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Outline

The Texas Legal Claim form is a crucial document for individuals seeking to navigate legal services under the Texas Legal Protection Plan (TLPP). This form collects essential participant and client information, ensuring that all relevant details are accurately captured. Key sections include participant identification, client information, and verification of coverage, which must be confirmed before any legal services are rendered. Additionally, the form requires attorney details, including billing information and services performed, along with dates and codes that correspond to the TLPP Participating Attorney Fee Schedule. It is vital to note that the submission of this claim indicates that the legal matter has been finalized, as TLPP does not provide interim payments. Furthermore, the form mandates signatures from both the member and the participating attorney, affirming the authenticity and necessity of the legal services provided. Understanding the components of this form is essential for ensuring a smooth claims process and securing the benefits entitled under the TLPP.

Sample - Texas Legal Claim Form

PART 1 PARTICIPANT INFORMATION

Member Name:

Subscriber ID:

Group ID:

Mailing Address:

Mailing City, ST, Zip:

,

 

 

Email Address:

 

 

 

Home/Cell Phone No.:

 

 

 

Office Phone No.:

 

 

 

PART 2 CLIENT INFORMATION (if not listed above)

Name:

Date of Birth:

Relationship to Member:

Contact Phone No.:

By checking this box I certify that the client/dependent (excepting spouse of Member) was under the age of 25 at the time when the legal matter occurred.

CLAIM FORM

PART 3 COVERAGE VERIFICATION

Contact TLPP for eligibility verification prior to providing service(s)

Toll (800) 252-9346 | Austin (512) 327-1372 | Email [email protected]

Date:

Authorization No.:

Notes:

OBTAINING VERIFICATION IS NOT A GUARANTEE OF PAYMENT

PART 4 ATTORNEY INFORMATION

Attorney Name:

Attorney TLPP ID:

Billing Address

Billing City, ST, Zip: ,

Email Address:

Telephone No.:

Fax No.:

Updated contact information provided

PART 5 SERVICES PERFORMED (refer to TLPP Participating Attorney Fee Schedule for codes and descriptions)

First Date of Service

Final Date of Service

Code

Description

Qty/Hour(s)

Charge

TOTALS

PART 6 COURT RELATED INFORMATION

Court/Administrative/Charge Date:

First Filing Date:

Court/Agency Name:

Cause/Docket No.:

PART 8 CLAIM SUBMISSION

Fax (512) 327-0163 | Email [email protected]

Mailing 7500 Rialto Blvd, Bldg One, Ste 120, Austin, Texas 78735

NOTICE By submitting this claim you are affirming that the legal matter has been finalized. Be advised that TLPP does not make interim payments.

PART 7 AUTHORIZATING SIGNATURES

MEMBER OR AUTHORIZED PERSON’S SIGNATURE I authorize the release of any legal or other information necessary to process this claim. I also request payment of benefits either to myself or to the party who accepts TLPP.

Participating Member Signature

Date

I certify that the service(s) listed were necessary for the legal services of the client and were personally furnished by me or my employee(s) under my personal direction. I certify that the foregoing information is true, accurate and complete. The itemized statement submitted includes hourly billing. I agree not to bill the Member and/or the Client for any covered legal services.

Participating Attorney Signature

Date

PART 9 TLPP Office Use Only

Effective Date:

Process Date:

Received Date:

Payment:

 

 

 

 

Coverage Type:

Batch No.:

Claim Count:

Claim No.:

 

 

 

 

Toll (800) 252-9346 | Fax (512) 327-0163 | Austin (512) 327-1372 | Office 7500 Rialto Boulevard, Building One, Suite 120, Austin, Texas 78735 |

