UFCW LOCAL 1776 and PARTICIPATING EMPLOYERS                                   HEALTH and WELFARE FUND

 

Disability Benefits

Coordinating With Third Parties (Subrogation or Reimbursement) The Fund has the right of subrogation or full reimbursement for all costs and benefits paid or incurred, or which will be incurred in the future, when any claim for benefits is filed on your behalf of your dependent or beneficiary (hereinafter collectively "you") where the event(s) that caused the claim are or may be the fault of, or the claim may be payable by, any other party, including but not limited to Workers' Compensation, an insurance policy, another benefit plan, or any party that may be responsible for the event(s) related to the claim. in these cases, you must notify the Fund of the existence of any such party and/or the occurrence of any such event(s). You are also obligated to notify the Fund if you receive payment from any party. If you are involved in a lawsuit, insurance claim, other claim or a result of such events, you must notify the Fund of the name and address of any counsel you retain, insurance adjuster handling the claim, the progress of the case or claim, any settlement offers, trial dates, payments, etc. The Fund is entitled to 100% reimbursement of all costs and benefits, except as may be specifically agreed to by the Fund in writing, when you receive any payment from another party, if the Fund has paid or incurred, or will incur in the future, any such costs and/or benefits. The Fund's rights of subrogation and reimbursement shall apply and be honored regardless of whether the participant or beneficiary has been, or will be, made whole. So if you submit a claim and receive payment from another party for the same claim or as a result of the injury or illness, you must reimburse the Fund. You must provide the Fund with all documents and information, including but not limited to the name and address of any counsel you retain, insurance adjuster, or other persons, that may be related to the claim and the Fund's reimbursement right, as requested by the Fund. You may not attempt to prejudice the Fund's subrogation or reimbursement rights. If you do not honor the Fund's subrogation or reimbursement rights, the Fund may bring an action against you to recover the costs and benefits paid, and/or you may be denied future benefits to the extent necessary to recover the costs and benefits paid by the Fund. If the Fund denies your future benefits in order to recover the costs and benefits paid by the Fund, your benefits will remain denied until such time as you have provided the Fund with information and documents on denied claims sufficient to fully satisfy your reimbursement obligations to the Fund. If legal action against you is necessary to protect the Fund's rights, you will also be liable for all costs of collection, including reasonable attorneys' fees. All disputes concerning reimbursement rights and obligations will be resolved in accordance with the claims review and appeal procedures. In addition, the Fund reserves the right to intervene in any action or to bring an action to protect its reimbursement rights. Special State Regulations Different states have different rules about disability coverage if you are injured in an automobile accident. Check below for your state's special regulations. Pennsylvania - If you live in Pennsylvania and are involved in a motor vehicle accident, you must file all disability claims with your motor vehicle insurance carrier, including all medical expenses and prescription costs. The Fund will supplement your disability and medical payments up to the maximums allowed under the Plan. Delaware - If you live in Delaware and are in a motor vehicle accident, you must file your disability claims and medical and prescription expenses with your motor vehicle insurance carrier. The Fund will not make any payments in this case. New Jersey - New Jersey residents must file all disability claims and medical and prescription expenses with their motor vehicle insurance carriers if they are involved in a motor vehicle accident. The Fund will not make any payments for medical expenses. However, the Fund will pay Weekly Accident and Sickness Benefits.