Subrogation and Right of Recovery Sample Clauses

Subrogation and Right of Recovery. If HMO provides health care benefits under this Certificate to a Member for injuries or illness for which another party is or may be responsible, then HMO retains the right to repayment of the full cost of all benefits provided by HMO on behalf of the Member that are associated with the injury or illness for which another party is or may be responsible. HMO’s rights of recovery apply to any recoveries made by or on behalf of the Member from the following sources, including but not limited to: payments made by a third-party tortfeasor or any insurance company on behalf of the third-party tortfeasor; any payments or awards under an uninsured or underinsured motorist coverage policy; any Workers’ Compensation or disability award or settlement; medical payments coverage under any automobile policy, premises or homeowners medical payments coverage or premises or homeowners insurance coverage; any other payments from a source intended to compensate a Member for injuries resulting from an accident or alleged negligence. The Member specifically acknowledges HMO’s right of subrogation. When HMO provides health care benefits for injuries or illnesses for which another party is or may be responsible, HMO shall be subrogated to the Member’s rights of recovery against any party to the extent of the full cost of all benefits provided by HMO. HMO may proceed against any party with or without the Member’s consent. The Member also specifically acknowledges HMO’s right of reimbursement. This right of reimbursement attaches when HMO has provided health care benefits for injuries or illness for which another party is or may be responsible and the Member and/or the Member’s representative has recovered any amounts from another party or any party making payments on the party’s behalf. By providing any benefit under this Certificate, HMO is granted an assignment of the proceeds of any settlement, judgment or other payment received by the Member to the extent of the full cost of all benefits provided by HMO. HMO’s right of reimbursement is cumulative with and not exclusive of HMO’s subrogation right and HMO may choose to exercise either or both rights of recovery. The Member and the Member’s representatives further agree to:
Sample 1Sample 2Sample 3See All (12)
AutoNDA by SimpleDocs
Subrogation and Right of Recovery. For purposes of subrogation and right of recovery, the Company will have the sole right to make claims under the Subrogation and Right of Recovery Provision contained in the Plan. In its sole discretion, the Company may litigate, negotiate, settle, compromise, release or waive any such claim. The Client hereby assigns to the Company all of its rights to make, litigate, negotiate, settle, compromise, release or waive any such claim. Claims subject to this subrogation and right of recovery section include, but are not limited to, recovery of covered expenses incurred by a covered person as the result of injuries or illness caused by a third party, recovery of covered expenses incurred by a covered person due to a work-related injury or sickness, and recovery of covered expenses through class action lawsuits. Recoveries under this Section will be distributed as follows: (1) first, 35.4% of the gross recovery to the Company, and/or its designated vendor for services related to obtaining the recovery; and (2) secondly, to the Company to be applied to reduce the Company’s payment of Individual Stop-Loss Benefits under the Stop Loss Policy or Stop-Loss Contract, if any, issued by the Company to the Client for the Member in respect of whom the recovery was obtained; and (3) thirdly, to the Company to be applied to reduce the Company’s payment of Aggregate Stop-loss Benefits under the Stop Loss Policy or Stop-Loss Contract, if any, issued by the Company to the Client; and (4) fourthly, the remainder, if any, to be credited as returned claim money for the Contract Year in which such claim payment was made under the Plan. Legal expenses will not be used when calculating the individual stop-loss benefits, or the aggregate stop- loss benefits, if any, pursuant to the Stop Loss Policy or Stop-Loss Contract issued by the Company to the Client.
Sample 1Sample 2See All (4)
Subrogation and Right of Recovery. For purposes of subrogation and right of recovery, the Company will have the sole right to make claims under the Subrogation and Right of Recovery Provision contained in the Plan. In its sole discretion, the Company may litigate, negotiate, settle, compromise, release or waive any such claim. The Plan Sponsor hereby assigns to the Company all of its rights to make, litigate, negotiate, settle, compromise, release or waive any such claim. Claims subject to this subrogation and right of recovery section include, but are not limited to, recovery of medical expenses incurred by a Member as the result of injuries or illness caused by a third party, recovery of medical expenses incurred by a Member due to work-related injury or sickness, and recovery of medical expenses through class action lawsuits. The Plan Sponsor will notify the Company immediately of any work-related accident suffered by a Member for which recovery may be available under any Workers' Compensation law or similar law. The Plan Sponsor also agrees to advise the Company of any potential subrogation rights or other contractual rights of recovery known to the Plan Sponsor. Legal expenses will not be used when calculating the aggregate stop-loss benefits, if any, according to the Stop Loss Policy issued by the Company to the Plan Sponsor.
Sample 1Sample 2Sample 3
Subrogation and Right of Recovery. For purposes of subrogation and right of recovery, the Company will have the sole right to make claims under the Subrogation and Right of Recovery Provision contained in the Plan. In its sole discretion, the Company may litigate, negotiate, settle, compromise, release or waive any such claim. The Plan Sponsor hereby assigns to the Company all of its rights to make, litigate, negotiate, settle, compromise, release or waive any such claim. Claims subject to this subrogation and right of recovery section include, but are not limited to, recovery of medical expenses incurred by a covered person as the result of injuries or illness caused by a third party, recovery of medical expenses incurred by a covered person due to work-related injury or sickness, and recovery of medical expenses through class action lawsuits. Legal expenses will not be used when calculating the individual stop-loss benefits or the aggregate stop-loss benefits, if any, pursuant to the Stop Loss Policy or Stop-Loss Agreement issued by the Company to the Plan Sponsor.
Sample 1Sample 2
Subrogation and Right of Recovery. The Subrogation and Right of Recovery Section contained in the Certificate does not apply to Virginia residents, unless they are Federal Government Employees. All other terms and conditions of the Certificate shall remain in full force and effect except as amended herein. HMO DC2 COC-AMEND-1 07-03 1 (Revised 08/29/03) The Covered Benefits section of the Certificate is hereby amended to include the following provision:
Sample 1Sample 2
Subrogation and Right of Recovery 
Sample 1Sample 2Sample 3See All (44)