Web www.tlpp.org

CREATED AND ENDORSED BY THE STATE BAR OF TEXAS SINCE 1972

12/2011
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Form Information

Fact Name Details
Governing Law The Texas Legal Claim form is governed by the Texas Insurance Code and the Texas Rules of Civil Procedure.
Participant Information The form requires detailed participant information, including the member's name, subscriber ID, and mailing address.
Client Information If the client is not the member, their name, date of birth, relationship to the member, and contact phone number must be provided.
Eligibility Verification Before providing services, eligibility verification must be obtained by contacting TLPP through the provided phone numbers or email.
Attorney Information The attorney’s name, TLPP ID, billing address, and contact details must be included to ensure proper processing.
Services Performed Details about the services performed, including dates, descriptions, and charges, are required for claim processing.
Court Related Information Information regarding the court or administrative body, including dates and cause/docket numbers, must be included.
Submission Method Claims can be submitted via fax, email, or regular mail, with specific contact information provided for each method.
Signature Requirement The form must be signed by the member or an authorized person, affirming the accuracy of the information provided.

Detailed Guide for Filling Out Texas Legal Claim

Filling out the Texas Legal Claim form requires careful attention to detail. Each section of the form must be completed accurately to ensure proper processing of your claim. Follow the steps below to complete the form correctly.

  1. Begin with PART 1: PARTICIPANT INFORMATION. Fill in your name, Subscriber ID, Group ID, mailing address, city, state, zip code, email address, and phone numbers.
  2. If applicable, complete PART 2: CLIENT INFORMATION. Provide the client's name, date of birth, relationship to the member, and contact phone number. Check the box if the client was under 25 years old at the time of the legal matter.
  3. Move to PART 3: COVERAGE VERIFICATION. Contact TLPP for eligibility verification before providing services. Record the date and authorization number. Note that verification does not guarantee payment.
  4. In PART 4: ATTORNEY INFORMATION, enter the attorney's name, TLPP ID, billing address, email address, telephone number, and fax number. Confirm if any contact information has been updated.
  5. Proceed to PART 5: SERVICES PERFORMED. List the first and final dates of service, along with the code description, quantity or hours, and charges. Calculate the total amount.
  6. Complete PART 6: COURT RELATED INFORMATION. Include the court or agency name, charge date, first filing date, and cause or docket number.
  7. In PART 7: AUTHORIZING SIGNATURES, sign and date the form as the member or authorized person. The attorney must also sign and date, certifying the accuracy of the information provided.
  8. Finally, submit the claim as indicated in PART 8: CLAIM SUBMISSION. You can fax, email, or mail the completed form to TLPP.

Obtain Answers on Texas Legal Claim

  1. What information do I need to provide on the Texas Legal Claim form?

    The Texas Legal Claim form requires several key pieces of information. You will need to fill out your personal details, including your name, Subscriber ID, and contact information. If you are submitting a claim for someone else, you must also provide their name, date of birth, and relationship to you. Additionally, you should include details about the attorney, services performed, and any relevant court information.

  2. How do I verify my coverage before submitting a claim?

    To verify your eligibility for coverage, contact TLPP directly. You can reach them at their toll-free number, (800) 252-9346, or the Austin office at (512) 327-1372. You may also email them at [email protected]. It's important to note that obtaining verification does not guarantee payment.

  3. What should I do if I need to submit my claim?

    You can submit your claim via multiple methods. Fax your completed claim form to (512) 327-0163 or email it to [email protected]. If you prefer to send a hard copy, mail it to the following address: 7500 Rialto Blvd, Building One, Suite 120, Austin, Texas 78735. Ensure that you have finalized the legal matter before submission, as TLPP does not make interim payments.

  4. What happens after I submit my claim?

    Once your claim is submitted, it will be reviewed by the TLPP office. They will process the claim and determine the payment based on the information provided. You will receive updates regarding the status of your claim, including the effective date and payment details. Keep in mind that you are affirming the legal matter has been finalized upon submission.

  5. What if I have additional questions about the claim process?

    If you have further inquiries about the claim process or need assistance, you can contact TLPP's office directly. Their toll-free number is (800) 252-9346, and the Austin office can be reached at (512) 327-1372. They are available to help clarify any concerns you may have regarding your claim or the form itself.

