Common Contracts
1 similar Subrogation Agreement contracts
SUBROGATION AGREEMENT AND ASSIGNMENT OF BENEFITSSubrogation Agreement • May 6th, 2016
I, , acknowledge that I claim that the injuries sustained by me and/or my lawful dependent on(date) , were the result of the fault, negligence or carelessness of a third party or parties or a work-related injury arising under the jurisdiction of the California Department of Industrial Standards, Division of Workers’ Compensation or under the jurisdiction of any other comparable agency located in another state, and as a condition to having the San Diego Electrical Health & Welfare Trust (“Trust”) pay claims for eligible expenses caused by or arising from these injuries, I agree to be bound by all of the terms of this Subrogation Agreement:
