of attorneys, real estate legal fees, etc.
  • Costs to sue a third party, except for a counterclaim brought directly as part of the defence of a claim against the member.
  • Damages, judgments or settlements of any kind.
  • Fines, penalties of any kind.

Important Restrictions

Matrimonial Claims

  • Coverage for matrimonial claims begins 365 days after February 26th, 2007 or the date you become a union member, whichever is later.
    • If you were a PWU member on February 26th, 2007, you will be covered as of February 26th, 2008.
    • If you became a member after February 26th, 2007, you will be covered for matrimonial claims 365 days after your union membership began.
  • Only the union members are covered for matrimonial claims. There is no coverage or benefit available for union members’ spouses or other family members, unless the spouse is also a member of the union.
  • Reimbursement of expenses related to family law and matrimonial law are limited to $3,500 for any one claim, to a maximum of $3,500 per policy period. The most that can be paid is also $3,500 for any one spousal relationship (member’s total limit per any one spousal relationship).

Criminal Charges of Any Kind

  • Fees and disbursements covered to the later of the point of acquittal or conviction.
  • Reimbursement of expenses for the following will be subject to certain sub-limits:
    • driving while impaired
    • driving with a blood alcohol level exceeding the legal limit
    • failing or refusal to provide a breath sample
  • No coverage for parking tickets. Also note that a $500 deductible applies for charges under the Ontario Highway Traffic Act (or equivalent provincial legislation) where the maximum penalty or the charge does not include imprisonment. If the maximum penalty for such a charge includes imprisonment, there is no deductible.

Business Related Claims

  • Legal actions arising out of your full time, part time or casual business activities (e.g. if you do part time contract work) are not covered. Any claims or legal proceedings relating to your contract of employment are also not covered.

Coverage Limits

  • The policy pays only up to a maximum of $50,000 for all legal proceedings arising out of any one occurrence.
  • The maximum payable over the course of any policy period to any individual union member and his/her covered family members is $50,000.
  • This $50,000 annual limit is eroded by any claims payments to you or covered members of your family.

Detailed Summary

ItemsCoverage Terms and ConditionsDescription/commentary
Policy Period
  • February 26th, 2007 to February 26th, 2008
  • The policy will be renewed and continued in full force and effect until and unless the Power Workers’ Union or the Insurer cancels or terminates the policy.
  • The Power Workers’ Union will advise you if the policy is cancelled or terminated.
Policy is continuous unless the Power Workers’ Union or the insurer cancel.
Limits
  • $50,000 per occurrence, and per policy period.
    • This $50,000 limit also applies to each occurrence or related occurrences from the same event or incident.
    • The limit per occurrence applies no matter when legal expenses are incurred, even if expenses are incurred in future years, for instance with respect to criminal and civil actions arising from the same event/incident, subsequent actions, and/or counter claims.
  • The maximum payable in any one policy period to an individual union member and his/her covered family members is $50,000.
  • Reimbursement of expenses related to family law and matrimonial law are limited to $3,500 for any one claim, to a maximum of $3,500 per policy period. The most that can be paid is also $3,500 for any one spousal relationship (member’s total limit per any one spousal relationship).
  • Coverage does not apply to the union member’s spouse, unless the spouse is also a union member.
  • Coverage for matrimonial claims begins 365 days after February 26th, 2007 or the date you become a union member, whichever is later.
  • Reimbursement of expenses for the following are sub-limited:
    • driving while impaired
    • driving with a blood alcohol level exceeding the legal limit
    • failing or refusal to provide a breath sample
The maximum the policy will pay in each calendar year is $50,000, regardless of any other limits stated.

Limits will not be increased by subsequent actions, or counter claims relating to the same occurrence.
This limit applies even if actions are brought in separate policy periods.

The maximum combined limit available is $50,000 for an occurrence that leads to both a civil and criminal action, counterclaims or appeals.