  6. Is there a deadline for submitting the Texas Legal Claim form?

    While the Texas Legal Claim form does not specify an explicit deadline, it is advisable to submit your claim as soon as the legal matter has been finalized. Delaying the submission may affect your eligibility for benefits. Always check with TLPP for any specific timelines related to your coverage.

Common mistakes

Filling out the Texas Legal Claim form can be straightforward, but many make common mistakes that can delay processing or lead to denials. One frequent error is failing to provide complete participant information. It's crucial to fill in all fields, including the member's name, subscriber ID, and mailing address. Missing any of this information can cause confusion and result in processing delays.

Another mistake involves the client information section. If the client is not the member, ensure that the client's name and relationship to the member are clearly stated. Additionally, remember to check the box certifying that the client was under 25 years old at the time of the legal matter, if applicable. Omitting this can lead to complications in verifying eligibility.

Many people overlook the importance of coverage verification. Before providing services, it's wise to contact TLPP for eligibility verification. Failing to do so can result in unexpected out-of-pocket expenses, as obtaining verification does not guarantee payment.

In the attorney information section, ensure that the attorney's name and TLPP ID are accurate. Incorrect details can lead to issues with payment processing. Double-check the billing address and contact information as well. Errors in these areas can delay communications and payment.

When detailing the services performed, be specific about the dates, codes, and descriptions. Incomplete or vague entries can lead to misunderstandings about the services rendered. Ensure that the quantities and charges are clearly outlined to avoid disputes.

Another common error occurs in the court-related information section. Make sure to provide accurate dates and the correct court or agency name. Any inaccuracies can hinder the claim's approval process and may require additional follow-up.

Finally, don’t forget the authorization signatures. Both the member and the attorney must sign and date the form. Missing signatures can result in immediate rejection of the claim. Always verify that all required signatures are included before submission.

Documents used along the form

The Texas Legal Claim form is a vital document used in legal proceedings, particularly for claims related to legal services. However, it often goes hand-in-hand with other important forms and documents. Understanding these additional documents can streamline the process and ensure that all necessary information is provided. Below are four forms frequently associated with the Texas Legal Claim form.

  • Eligibility Verification Form: This document is used to confirm that the individual seeking legal services is eligible for coverage. It typically includes personal information and may require signatures to authorize the release of information.
  • Attorney Fee Schedule: This schedule outlines the fees associated with various legal services. It provides clarity on what services are covered and helps in calculating the total charges for the legal representation provided.
  • Client Authorization Form: This form is essential for obtaining consent from the client or dependent to release their information to the attorney. It ensures that the attorney has the necessary permissions to act on behalf of the client.
  • Itemized Billing Statement: An itemized statement details the specific services rendered, hours worked, and charges incurred. This document supports the claim by providing a breakdown of costs and justifying the expenses submitted for reimbursement.

Each of these documents plays a crucial role in the claims process. By ensuring that they are completed accurately and submitted alongside the Texas Legal Claim form, individuals can help facilitate a smoother and more efficient resolution to their legal matters.

Similar forms

  • Insurance Claim Form: Like the Texas Legal Claim form, an insurance claim form collects personal and service-related information to process claims for benefits. Both require details about the member, services performed, and an authorization signature.
  • Medical Claim Form: This form is used to request payment for medical services. Similar to the Texas Legal Claim form, it includes patient information, service dates, and verification of coverage, ensuring that all necessary details are provided for processing.
  • Workers' Compensation Claim Form: This document is used when an employee files a claim for work-related injuries. It shares similarities with the Texas Legal Claim form in that both require information about the claimant, service details, and verification of eligibility.
  • Personal Injury Claim Form: This form is used to seek compensation for injuries. It parallels the Texas Legal Claim form by requiring information about the injured party, details of the incident, and a signature to authorize the claim process.
  • Property Damage Claim Form: Used to report damages to property, this form requires details about the damage and related costs. Like the Texas Legal Claim form, it necessitates personal information and documentation to support the claim.
  • Disability Claim Form: This form is used to apply for disability benefits. It includes personal and medical information, similar to the Texas Legal Claim form, which also requires details about services rendered and eligibility verification.
  • Auto Accident Claim Form: This document is used to report auto accidents and request compensation. It requires similar information about the involved parties, incident details, and an authorization signature, much like the Texas Legal Claim form.
  • Liability Claim Form: This form seeks compensation for damages caused by another party. It requires personal and incident-related information, paralleling the structure of the Texas Legal Claim form in its emphasis on accurate details for processing.
  • Homeowners Insurance Claim Form: This form is used to report damage to a home. It shares similarities with the Texas Legal Claim form in that both require claimant information, details about the incident, and verification of coverage for processing.
  • Health Insurance Claim Form: This document is used to request payment for health services. Like the Texas Legal Claim form, it requires personal details, service dates, and an authorization signature to process the claim effectively.

