Intentionally False or Misleading Statements. If this plan’s benefits are paid in error due to a Member's or Provider's commission of fraud or providing any intentionally false or misleading statements, CHPW shall be entitled to recover those amounts. Please see the Right of Recovery provision later in this section. And, if a Member commits fraud or makes any intentionally false or misleading statements on any application or enrollment form that affects the Member's acceptability for coverage, CHPW may, at its option: • Deny the Member's Claim; • Reduce the amount of benefits provided for the Member's Claim; or • Void the Member's coverage under this plan (void means to cancel coverage back to its Effective Date, as if it had never existed at all). Finally, statements that are fraudulent, intentionally false or misleading on any form required by CHPW or the Washington State Health Benefits Exchange, and which affect the acceptability of a Member or the risks to be assumed by us, may cause this Agreement to be voided.
Intentionally False or Misleading Statements. If this plan's benefits are paid in error due to a member's or provider's commission of fraud or providing any intentionally false or misleading statements, we'll be entitled to recover these amounts. See Right of Recovery later in this section. And, if a member commits fraud or makes any intentionally false or misleading statements on any application or enrollment form that affects the member's acceptability for coverage, we may, at our option: • Deny the member's claim. • Reduce the amount of benefits provided for the member's claim. • Void the member's coverage under this plan (void means to cancel coverage back to its effective date, as if it had never existed at all). Finally, statements that are fraudulent, intentionally false or misleading on any form required by us, that affect the acceptability of the Member or the risks to be assumed by us, may cause the contract for this plan to be voided. Note: We cannot void your coverage based on a misrepresentation you made unless you have performed an act or practice that constitutes fraud; or made an intentional misrepresentation of material fact that affects your acceptability for coverage. Limitations of Liability We are not legally responsible for any of the following: • Epidemics, disasters, or other situations that prevent members from getting the care they need. • The quality of services or supplies that members get from providers, or the amounts charged by providers. • Providing any type of hospital, medical, dental, vision, or similar care. • Xxxx that comes to a member while in a provider's care. • Amounts in excess of the actual cost of services and supplies. • Amounts in excess of this plan's maximums. This includes recovery under any claim of breach. • General or special damages including, without limitation, alleged pain, suffering, mental anguish or consequential damages. Member Cooperation You're under a duty to cooperate with us in a timely and appropriate manner in our administration of benefits. You're also under a duty to cooperate with us in the event of a lawsuit. Nonwaiver No delay or failure when exercising or enforcing any right under this contract shall constitute a waiver or relinquishment of that right and no waiver or any default under this contract shall constitute or operate as a waiver of any subsequent default. No waiver of any provision of this contract shall be deemed to have been made unless and until such waiver has been reduced to writing and signed by the party waiving...