  • If you were a PWU member on February 26th, 2007, you will be covered as of February 26th, 2008.
  • If you became a member after February 26th, 2007, you will be covered for matrimonial claims 365 days after your union membership began.
What is Covered?
  • Defence of civil claims or legal proceedings including third party and counter claims brought in relation to the defence of a claim against a member.
  • Defence of criminal or statutory charges
  • In respect only of mutual separation or mutual divorce agreements or matrimonial legal proceedings – please see details on “What types of legal expense are covered?” above for coverage details and restrictions.

But all claims are covered only if the criminal acts, negligence, or other events or occurrences (which necessitated the defence, and/or legal bills) occurred on or after February 26, 2007.

See the section below on “What is Not Covered” for further details.
What are Criminal or Statutory Charges?These are offences under the Criminal Code of Canada, The Controlled Drugs and Substances Act, and any other provincial or federal laws which prescribe punishable offences.Most criminal charges are covered.
What kind of Legal Expenses are Covered?
  1. Fees, expenses and other disbursements as reasonably claimed by your lawyer and agreed to by the insurance company. You must NOT pay your lawyer yourself, but must contact the Call Centre (1-877-393-0338) at the outset of your claim to have your lawyer approved and to have fees approved and paid for by the PWUPP. You lawyer will bill the PWUPP and be reimbursed by the PWUPP. You will not pay fees to your lawyer.
  2. Costs you are ordered to pay by a court as an award of costs in connection with a civil legal dispute or costs payable following an out of court settlement made in connection with such a civil legal dispute.
    1. But this excludes costs you are ordered to pay in connection with a criminal or statutory charge.
    2. Judgments, damages or settlements of any kind against you are excluded.
  • The policy covers legal expenses only. Judgments or settlements are not covered by this policy.
  • Fines and penalties are also excluded.
  • See the section below on “What is Not Covered” for further details.
Coverage TerritoryCanada only.The claim or legal proceeding must be brought against you, in Canada by an occurrence that took place in Canada.
DeductibleNil, except that for charges under the Ontario Highway Traffic Act (or equivalent statutes in other provinces) where the offence charged has a maximum penalty that does not include imprisonment, a $500 deductible applies.

What do I do if I find out about a claim or legal proceeding?If you are covered by this policy, once you are aware of an event that results in a claim or legal proceeding – or that might lead to a claim or legal proceeding – you must:

  • Call the Power Workers’ Union Call Centre at 1-877-393-0338.
  • Provide a copy of the document outlining the date and specific of the charge(s).
  • Co-operate with the insurance company, complete all forms they provide you and return them as soon as practicable.
  • Send the insurance company any additional documentation they may request.
  • Note that it is important that you notify the Call Centre as soon as practicable, once you become aware of a claim or a situation that might give rise to a claim and that you not pay any legal fees or a retainer to your lawyer
  • Advise the Call Center if anticipated expenses exceed $3,500 for any type of claim. The insurer will require that you or your lawyer submit a legal expense budget for pre-approval.
  • Call the 1-877-393-0338
  • You have the duty to report the claim as soon as practicable.
  • Failure to notify the Call Centre promptly can result in a claim being denied.
What Happens Next?
  • First, you need to retain a lawyer or someone else who is qualified to act on your behalf in the claim or legal proceeding.
    • This person is called the Appointed Representative.
    • Under this policy, you can either nominate your own Appointed Representative or you can ask the insurance company to appoint one for you. If you retain your own lawyer, you must tell the Call Centre (1-877-393-0338) of this so approval of your lawyer and his/her proposed fees can be arranged. You are NOT to pay fees to your lawyer – billings and payment of fees will be arranged between the PWUPP and your lawyer directly.
    • The insurer has the right to reject the Appointed Representative on reasonable grounds.
You can retain your own lawyer or use the recommended counsel from the PWUPP claims reporting. If you select your own lawyer, the insurer has the right to reject your choice and make you select someone else, on reasonable grounds.
  • You have a duty to co-operate with the Appointed Representative and to provide all information and assistance they may require to assist in your defence.
You must provide a complete and truthful account of all facts and provide all relevant documents and other evidence, attend meetings, and do whatever else is reasonably asked of you.
  • The insurance company has the right to access any information between you and the Appointed Representative unless the Appointed Representative refuses.
The Appointed Representative can refuse to give the insurer certain information. You cannot refuse such requests.
  • Submit all legal bills and invoices to the insurance company.
  • You must not pay any fees or expenses on your own. All of these must be sent to the insurance company.
Submit your claims to the insurance company, do not pay them yourself or agree to pay them. The designated adjuster will pay your legal expenses in accordance with the conditions in the section below entitled “How are Expenses Approved by the Insurer?”.
  • The Appointed Representative can ask for senior or specialist counsel, by special request to the insurance company. The insurance company cannot unreasonably withhold or delay such action.
  • You must be sure that you or the Appointed Representative notifies the insurance company if you give or receive an offer to settle; or an offer of payment into court is received.
If the insurance company is not notified, they can refuse to pay further legal expenses.
  • You cannot agree to settle without the insurance company’s written permission.
How are Expenses Approved by the Insurer?The insurance company will pay all legal expenses provided that they are covered by this policy, and:

