How to Fill Out and Submit the FOP Legal Plan Claim Form

To file an FOP Legal Plan claim form, complete it online at foplegal.com or print it and mail it to Sedgwick Claims Management Services in Cleveland, Ohio. The form collects your member information, the date and circumstances of the incident, and your attorney’s contact details so a Sedgwick adjuster can decide whether the Fraternal Order of Police Legal Defense Plan will cover your defense. Either you or your attorney can submit it.¹

What to Have Ready Before You Start

The form has three parts: who you are, what happened, and who’s representing you.

For member identification, you’ll be asked for your full legal name, lodge number, the last four digits of your Social Security number, and your FOP ID number.² Your lodge number and member ID are printed on your FOP membership card. The plan uses these to confirm you were an eligible participant on the date of the incident.

For incident details, you’ll need the exact date and location of the event and a concise description of the legal matter. Explain what happened and how it connects to your law enforcement duties. If it’s an internal affairs investigation, say so. If criminal charges were filed after a use-of-force incident, say that. The adjuster uses this narrative to determine whether the matter fits within the scope of your employment and which part of the plan applies.

For attorney information, the form includes fields for your attorney’s name, firm, mailing address, phone, fax, email, and an assistant’s name and email.² If you haven’t retained counsel yet, submit the form anyway and email the attorney’s name to foplegal@sedgwick.com once counsel accepts the case.¹ Getting the incident on file quickly matters more than waiting until every blank is complete.

How to Submit the Form

The plan requires that you notify the Benefit Administrator as soon as practicable after any occurrence that might result in a claim. The notice must include enough information to identify you and the time, place, and circumstances of the incident. Verbal notice has to be followed by the written claim form.³

You have two submission options. Complete the online form through the FOP Legal Plan website, or print it and mail it to:

Sedgwick Claims Management Services
P.O. Box 94950
Cleveland, OH 44101-4950⁴

After the form is in, email supporting documents to foplegal@sedgwick.com: notices of investigation, interview details, disciplinary notices, court summons, correspondence, and anything else tied to the claim.¹ You don’t have to assemble a complete file before you file. Send what you have, then follow with the rest as it comes in.

What Happens After You File

A Sedgwick claims adjuster reviews your claim within three business days of receiving it.¹ You’ll get an email that does one of three things: confirms coverage, denies coverage, or asks for more information. If coverage is confirmed, the adjuster may request specific documents at that point.

Under the plan’s own terms, the Benefit Administrator must make a final decision on any claim within 90 days of receiving it. If special circumstances require more time, Sedgwick will notify you in writing of an extension, which cannot exceed an additional 90 days.³ Straightforward claims resolve much faster.

Once approved, payments go directly to a Plan Attorney. For a Non-Plan Attorney, Sedgwick either pays the attorney or reimburses you. You’re responsible for keeping Sedgwick updated on new developments in your case throughout.¹

The Attorney Choice Changes What the Plan Pays

You have the right to select an attorney of your own choice.⁵ Whom you pick, though, controls how much of your defense the plan actually pays for, and the decision belongs on your radar before you file.

With a Plan Attorney (one contracted through the plan), reasonable and necessary legal fees and costs are paid in full across administrative, civil, and criminal matters. Approved reimbursable costs such as expert witnesses, investigators, and transcripts are also covered in full, provided the Benefit Administrator approved them in advance.³

With a Non-Plan Attorney, coverage is capped per claim:

Administrative matters: $10,000 for all services, including off-duty matters.
Civil matters: $10,000 for all services except trial, plus an additional $10,000 for trial.
Criminal matters: $10,000 for all services except trial and grand jury, $10,000 for trial, and $2,500 for advice and consultation on a grand jury hearing.
Reimbursable costs: capped at $1,000 per claim.³

The plan also reserves the right to refuse direct payment to a Non-Plan Attorney who hasn’t provided required reports and billings or who has billed hours exceeding the usual and customary amount for similar representation in the area. In that case the plan reimburses you at the usual and customary rate.³

Salary Reimbursement Instead of Defense Costs

If your claim involves a suspension or other discipline that causes actual salary loss, you can elect to receive reimbursement of up to three days’ actual salary loss instead of legal defense costs. The loss must result directly from the matters at issue in the claim. It’s one or the other, not both.³

Situations the Plan Won’t Cover

Some matters fall outside the plan regardless of how carefully you fill out the form, so it’s worth knowing before you file. Activities outside the scope of your law enforcement employment generally don’t qualify. Neither do disputes over collective bargaining agreements, workers’ compensation, unemployment, or disability benefits. The plan won’t pay judgments, fines, settlements, or penalties against you. If another policy covers the matter, such as a motor vehicle policy, the plan defers to that coverage. Pension and retirement benefit disputes are excluded, and the plan does not cover bail, appeal, or other bonds.³

Private university, college, hospital, railway, and Native American tribal law enforcement personnel have an additional limit: their coverage does not extend to civil lawsuits.³

If Your Claim Is Denied

Because the plan is governed by ERISA, federal law requires that a denial come with a written explanation setting out the specific reasons, written so you can understand it, and you have the right to a full and fair review.⁶ You get at least 60 days from the date you receive the denial notice to file an appeal, and the administrator then has 60 days to decide it, with a possible 60-day extension in special circumstances.⁷

Interpretation of plan provisions, including coverages and benefits, is vested exclusively in the Board in its absolute discretion, so an appeal should respond directly to the specific coverage criteria the adjuster cited in the denial letter rather than argue the equities.³

To discuss a denial or ask questions at any stage of the claims process, contact Sedgwick at (866) 857-3276 or foplegal@sedgwick.com.⁵

1
FOP Legal Plan. Claims Process
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Hylant. FOP Legal Plan Claim Form
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FOP Legal Plan. FOP Legal Defense Plan Description
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FOP Legal Plan. Contact Us
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Fraternal Order of Police. Legal Defense Plan
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Office of the Law Revision Counsel. 29 USC 1133 – Claims Procedure
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eCFR. 29 CFR 2560.503-1 – Claims Procedure