Contract Dispute with Legal Insurance Regarding Real Estate Matter

[WarrantSeeker]

What is the name of your state? Virginia

Hello, I am not sure if this is the proper forum for this issue. This issue involves a contract with a legal insurance provider. Please move to the appropriate area if it is not appropriate here.

I would like to sue the home flipper who sold me my home for actively concealing latent defects. I have a legal insurance plan through my employer that provides coverage for certain issues. The legal insurance company is stating that a lawsuit would not be covered under full coverage, but under the 25% discount coverage.

The contract states:

"SUMMARY OF SERVICES
The duties and responsibilities of the Plan Attorney to the Primary Member and Members (where applicable) shall consist of the following legal services:
.....
8.Civil Actions (Plaintiff): Representation as a plaintiff in connection with the filing of a civil action subject to the jurisdiction of the District Court. Representation shall be limited to action in the District Court. Collection of judgments covered under the Expanded Coverage Benefit. No representation shall be available under this item for any action that the Plan Attorney deems as either non-meritorious, calculated to be vexatious only, of a non-material or non-consequential nature, or which would be contrary to public policy."

Later in the contract, there is a section for "Master Plan Exclusions," but there is no mention of real estate matters.

Further down in the contract from there there is a section that states:

EXPANDED COVERAGE BENEFIT

"A TWENTY-FIVE percent (25%) savings on customary and usual attorney fees and/or legal assistant paralegal fees applies for the following matters:
•Pre-Existing matters. The matter requiring legal services originated prior to the effective date on the Enrollment Form and involved either (1) the commencement of any legal action or legal proceeding by or against Primary Member including the issuance of a summons; or (2) the prior retention by Primary Member of the services of another attorney or mediator; or (3) the signing of a real estate contract or separation agreement prior to membership. •Probation Violations, Bond Hearings, and/or violations of existing court orders, and capias charges (failure to appear).•Defense of criminal actions which involve the use of alcohol, illegal drugs, or fire arms, except alcohol or controlled substance related traffic offenses as set forth under item 19 and juvenile first offenses as set forth under item 21. •Any matter not specifically covered under the Summary of Services herein.
Where specialized attorney services are available, Plan Attorney will evaluate all factors before representation will be provided."

Note that real estate matters are not directly linked to this statement. The contract starts listing areas without any transition from this statement, and it says in one part:

"REAL ESTATE MATTERS: Matters evolving from a real estate closing such as a dispute with builder and/or breach of contract. Other matters include specialized property rights, adjacent property acquisitions, home equity/improvement matters, builder/contractor disputes, refurbishment requirements, for sale by owner, rent to own, second homes and rental property."

The legal insurance company is interpreting this provision to override the promise for full coverage for civil litigation listed earlier.

Does this sound appropriate? How can I dispute this?

 

[Zigner]

Contract review is beyond the scope of this (or any) internet forum. You should take your contract, in its entirety, to a local attorney for review and advice.

 

[adjusterjack]

Besides, the entire contract would have to be reviewed, not just the parts that you are taking out of context that you think might be in your favor.

I would like to sue the home flipper who sold me my home for actively concealing latent defects.

Merriam-Webster definition of "latent."

"present and capable of emerging or developing but not now visible, obvious, active, or symptomatic."

1 - Since they were "latent" how would you prove that the flipper knew about them?

2 - Check your disclosure statutes. You may find (as with many states) that someone is exempt from disclosure if they have only owned the home for a short time and never lived in it.

 

[WarrantSeeker]

Besides, the entire contract would have to be reviewed, not just the parts that you are taking out of context that you think might be in your favor.



Merriam-Webster definition of "latent."

"present and capable of emerging or developing but not now visible, obvious, active, or symptomatic."

1 - Since they were "latent" how would you prove that the flipper knew about them?

2 - Check your disclosure statutes. You may find (as with many states) that someone is exempt from disclosure if they have only owned the home for a short time and never lived in it.

"Latent" is probably the wrong word. "Obvious" structural defects would be more accurate.
Mandatory disclosure is not required in Virginia. There is a duty though to not actively conceal defects. The seller actively concealed issues with with floor joists by covering them with an unnecessary (and even harmful) vapor barrier.

Also, the seller took active steps to mislead on the moisture issue in the crawlspace. I have spoken with a lawyer who has acknowledged that the issues are problematic and I have a case. My main concern now is getting my legal insurance plan to pay for that lawyer's services.

Also, I spoke to the Legal Services plan administrator, and her explanation was illogical and riddled with inaccuracy. The legal basis of the denial may be sound, but her explanation certainly wasn't. In the end she even admitted I was right on one issue without fully willing to commit to the fact that I was right in my objection. I don't believe I am taking the terms out of context. The contract itself is somewhat ambiguous, and the plan administrator's interpretation is certainly not in accord with the plain language of the contract.

 

[Taxing Matters]

I don't have the benefit of the full contract to read, nor do I know specifically why the insurer rejected your claim. As a result I couldn't tell you if the claim is covered or not. The insurance is provided through your employer, so your employer presumably arranged for the service and pays for it or pays it with deductions from your pay. Have you discussed this with your employer? As your employer set this up, it may have better success with convincing the insurer.

Also, I can't tell whether you get to pick any lawyer for this, or choose from a list the insurer gives you, or whether the insurer simply provides one.

 

[WarrantSeeker]

Besides, the entire contract would have to be reviewed, not just the parts that you are taking out of context that you think might be in your favor.



Merriam-Webster definition of "latent."

"present and capable of emerging or developing but not now visible, obvious, active, or symptomatic."

1 - Since they were "latent" how would you prove that the flipper knew about them?

2 - Check your disclosure statutes. You may find (as with many states) that someone is exempt from disclosure if they have only owned the home for a short time and never lived in it.

I don't have the benefit of the full contract to read, nor do I know specifically why the insurer rejected your claim. As a result I couldn't tell you if the claim is covered or not. The insurance is provided through your employer, so your employer presumably arranged for the service and pays for it or pays it with deductions from your pay. Have you discussed this with your employer? As your employer set this up, it may have better success with convincing the insurer.

Also, I can't tell whether you get to pick any lawyer for this, or choose from a list the insurer gives you, or whether the insurer simply provides one.

I don't have the benefit of the full contract to read, nor do I know specifically why the insurer rejected your claim. As a result I couldn't tell you if the claim is covered or not. The insurance is provided through your employer, so your employer presumably arranged for the service and pays for it or pays it with deductions from your pay. Have you discussed this with your employer? As your employer set this up, it may have better success with convincing the insurer.

Also, I can't tell whether you get to pick any lawyer for this, or choose from a list the insurer gives you, or whether the insurer simply provides one.

Thank you for your response. That is excellent advice. My employer is very large and very powerful.

The insurer has partners signed up to provide legal coverage. The insurer found a partner for me and I discussed my case was him. He is willing to represent me. The question now is whether the insurer pays his full fee, or only pays 25% of his fee.

 

[quincy]

Thank you for your response. That is excellent advice. My employer is very large and very powerful.

The insurer has partners signed up to provide legal coverage. The insurer found a partner for me and I discussed my case was him. He is willing to represent me. The question now is whether the insurer pays his full fee, or only pays 25% of his fee.

That is a question for the insurer.