Third Party Coverage. In the event than an employee is absent from duty because of illness or injury in respect of which wage loss benefits may be payable to the employee by the Insurance Corporation of British Columbia (ICBC), the liability of the Employer to pay sick pay shall rank after the ICBC. Notwithstanding such liability, the Employer shall pay the employee such sick leave pay as would otherwise be payable under this agreement. The employee shall not be obliged to take action against the ICBC, but the Employer shall be entitled to subrogate to the rights of the employee and to take whatever action may be appropriate against the ICBC at any time after six months following the illness or injury, unless the employee first elects to take action on their own behalf. To the extent that the employee recovers monies as compensation for wages lost, the Employer shall be reimbursed any sick leave pay that it may have paid to the employee. Where the Employer recovers monies from the ICBC, the employee's sick leave credits shall be proportionately reinstated.
Third Party Coverage.
(a) In the event that an employee is absent from duty because of illness or injury in respect of which wage loss benefits may be payable to the employee by the Insurance Corporation of British Columbia (ICBC), the liability of the Employer to pay sick pay shall rank after the ICBC. Notwithstanding such liability, the Employer shall pay the employee such sick leave pay as would otherwise be payable under this agreement. The employee shall not be obliged to take action against the ICBC, but the Employer shall be entitled to subrogate to the rights of the employee and to take whatever action may be appropriate against the ICBC at any time after six months following the illness or injury, unless the employee first elects to take action on his/her own behalf. To the extent that the employee recovers monies as compensation for wages lost, the Employer shall be reimbursed any sick leave pay that it may have paid to the employee.
(b) Where the Employer recovers monies from the ICBC, the employee's sick leave credits shall be proportionately reinstated.
Third Party Coverage. 5.5 Withholds.....................................................
Third Party Coverage.
4.1 Medicare Enrollment At all times during which Resident is eligible, Resident shall be and remain enrolled in Medicare Parts A and B or a hospitalization and medical insurance program with benefits at least equal to those provided by Medicare. Resident or Responsible Party will provide XX Xxxxx with a certificate of insurance or other proof reflecting the coverage.
Third Party Coverage. The DEPARTMENT is the payer of last resort when third party resources are . available to cover the costs of medical services provided to Medicaid recipients. Pursuant to this requirement, the MCO is required to comply with federal and state statutes and regulations regarding third party liability. The MCO shall be responsible for making every reasonable effort to determine the legal liability of third parties to pay for services rendered to Members under this contract. The MCO shall be responsible for identifying appropriate third party resources, and if questions arise they shall consult with the DEPARTMENT. The MCO shall pursue, collect, and retain any monies from third party payers for services to the MCO's Members under this contract, subject to the following terms and conditions:
a. The DEPARTMENT hereby assigns to the MCO all rights to third party recoveries from Medicare, health insurance, casualty insurance, workers' compensation, tortfeasors, or any other third parties who may be responsible for payment of medical costs for the MCO's Members. The MCO may assign the right of recovery to their subcontractors and/or network providers. Notwithstanding any such assignment of the right of recovery, the MCO remains responsible for the effective and diligent performance of third party recovery.
1. Other Insurance, Cost Avoidance and Third Party Resources The MCO will have primary responsibility for cost avoidance through the coordination of benefits relative to federal and private health insurance resources including, but not limited to Medicare, individual health insurance, employment-related group health insurance and self administered or self funded health benefit plan, including ERISA (Employee Retirement and Income Security Act) plans. The MCO shall avoid initial payments of claims, as permitted by federal law, where federal or private health insurance resources are available. When cost avoidance is not possible, the MCO may utilize post payment recovery. If a third party insurer requires the Member to pay any co-payment, coinsurance or deductible, the MCO is responsible for making any such payments to the extent that the third party insurer's co-payment exceeds the co-payment applicable under this contract. The MCO or its assignee must initiate third party recoveries within sixty (60) days after the end of the month in which the MCO learns of the existence of the liable third party. The MCO or its assignees must maintain dated documentation of all c...
Third Party Coverage. (i) If and to the extent that an Occurrence for which coverage is available under the Duke Liability Insurance Policies, in whole or in part, happens prior to the Closing, and a claim arising therefrom has been or is eventually asserted against Crescent or any Crescent Subsidiary and such claim is Reported on or before the date which is one hundred eighty (180) days after the Effective Date with respect to any of the Duke Liability Insurance Policies, then Duke Ventures shall cause an insurance carrier selected by Duke Ventures (or, at Duke Ventures’ option, Duke Parent or any Non-Crescent Affiliate) to Administer the Third Party Insurance Claim arising therefrom. Except as specifically provided in this Section 6.6(b)(i), no Duke Liability Insurance Policy shall be available for payment of any damages, costs of defense, or other sums with respect to any other Occurrence, and Crescent agrees and covenants (on behalf of itself, Crescent and each Crescent Subsidiary) not to make any claim or assert any rights against Duke Ventures, any Non-Crescent Affiliate, or any Duke Liability Insurance Policy with respect to any such Occurrence.
