If a participant or an eligible dependent incurs any medical expenses or lost time expense
resulting from injury or illness for which he may have any right of recovery against a third party
(such as in workers compensation, slip and fall, or product liability cases), then any benefits paid by the Fund
for such expenses shall be made on the express and automatic condition that the Fund shall be reimbursed
therefor by such participant or eligible dependent if there is any recovery against such third party.
Accordingly, in order to protect the Fund's interest, the Fund has the right to elect to be
subrogated (
that is, the right to stand in the place of the participant or eligible dependent) to all rights of recovery of such
participant or eligible dependent against such third party to the extent of the full amount of any benefits
paid by the Fund with respect to such expense. Alternatively, the Fund has the
right to elect
instead to proceed with
a cause of action for reimbursement. The Fund's right to subrogation or reimbursement
shall not be subject to any reduction for attorneys' fees or cost greater than
20%, except as may be specifically agreed to by the Fund
in writing. The Fund's rights to subrogation or reimbursement shall arise automatically once the Fund pays
any benefits for the underlying injury or illness for which a right of recovery against a third party may exist.
However, to further protect its rights to subrogation or reimbursement, the Fund may require a participant
or eligible dependent to do one or more of the following:
 To agree in writing to assign to the Fund any right of recovery it may have against a third party for the injury
or illness to the extent of benefits provided; and to agreed that any benefit payments for the injury or
illness are conditioned on such assignment.
To agree in writing to
assign to the Fund any amounts recovered from a third party to the injury or illness,
by way of settlement, judgment or otherwise, to the extent of benefits provided; and to agree that any benefit
payments for the injury or illness are conditioned on such assignment.
To otherwise assist the fund in protecting its rights to subrogation or reimbursement by, among other things, agreeing
not to settle or otherwise compromise a right of recovery against a third party without the prior written consent of
the Fund; and authorizing the Fund to negotiate such third party on behalf of the participant or eligible dependent,
and to settle or otherwise compromise such suit, to the extent of benefits provided.
In addition, to further protect its rights to subrogation or reimbursement, the Fund may take one or more
of the following actions:
To
deny benefits to a participant or eligible dependent who does nor assist the Fund in protecting its rights to
subrogation or reimbursement. In this regard, the Fund may deny benefits for the injury or illness for which a right
of recovery against a third party may exist, or it may deny benefits for other injuries or illnesses of the
participant and eligible dependent(s) to the extent necessary to offset benefits paid for such injury or illness.
To sue a participant or eligible
dependent who does not assist the Fund in protecting its rights to subrogation or reimbursement, to the extent of
benefits paid for underlying injury or illness and the cost of such suit (including attorney's fees).
In the event of a settlement or compromise of a right of recovery against a third party, to deny the payment of any future
benefits for the underlying injury or illness until such time as the participant or eligible dependent has exhausted all
proceeds from such settlement or compromise.
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