Claims Recovery. The Plan Administrator acknowledges that, because of the great volume of claims processed by HEBP, unintentional administrative errors may occur. When HEBP becomes aware of a claims overpayment, HEBP will promptly take the appropriate action, in accordance with HEBP’s standard procedures, to recover the excess payment at HEBP’s sole expense. HEBP, however, will not be required to enter into litigation to obtain a recovery, nor will HEBP be required to reimburse the Plan, except for gross negligence or intentional acts by HEBP. HEBP will provide reasonable assistance to Plan Administrator in pursuing rights of recovery arising from claim overpayments or such provisions as coordination of benefits, subrogation, and fraud detection. Only subrogation recoveries are subject to those fees indicated in Item Three of the Fee Schedule.
Claims Recovery. The proceeds of any insurance or claim in connection with the Petroleum Operations or any assets charged to the accounts.
Claims Recovery. Claims by City resulting from Consultant's failure to comply with the terms of and specifications of this Agreement and/or default hereunder may be recovered by City by withholding the amount of such claims from compensation otherwise due Consultant for work performed or to be performed. City shall notify Consultant of any such failure, default or damage therefrom as soon as practicable after discovery of such event by written notice. Nothing provided herein shall be deemed as constituting an exclusive remedy on behalf of City, nor a waiver of any other rights hereunder at law or in equity.
Claims Recovery. Benefit payments under the Group Health Plan made by BCBSNC based on Member eligibility data reflected in BCBSNC’s records as of the time of such payments, though incurred after the date a Member’s coverage terminates after corrective action is directed by the Plan Administrator, shall be the liability of the Plan Sponsor. Notwithstanding anything herein to the contrary, BCBSNC shall not be required to seek recovery of any payment made consistent with BCBSNC’s records to the extent that such recovery would conflict with BCBSNC’s obligations under a Provider contract or to the extent that a payment was made by a subcontractor retained by BCBSNC pursuant to this Agreement. BCBSNC shall effect such a corrective eligibility change no later than 15 business days following the date BCBSNC receives the updated information, along with other information as reasonably may be required by BCBSNC for the proper administration of the Group Health Plan, from the Plan Sponsor or the Plan Administrator. The Plan Sponsor agrees to pay BCBSNC the Total Balance Funding Liability attributable to any Member whose membership is corrected retroactively for the time period between the effective date of the change and the date BCBSNC processes the membership change.
Claims Recovery. Claims by City resulting from Consultant’s failure to comply with the terms of and specifications of this contract and/or default hereunder may be recovered by City by withholding the amount of such claims from compensation otherwise due Consultant for work performed or to be performed. City shall notify Consultant of any such failure, default or damage therefrom as soon as practicable and no later than 10 days after discovery of such event by written notice. Nothing provided herein shall be deemed as constituting an exclusive remedy on behalf of City, nor a waiver of any other rights hereunder at law or in equity. Design changes required as a result of failure to comply with the applicable standard of care shall be performed by the Consultant without additional compensation.
Claims Recovery. HPS agrees to use its reasonable commercial efforts to assist the Provident Parties and an independent Recovery Agency to be selected at The Provident Parties' sole discretion, to recover any amounts which the Provident Parties and the Recovery Agency deem to have been overpaid or double paid, and represent in their opinion recoverable amounts. HPS agrees to use reasonable commercial efforts to provide the Provident Parties and the Recovery Agency all necessary customary reports, HPS shall cooperate fully with Recovery Agency and allow Inspection and audit of all necessary records with reasonable notice. All amounts actually recovered will be the sole property of the Provident Parties. All costs and fees of the Recovery Agency shall be paid by PAMCO.
Claims Recovery. If We pay a benefit to which You or Your Enrolled Dependent was not entitled, or if We pay a person who is not eligible for benefits at all, We have the right, at Our discretion, to recover the payment from the person We paid or anyone else who benefited from it, including a Provider of services. Our right to recovery includes the right to deduct the mistakenly paid amount from future benefits We would provide the Enrolled Employee or any of his or her Enrolled Dependents, even if the mistaken payment was not made on that person's behalf. We regularly work to identify and recover claims payments that should not have been made (for example, claims that are the responsibility of another, duplicates, errors, fraudulent claims, etc.). We will credit all amounts that We recover, less Our reasonable expenses for obtaining the recoveries, to Your Group's experience or the experience of the pool under which You or Your Group is rated. Crediting reduces claims expense and helps reduce future premium rate increases. This claims recovery provision in no way reduces Our right to reimbursement or subrogation. Refer to the other-party liability provision in the Contract and Claims Administration Section for additional information.