  • The legal expenses are reasonable
  • You have reasonable grounds for bringing or defending the claim or legal proceeding
The insurer agrees to pay for your legal expenses if they are covered by the policy (in other words not excluded) and they are reasonably incurred.

If the anticipated expense exceeds $3,500 the insurance company requires you or your lawyer to submit a legal expense budget for pre-approval.

What Happens if I have a Disagreement with the Insurance Company?
  • Firstly, report your complaint, problem, or issue to the Power Workers’ Union Call Centre.
  • If the situation is not resolved, then you and the insurance company will go to arbitration. In such instances:
    • There will be a single arbitrator, either
      • A lawyer agreed upon by both you and the insurer; or
      • A person appointed by a judge of the Supreme Court of Ontario.
    • Arbitration will be governed by arbitration laws in Ontario.
    • Decision of the arbitrator will be final and binding.
    • All costs of the arbitrator will be paid by the party against whom the decision is made.
If there are problems, contact the Call Centre and you will be looked after. If the problem is not resolved, there’s an arbitration process incorporated into the policy.
Appeals
  • Are only covered in criminal cases where you are found not guilty, and where the crown appeals.
  • Appeals will not increase the insurer’s limit of liability.
Other Conditions on Coverage
  • Fraud – if you knowingly make a fraudulent or false claim, or if you co-operate with a third party for the purposes of fraud, your coverage under this policy is cancelled automatically and coverage will be void. Any sums paid under this policy will be reimbursed to the insurance company.
  • Other Insurance – if you have other legal expense insurance that covers a claim also covered by this policy, then you must collect under the other policy first.
This policy is only effective once you have exhausted the limits of the other legal expense insurance.
What is not Covered?
  • Parking tickets/infractions.
  • Divorce or matrimonial matters during the first year you are covered by this policy.
  • Legal bills or fees relating to criminal acts, negligence, or other events or occurrences which occurred prior to February 26th, 2007.
You have to wait until you have been covered by the policy for more than a year, before you can claim for divorce or matrimonial matters.
  • Claims or legal proceedings arising out of or related to business or trading activities.
Business activities are excluded including any claims or legal proceedings relating to your contract of employment.
  • Breach of professional duty, giving any kind of professional advice.
  • Your duties as a director or officer of any company.
  • Claims against a public or government authority.
  • Compensation, settlements or damages of any kind.
  • Fines and penalties are excluded.
  • Legal expenses incurred or paid before the insurer has approved.
  • Any claims which occurred prior to February 26th, 2007.
  • All claims must be reported to the insurance company prior to the expiration of the policy.
  • Divorce or matrimonial matters during the first year you are covered by this policy.
You have to wait until you have been covered by the policy for more than a year, before you can claim for divorce or matrimonial matters.
  • Claims against the PWU or other Power Workers’ Union members or their spouses/children covered by this policy – except where there is coverage for divorce and matrimonial matters against other Power Workers’ Union members or their spouses/children covered by this policy.
You are not covered for suits against the PWU or other people covered by this policy (union members and their spouses, children) except for legal expenses related to divorces and other matrimonial matters.
  • Anything related to loss, destruction, or use of data is not covered.
  • Anything related to terrorism, asbestos, fungus and mold, or nuclear incidents is not covered.

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