Related to Subrogation and Right of Recovery

  • Right of Recovery KFHPWA has the right to recover excess payment whenever it has paid allowable expenses in excess of the maximum amount of payment necessary to satisfy the intent of this provision. KFHPWA may recover excess payment from any person to whom or for whom payment was made or any other issuers or plans. Questions about Coordination of Benefits? Contact the State Insurance Department.

  • Subrogation Rights Except where prohibited by Law, the Purchaser shall require its insurer (if any) to waive all rights of subrogation against Sandvik or Xxxxxxx’x insurers.

  • Subrogation In the event of payment under this Agreement, the Company shall be subrogated to the extent of such payment to all of the rights of recovery of Indemnitee, who shall execute all papers required and shall do everything that may be necessary to secure such rights, including the execution of such documents necessary to enable the Company effectively to bring suit to enforce such rights.

  • Subrogation and Subordination (a) Each Subsidiary Guarantor will not exercise any rights which it may have acquired by way of subrogation under this Subsidiary Guaranty Agreement, by any payment made hereunder or otherwise, or accept any payment on account of such subrogation rights, or any rights of reimbursement, contribution or indemnity or any rights or recourse to any security for the Notes or this Subsidiary Guaranty Agreement unless and until all of the Guaranteed Obligations shall have been indefeasibly paid in full in cash. (b) Each Subsidiary Guarantor hereby subordinates the payment of all Indebtedness and other obligations of the Company or any other guarantor of the Guaranteed Obligations owing to such Subsidiary Guarantor, whether now existing or hereafter arising, including, without limitation, all rights and claims described in clause (a) of this Section 5, to the indefeasible payment in full in cash of all of the Guaranteed Obligations. If the Required Holders so request, any such Indebtedness or other obligations shall be enforced and performance received by such Subsidiary Guarantor as trustee for the holders and the proceeds thereof shall be paid over to the holders promptly, in the form received (together with any necessary endorsements) to be applied to the Guaranteed Obligations, whether matured or unmatured, as may be directed by the Required Holders, but without reducing or affecting in any manner the liability of any Subsidiary Guarantor under this Subsidiary Guaranty Agreement. (c) If any amount or other payment is made to or accepted by any Subsidiary Guarantor in violation of any of the preceding clauses (a) and (b) of this Section 5, such amount shall be deemed to have been paid to such Subsidiary Guarantor for the benefit of, and held in trust for the benefit of, the holders and shall be paid over to the holders promptly, in the form received (together with any necessary endorsements) to be applied to the Guaranteed Obligations, whether matured or unmatured, as may be directed by the Required Holders, but without reducing or affecting in any manner the liability of such Subsidiary Guarantor under this Subsidiary Guaranty Agreement. (d) Each Subsidiary Guarantor acknowledges that it will receive direct and indirect benefits from the financing arrangements contemplated by the Note Agreement and that its agreements set forth in this Subsidiary Guaranty Agreement (including this Section 5) are knowingly made in contemplation of such benefits. (e) Each Subsidiary Guarantor hereby agrees that, to the extent that a Subsidiary Guarantor shall have paid an amount hereunder to any holder that is greater than the net value of the benefits received, directly or indirectly, by such paying Subsidiary Guarantor as a result of the issuance and sale of the Notes (such net value, its “Proportionate Share”), such paying Subsidiary Guarantor shall, subject to Section 5(a) and 5(b), be entitled to contribution from any Subsidiary Guarantor that has not paid its Proportionate Share of the Guaranteed Obligations. Any amount payable as a contribution under this Section 5(e) shall be determined as of the date on which the related payment is made by such Subsidiary Guarantor seeking contribution and each Subsidiary Guarantor acknowledges that the right to contribution hereunder shall constitute an asset of such Subsidiary Guarantor to which such contribution is owed. Notwithstanding the foregoing, the provisions of this Section 5(e) shall in no respect limit the obligations and liabilities of any Subsidiary Guarantor to the holders of the Notes hereunder or under the Notes, the Note Agreement or any other document, instrument or agreement executed in connection therewith, and each Subsidiary Guarantor shall remain jointly and severally liable for the full payment and performance of the Guaranteed Obligations.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!