(ii) Duke Ventures shall maintain, or caused to be maintained, coverage for Third Party Insurance Claims under the Duke Liability Insurance Policies during the one-hundred eighty (180) day period described in Section 6.6(b)(i) above. For the avoidance of doubt, the terms of this Section 6.6(b) shall not limit the coverage under the Duke Occurrence-Based Insurance Policies as provided in Section 6.6(d).
Third Party Coverage. Third party insurers have the primary responsibility for health restoration and provide the majority of funding for rehabilitation services. This includes, but is not limited to, services and programs provided by: As secondary payer, SaskPower may provide funding in the following areas: Hierarchy for Return to Work: SaskPower will use the following hierarchy for return to work: Whenever possible the employee will be returned to work using the following order: There are number of people involved in SaskPower's return to work process with the following roles: Employer: The employer is responsible for creating a safe work environment for all employees. To do so the employer has the following responsibilities:
Third Party Coverage. The amount of any Damages for which indemnification is provided under this Agreement will be net of any amounts actually recovered by the Indemnified Party from any third Person (including, without limitation, amounts actually recovered under insurance policies) with respect to such Damages. Any Indemnifying Party hereunder will be subrogated to the rights of the Indemnified Party upon payment in full of the amount of the relevant indemnifiable Damages. An insurer who would otherwise be obligated to pay any claim will not be relieved of the responsibility with respect thereto or, solely by virtue of the indemnification provision hereof, have any subrogation rights with respect thereto. If any Indemnified Party recovers an amount from a third Person in respect of Damages for which indemnification is provided in this Agreement after the full amount of such indemnifiable Damages has been paid by an Indemnifying Party or after an Indemnifying Party has made a partial payment of such indemnifiable Damages and the amount received from the third Person exceeds the remaining unpaid balance of such indemnifiable Damages, then the Indemnified Party will promptly remit to the Indemnifying Party the excess (if any) of (X) the sum of the amount theretofore paid by such Indemnifying Party in respect of such indemnifiable Damages plus the amount received from the third Person in respect thereof, less (Y) the full amount of such indemnifiable Damages.
Third Party Coverage. The Facility understands that the Resident may be eligible for insurance coverage of all or a portion of the Facility’s charges pursuant to the terms of a third-party payor’s health benefit plan or program (“third party payor” or “plan”). Although the Facility has relied on insurance verification of eligibility and coverage, verification of coverage does not guarantee all coverage. Some plans review and deny coverage after the services are provided and continued coverage may be subject to specific additional pre-authorization requirements, to modifications by the plan, and by its determination that recommended services are “medically necessary” as well as covered. The Facility is not responsible for benefit denials, limitations, or terminations by third party payers. The Facility will, however, make best efforts to (1) present information to support the medical necessity of treatment recommended by the Resident’s care team; and (2) notify the Resident and/or the Resident Representative/Sponsor as soon as it is informed by the third-party payor that coverage will cease or decrease. Financial liability for all non-covered care becomes the responsibility of the Resident. The Resident and Resident Representative/Sponsor agree, in a timely manner, to pursue all applicable appeals, fair hearings, or other remedies available as a result of or following a denial or termination of applicable coverage.
Third Party Coverage. The Facility understands that you may be eligible for insurance coverage of all or a portion of the Facility’s charges pursuant to the terms of a third-party payer’s health benefit plan or program (“third party payer” or “plan”). Although the Facility has relied on insurance verification of eligibility and coverage, verification of coverage does not guarantee all coverage. Some plans review and deny coverage after the services are provided and continued coverage may be subject to specific additional pre-authorization requirements, to modifications by the plan, and by its determination that recommended services are “medically necessary” as well as covered. The Facility is not responsible for benefit denials, limitations, or terminations by third party payers. The Facility will, however, make best efforts to (1) present information to support the medical necessity of treatment recommended by your care team; and (2) notify you and/or your Resident Representative as soon as it is informed by the third party payer that coverage will cease or decrease. Financial liability for all non-covered care becomes the responsibility of the resident.
