October 19, 2000
Health and Welfare Fund
6281 Youngstown-Warren Rd., Suite 240
Niles, Ohio 44446
Phone 330-652-3475
FAX 330-652-3513
Toll Free 1-800-362-9354
Ochw@aol.com
To All Participants:
Attached is the revised subrogation language approved by the Board of Trustees at the June 1, 2000 Board of Trustees Meeting. This notice replaces page 40 in your Summary Plan Description. If you have any questions do not hesitate to call the Fund Office.
Sincerely,
The Board of Trustees
REVISED SUBROGATION LANGUAGE
The Ohio Carpenters Health and Welfare Fund will take advantage of its right to subrogation if you or your dependent is paid benefits by the Plan due to any injury or illness which arises out of the acts or omissions of any person or entity or which arise under any no-fault coverage (for the purpose of this provision, collectively referred to as "Other Coverage").
The term Covered Person as used hereinafter shall include the employee, participant, or any eligible dependent as defined elsewhere in the Plan.
Subrogation:
In the event of any payment under the Plan, the Plan shall, to the extent of such payment, be subrogated to all the rights of recovery of a Covered Person which arise out of the acts or omissions of any person or entity or which arise under any no-fault coverage or any uninsured or underinsured coverage (for the purpose of this provision, collectively referred to as "Other Coverage").
The Plan is subrogated to all rights of recovery of a Covered Person regardless of whether the Covered Person obtains a full or partial recovery from such person, entity or Other Coverage. The Plan's subrogation interest shall take priority over any and all rights of recovery held by a Covered Person against such person, entity, or Other Coverage arising out of the event which triggered the Plan's payment of Medical Benefits. The Plan's subrogation interest shall apply regardless of whether the Covered Person has been or will be made whole and regardless of whether the Covered Person has incurred fees or will be made whole and regardless of whether the Covered Person has incurred fees or costs in order to obtain a recovery from any person, entity, or Other Coverage. The "make-whole" rule shall not apply.
In the event the Plan has a subrogated interest or right of recovery, no Covered Person shall release any party, person, corporation, entity, insurance company, insurance policies, or funds that may be liable or obligated to the Covered Person for the acts or omissions of any person or entity without the written approval of the Plan.
In the event a Covered Person pursues a claim against any person, entity, or Other Coverage, the Covered Person agrees to include the Plan's subrogated interest and rights of recovery in that claim, and if there is a failure to do so, the Plan shall be legally presumed to be included in such claim. In the event a Covered Person does not pursue a claim against any person, entity, or Other Coverage, the Plan shall have the right to pursue, sue, compromise, or settle any such claims in the Covered Person's name and to execute any and all documents necessary to pursue said claim in the Covered Person's name.
Reimbursement:
Each Covered Person hereby agrees to reimburse the Plan, for any Medical Benefits paid by the Plan, out of any money recovered from any person, entity, or Other Coverage as the result of 'judgment, settlement, or otherwise, regardless of how the money is classified.
The Plan has the right to be reimbursed in an amount equal to the amount of Medical Benefits paid hereunder, regardless of whether the Covered Person obtains a full or partial recovery from such person, entity or Other Coverage. The Plan shall be reimbursed on a first priority basis, regardless of whether or not the Covered Person has been or will be made whole and regardless of whether the Covered Person has incurred fees or costs in order to obtain a recovery from any person, entity, or Other Coverage. The "make-whole" rule shall not apply.
In the event a Covered Person settles, recovers, or is reimbursed by any person, entity, or Other Coverage, the Covered Person shall hold any such money in trust for the benefit of the Plan. If a Covered Person fails to reimburse the Plan in accordance with this provision, the Covered Person shall be liable to the Plan for any and all expenses (whether fees or costs) associated with the Plan's attempt to recover such money from the Covered Person, Each Covered Person also agrees to execute and deliver all necessary instruments, to furnish such information and assistance, and to take any action the Plan Administrator may require to facilitate enforcement of its rights under this Plan.
The Plan will not pay or be responsible for, without the written consent of the Plan Administrator, any fees or costs associated with a Covered Person pursuing a claim against a third party or any other coverage. The Plan's subrogation interest and the Plan's reimbursement interest shall not be subject to offset for any fees or costs associated with a Covered Person pursuing a claim against a third party or any Other Coverage.
For purposes of this provision, the term "Covered Person" includes anyone acting for, or on behalf of, a Covered Person when the Covered Person is referred to as taking an action.
You must not do anything to impair or negate Fund's Right to Subrogation; and if any of your acts or omissions to act compromise this Fund's Right to Subrogation, this Plan will seek reimbursement of all appropriate benefits paid directly to you and/or your Dependents.
If you recover lost wages benefits from another source, e.g. from an individual who caused the injury which resulted in your receiving time loss weekly benefits, the Fund has a right to seek repayment from you of any lost weekly benefits which, in addition to the lost wages benefits recovered from the other source, exceed your weekly income prior to the disability.
The Fund will provide benefits at the onset of the disability, but you will be asked to execute and deliver such documents or take other action as is necessary to assure the Fund's rights should your lost wages claim prove successful.
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