Dos and Don'ts

When filling out the Texas Legal Claim form, it’s important to be careful and thorough. Here are some things you should and shouldn’t do to ensure your claim is processed smoothly.

  • Do provide accurate and complete participant information.
  • Do verify your coverage before submitting the claim.
  • Do include all necessary signatures on the form.
  • Do double-check the dates of service for accuracy.
  • Don't leave any sections blank unless instructed to do so.
  • Don't submit the claim without verifying the eligibility first.
  • Don't forget to keep a copy of the submitted form for your records.
  • Don't send the claim to the wrong fax number or email address.

Following these guidelines can help prevent delays and ensure that your claim is handled properly.

Misconceptions

Understanding the Texas Legal Claim form can be challenging. Many people hold misconceptions that can lead to confusion when filling it out. Here’s a list of common misunderstandings:

  • All claims are automatically approved. Many believe that submitting a claim guarantees approval. In reality, claims are reviewed, and eligibility must be verified.
  • You can submit claims for any legal matter. Some think they can claim any legal service. However, only services covered under the TLPP are eligible.
  • Filling out the form is optional. There’s a misconception that completing the form is not necessary. In fact, it is essential for processing claims.
  • Verification guarantees payment. Many assume that obtaining eligibility verification ensures payment. This is not true; verification does not guarantee payment.
  • Only the member can submit the claim. Some believe that only the member can file a claim. Authorized persons can also submit claims on behalf of the member.
  • All legal services are covered. There’s a common belief that all legal services are included. Coverage is limited to specific services outlined in the TLPP Participating Attorney Fee Schedule.
  • You can bill the member for covered services. Some think they can charge the member for services that are covered. This is incorrect; members should not be billed for covered services.
  • The claim must be submitted immediately. Many believe claims must be submitted right after services are rendered. While timely submission is important, there may be some flexibility.
  • Signature is not required. Some individuals think that a signature is optional. However, a signature is necessary to authorize the release of information and process the claim.
  • All information can be provided verbally. There’s a misconception that verbal communication is sufficient. Written information must be submitted on the claim form for processing.

Being aware of these misconceptions can help ensure a smoother experience when navigating the Texas Legal Claim form. Always refer to the guidelines and instructions provided to avoid potential pitfalls.

Key takeaways

When filling out and using the Texas Legal Claim form, it's important to keep several key points in mind to ensure a smooth process. Here are some essential takeaways:

  • Accurate Participant Information: Fill out the participant information section completely. This includes the member's name, subscriber ID, group ID, and contact details. Incomplete information can lead to delays.
  • Client Information: If the client is different from the member, provide their details in the client information section. Make sure to include their relationship to the member and verify their age if applicable.
  • Coverage Verification: Before offering any services, contact TLPP to verify eligibility. This step is crucial as obtaining verification does not guarantee payment.
  • Detail Services Performed: Clearly list the services performed, including dates, codes, and charges. Refer to the TLPP Participating Attorney Fee Schedule for accurate coding.
  • Signatures Required: Ensure that both the member (or authorized person) and the participating attorney sign the claim form. This certification is vital for processing the claim.

By following these guidelines, you can help streamline the claims process and avoid potential issues.