Subrogation and Reimbursement. 1. In the event a Participant is legally entitled to recover all or a portion of the cost of a service or a prescription drug covered by this Plan from a third party, the Employer will, upon making payment under this Plan, succeed to any rights of recovery the Participant may have or acquire (with respect to such service or prescription drug) against any individual or organization except insurers of individual hospital, surgical or medical policies issued to the Participant.
Subrogation and Reimbursement. Subject to the limitations of Section 10.2(d), the Committee shall maintain, as part of each Plan, a comprehensive subrogation and reimbursement policy, updated from time to time as appropriate.
Subrogation and Reimbursement. These paragraphs apply when another party (including any insurer) is, or may be found to be, responsible for Your injury, illness or other condition and We have provided benefits related to that injury, illness or condition. As permitted by applicable state law, unless preempted by federal law, We may be subrogated to all rights of recovery against any such party (including Your own insurance carrier) for the benefits We have provided to you under this Policy. Subrogation means that We have the right, independently of you, to proceed directly against the other party to recover the benefits that We have provided. Subject to applicable state law, unless preempted by federal law, We may have a right of reimbursement if you or anyone on your behalf receives payment from any responsible party (including Your own insurance carrier) from any settlement, verdict or insurance proceeds, in connection with an injury, illness, or condition for which We provided benefits. Under Section 5-335 of the New York General Obligations Law, Our right of recovery does not apply when a settlement is reached between a plaintiff and defendant, unless a statutory right of reimbursement exists. The law also provides that, when entering into a settlement, it is presumed that You did not take any action against Our rights or violate any policy between You and us. The law presumes that the settlement between You and the responsible party does not include compensation for the cost of dental care services for which We provided benefits. We request that You notify Us within 30 days of the date when any notice is given to any party, including an insurance company or attorney, of Your intention to pursue or investigate a claim to recover damages or obtain compensation due to injury, illness or condition sustained by You for which we have provided benefits. You must provide all information requested by Us or Our representatives including, but not limited to, completing and submitting any applications or other forms or statements as We may reasonably request.
Subrogation and Reimbursement. If the Plan is self-insured, the following provisions regarding subrogation and third-party reimbursement will apply.
Subrogation and Reimbursement. THIRD-PARTY LIABILITY
Subrogation and Reimbursement. If we make Claims payment on your behalf for Injury or Illness for which another party is liable, or for which uninsured/underinsured motorist (UIM) or personal injury protection (PIP) insurance exists, we will be subrogated to any rights that you may have to recover compensation or damages from that liable party related to the Injury or Illness, and we would be entitled to be repaid for payments we made on your behalf out of any recovery that you obtain from that liable party after you have been fully compensated for your loss. The liable party is also known as the "third party" because it is a party other than you or us. This party includes a UIM carrier because it stands in the shoes of a third party tort feasor and because we exclude coverage for such benefits. Definitions The following terms have specific meanings in this contract: Subrogation means we may collect directly from third parties or from proceeds of your recovery from third parties to the extent we have paid on your behalf for Illnesses or Injury caused by the third party and you have been fully compensated for your loss. Reimbursement means that you are obligated under the contract to repay any monies advanced by us from amounts you have received on your claim after you have been fully compensated for your loss. Restitution means all equitable rights of recovery that we have to the monies advanced under your plan. Because we have paid for your Illness or Injury, we are entitled to recover those expenses from any responsible third‐party once you have been fully compensated for your loss. To the fullest extent permitted by law, we are entitled to the proceeds of any settlement or judgment that results in a recovery from a third party, up to the amount of payments we have made on your behalf after you have been fully compensated for your loss. Our right to recover exists regardless of whether it is based on subrogation, reimbursement or restitution. In recovering payments made on your behalf, we may at our election hire our own attorney to prosecute a subrogation claim for recovery of payments we have made on your behalf directly from third‐parties, or be represented by your attorney prosecuting a claim on your behalf. Our right to prosecute a subrogation claim against third‐parties is not contingent upon whether or not you pursue the party at fault for any recovery. If you recover from a third party and we share in the recovery, we will pay our share of the legal expenses. Our share i...
Subrogation and Reimbursement. Subrogation is the substitution of one person or entity in the place of another with reference to a lawful claim, demand or right. The Company shall be entitled to all rights of recovery for the reasonable value of services and Benefits provided by The Company to any Covered Person, from any third party or entity that either provides or is obligated to provide Benefits or payments to the Covered Person. The Covered Person agrees to execute and deliver such documents (including a written confirmation of assignment, and consents to release medical records), and provide such help as may be reasonably requested by The Company.
Subrogation and Reimbursement. To the extent the Insured, the Plan and/or the Trust, if any, becomes subrogated to or has a claim for restitution or reimbursement of Plan Benefits for which the Insured, the Plan and/or the Trust, if any, has obtained or seeks subrogation, restitution, or reimbursement, under this Contract, BCBSND shall be entitled to a pro rata share of any recovery by settlement, judgment, or otherwise based on the ratio of its payment under this Contract as it relates to the Plan Benefits. Any reasonable attorney fees or other reasonable legal costs incurred in the subrogation, restitution, or reimbursement recovery, if any, shall be charged to the total amount recovered prior to any pro rata apportionment between the Plan and BCBSND. Neither the Insured, the Plan nor the Trust, if any, shall be entitled to waive any portion of any subrogation, restitution, or reimbursement claim for which the Insured, the Plan and/or the Trust, if any, has obtained or seeks reimbursement under this Contract without the express written approval of BCBSND.
Subrogation and Reimbursement. We have the right to subrogation and reimbursement. References to “you” or “your” in this Subrogation and Reimbursement section shall include you, your Estate and your heirs and beneficiaries unless otherwise stated. Subrogation applies when we have paid Benefits on your behalf for a Sickness or Injury for which any third party is allegedly responsible. The right to subrogation means that we are substituted to and shall succeed to any and all legal claims that you may be entitled to pursue against any third party for the Benefits that we have paid that are related to the Sickness or Injury for which any third party is considered responsible. Subrogation Example: Suppose you are injured in a car accident that is not your fault, and you receive Benefits under the Policy to treat your injuries. Under subrogation, the Policy has the right to take legal action in your name against the driver who caused the accident and that driver's insurance carrier to recover the cost of those Benefits. The right to reimbursement means that if it is alleged that any third party caused or is responsible for a Sickness or Injury for which you receive a settlement, judgment, or other recovery from any third party, you must use those proceeds to fully return to us 100% of any Benefits you receive for that Sickness or Injury. The right of reimbursement shall apply to any benefits received at any time until the rights are extinguished, resolved or waived in writing. Reimbursement Example:
Subrogation and Reimbursement. The rights of the Plan as described in this Section 5.04 are, with respect to any particular coverage under the Plan, in addition to any rights described in the applicable Coverage Document, and shall apply to the extent not inconsistent with the terms of such Coverage Document. To the extent that benefits are provided for a Covered Person, the Plan is entitled to certain subrogation and reimbursement rights. The Covered Person must:
