Subrogation and Reimbursement. 1. In the event a Participant is legally entitled to recover all or a portion of the cost of a service or a prescription drug covered by this Plan from a third party, the Employer will, upon making payment under this Plan, succeed to any rights of recovery the Participant may have or acquire (with respect to such service or prescription drug) against any individual or organization except insurers of individual hospital, surgical or medical policies issued to the Participant.
Subrogation and Reimbursement. Subject to the limitations of Section 10.2(d), the Committee shall maintain, as part of each Plan, a comprehensive subrogation and reimbursement policy, updated from time to time as appropriate.
Subrogation and Reimbursement. These paragraphs apply when another party (including any insurer) is, or may be found to be, responsible for Your injury, illness or other condition and We have provided benefits related to that injury, illness or condition. As permitted by applicable state law, unless preempted by federal law, We may be subrogated to all rights of recovery against any such party (including Your own insurance carrier) for the benefits We have provided to you under this Policy. Subrogation means that We have the right, independently of you, to proceed directly against the other party to recover the benefits that We have provided. Subject to applicable state law, unless preempted by federal law, We may have a right of reimbursement if you or anyone on your behalf receives payment from any responsible party (including Your own insurance carrier) from any settlement, verdict or insurance proceeds, in connection with an injury, illness, or condition for which We provided benefits. Under Section 5-335 of the New York General Obligations Law, Our right of recovery does not apply when a settlement is reached between a plaintiff and defendant, unless a statutory right of reimbursement exists. The law also provides that, when entering into a settlement, it is presumed that You did not take any action against Our rights or violate any policy between You and us. The law presumes that the settlement between You and the responsible party does not include compensation for the cost of dental care services for which We provided benefits. We request that You notify Us within 30 days of the date when any notice is given to any party, including an insurance company or attorney, of Your intention to pursue or investigate a claim to recover damages or obtain compensation due to injury, illness or condition sustained by You for which we have provided benefits. You must provide all information requested by Us or Our representatives including, but not limited to, completing and submitting any applications or other forms or statements as We may reasonably request.
Subrogation and Reimbursement. If the Plan is self-insured, the following provisions regarding subrogation and third-party reimbursement will apply.
Subrogation and Reimbursement. THIRD-PARTY LIABILITY
Subrogation and Reimbursement. We have the right to subrogation and reimbursement. References to “you” or “your” in this Subrogation and Reimbursement section shall include you, your Estate and your heirs and beneficiaries unless otherwise stated. Subrogation applies when we have paid Benefits on your behalf for a Sickness or Injury for which any third party is allegedly responsible. The right to subrogation means that we are substituted to and shall succeed to any and all legal claims that you may be entitled to pursue against any third party for the Benefits that we have paid that are related to the Sickness or Injury for which any third party is considered responsible. Subrogation Example: Suppose you are injured in a car accident that is not your fault, and you receive Benefits under the Policy to treat your injuries. Under subrogation, the Policy has the right to take legal action in your name against the driver who caused the accident and that driver's insurance carrier to recover the cost of those Benefits. The right to reimbursement means that if it is alleged that any third party caused or is responsible for a Sickness or Injury for which you receive a settlement, judgment, or other recovery from any third party, you must use those proceeds to fully return to us 100% of any Benefits you receive for that Sickness or Injury. The right of reimbursement shall apply to any benefits received at any time until the rights are extinguished, resolved or waived in writing. Reimbursement Example: Suppose you are injured in a boating accident that is not your fault, and you receive Benefits under the Policy as a result of your injuries. In addition, you receive a settlement in a court proceeding from the individual who caused the accident. You must use the settlement funds to return to the Policy 100% of any Benefits you received to treat your injuries. The following persons and entities are considered third parties: • A person or entity alleged to have caused you to suffer a Sickness, Injury or damages, or who is legally responsible for the Sickness, Injury or damages. • Any insurer or other indemnifier of any person or entity alleged to have caused or who caused the Sickness, Injury or damages. • Your employer in a workers’ compensation case or other matter alleging liability. • Any person or entity who is or may be obligated to provide benefits or payments to you, including benefits or payments for underinsured or uninsured motorist protection, no-fault or traditional auto insurance, med...
Subrogation and Reimbursement. Subrogation is the substitution of one person or entity in the place of another with reference to a lawful claim, demand or right. The Company shall be entitled to all rights of recovery for the reasonable value of services and Benefits provided by The Company to any Covered Person, from any third party or entity that either provides or is obligated to provide Benefits or payments to the Covered Person. The Covered Person agrees to execute and deliver such documents (including a written confirmation of assignment, and consents to release medical records), and provide such help as may be reasonably requested by The Company.
Subrogation and Reimbursement. SHL has the right to subrogation and reimbursement. References to “you” or “your” in this Subrogation and Reimbursement section shall include you, your Estate and your heirs and beneficiaries unless otherwise stated. Subrogation applies when SHL has paid benefits on your behalf for an Illness or Injury for which any third party is allegedly responsible. The right to subrogation means that SHL is substituted to and shall succeed to any and all legal claims that you may be entitled to pursue against any third party for the benefits that SHL has paid that are related to the Illness or Injury for which any third party is considered responsible.
Subrogation and Reimbursement. To the extent the Insured, the Plan and/or the Trust, if any, becomes subrogated to or has a claim for restitution or reimbursement of Plan Benefits for which the Insured, the Plan and/or the Trust, if any, has obtained or seeks subrogation, restitution, or reimbursement, under this Contract, BCBSND shall be entitled to a pro rata share of any recovery by settlement, judgment, or otherwise based on the ratio of its payment under this Contract as it relates to the Plan Benefits. Any reasonable attorney fees or other reasonable legal costs incurred in the subrogation, restitution, or reimbursement recovery, if any, shall be charged to the total amount recovered prior to any pro rata apportionment between the Plan and BCBSND. Neither the Insured, the Plan nor the Trust, if any, shall be entitled to waive any portion of any subrogation, restitution, or reimbursement claim for which the Insured, the Plan and/or the Trust, if any, has obtained or seeks reimbursement under this Contract without the express written approval of BCBSND.
Subrogation and Reimbursement. We have the right to subrogation and reimbursement. References to “you” or “your” in this Subrogation and Reimbursement section shall include you, your Estate and your heirs and beneficiaries unless otherwise stated. Subrogation applies when we have paid Benefits on your behalf for a Sickness or Injury for which any third party is allegedly responsible. The right to subrogation means that we are substituted to and shall succeed to any and all legal claims that you may be entitled to pursue against any third party for the Benefits that we have paid that are related to the Sickness or Injury for which any third party is considered responsible. Subrogation Example: Suppose you are injured in a car accident that is not your fault, and you receive Benefits under the Policy to treat your injuries. Under subrogation, the Policy has the right to take legal action in your name against the driver who caused the accident and that driver's insurance carrier to recover the cost of those Benefits. The right to reimbursement means that if it is alleged that any third party caused or is responsible for a Sickness or Injury for which you receive a settlement, judgment, or other recovery from any third party, you must use those proceeds to fully return to us 100% of any Benefits you receive for that Sickness or Injury. The right of reimbursement shall apply to any benefits received at any time until the rights are extinguished, resolved or waived in writing. Reimbursement Example:
