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. 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. 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, medical payment coverage (auto, homeowners or otherwise), workers' compensation coverage, other insurance carriers or third party administrators. • Any person or entity against whom you may have any claim for professional and/or legal malpractice arising out of or connected to a Sickness or Injury you allege or could have alleged were the responsibility of any third party. • Any person or entity that is liable for payment to you on any equitable or legal liability theory. You agree as follows: • You will cooperate with us in protecting our legal and equitable rights to subrogation and reimbursement in a timely manner, including, but not limited to: Notifying us, in writing, of any potential legal claim(s) you may have against ...
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. 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.
2. Participants, by acceptance of such benefit payments, agree to furnish such information and assistance and execute such assignments and other instruments as the Employer may reasonably request to facilitate enforcement of the successor rights of the Employer. Participants shall take no action prejudicing such rights of the Employer.
3. An Employee who is required to appear and defend against a civil action involving this subrogation provision shall be compensated for time lost from his or her regular scheduled shift. The rate of pay shall be the Employee's "average hourly earnings" (as determined pursuant to Part II, Article IV).
Subrogation and Reimbursement. THIRD-PARTY LIABILITY
(a) Health and Dental Insurance Coverage
Subrogation and Reimbursement. If the Plan is self-insured, the following provisions regarding subrogation and third-party reimbursement will apply.
(a) If the Trust Fund pays, or is obligated to pay, any amount to or on behalf of an individual (“Benefit Recipient”), the Trust Fund shall be subrogated as provided in this Section 9.14 to all the Benefit Recipient’s rights of recovery with respect to the illness or injury for which the payment of benefits is made by the Trust Fund. The right of recovery referred to in the preceding sentence shall include the right to make a claim, xxx, and recover against any person or entity from the first dollars of any funds which are paid or payable as a result of a personal injury claim or any reimbursement of health care expenses. If requested in writing by the Board, the Benefit Recipient shall take, through any representative designated by the Board, such action as may be necessary or appropriate to recover such payment from any person or entity, said action to be taken in the name of the Benefit Recipient. In the event of a recovery or settlement, the Trust Fund shall be reimbursed in full on a first priority basis out of such recovery or settlement for expenses, costs, and attorneys’ fees incurred by it in connection therewith.
(b) If the Trust Fund pays, or is obligated to pay, any amount to or on behalf of a Benefit Recipient for an illness or injury, the Trust Fund shall be entitled to, and shall have a first priority equitable lien on, the proceeds of any recovery, by judgment, settlement or otherwise, with respect to the illness or injury, and if paid to the Benefit Recipient, the Benefit Recipient shall immediately pay any such proceeds to the Trust Fund. If the Benefit Recipient fails to pay such proceeds, or does not cause such proceeds to be paid, to the Trust Fund, the Board may, in addition to any other remedy to which it may be entitled, recover the proceeds directly or by offset against claims for benefits under the Plan and Trust made with respect to the affected Benefit Recipient (or such Benefit Recipient’s beneficiaries, heirs, attorneys, agents, representatives, or estate).
(c) The Trust Fund shall have the right of subrogation and reimbursement set forth in this Section 9.14 regardless of whether the Benefit Recipient is made whole and regardless of whether the recovery, or any part thereof, is designated as payment for health care expenses, pain and suffering, loss of income or any other specified or unspecified damages or re...
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. 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.
2. Participants, by acceptance of such benefit payments, agree to furnish such information and assistance and execute such assignments and other instruments as the Employer may reasonably request to facilitate enforcement of the successor rights of the Employer. Participants shall take no action prejudicing such rights of the Employer.
3. An Employee who is required to appear and defend against a civil action involving this subrogation provision shall be compensated for time lost from his or her regular scheduled shift. The rate of pay shall be the Employee's "average hourly earnings" (as determined pursuant to Part II, Article IV).
4. In the event a Participant recovers all or a portion of the cost of a service or a prescription drug covered by this Plan from a third party or first party insurer, the Employer shall have the right to reimbursement from the Participant for all sums which the Employer may pay or has paid under this Plan. In such event, the Employer shall be entitled to require from such Participant a reimbursement agreement (in a form to be provided by the Plan Administrator) to the extent of any payments so made. If such Participant fails to execute a reimbursement agreement as directed by the Plan Administrator or fails to reimburse the Plan, such Participant's benefits under this Plan shall terminate immediately upon such failure.
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.
Subrogation and Reimbursement. When an Employee's Injury or Sickness appears to be someone else's fault, benefits otherwise payable under this Plan for loss of time as a result of that Injury or Sickness will not be paid unless the Employee or his legal representative agree(s):
Subrogation and Reimbursement. These provisions apply when We pay benefits as a result of injuries or illness you sustained and you have a right to a Recovery or have received a Recovery.
