Teamsters Local 805 Welfare Fund

SUMMARY PLAN DESCRIPTION -

REPAYMENT OF MEDICAL BENEFITS (SUBROGATION)

Benefits payable by the Fund for the treatment of an illness or injury shall be limited in the following ways when the illness or injury is the result of an act or omission of another (including a legal entity) and when the Participant or Eligible Dependent pursues or has the right to pursue a recovery for such act or omission.

The Fund shall pay benefits for covered expenses related to such illness and injury only to the extent not paid by the third party and only after the Participant or Eligible Dependent (and his or her attorneys, if applicable) has entered into a written subrogation and reimbursement agreement with the Fund. In addition, as set forth more fully below, to the extent of such recovery, the Participant and/or Eligible Dependent (and any agents and representatives) agree to act as a constructive trustee and the Plan maintains an equitable lien by agreement in such amounts.

By accepting benefits related to such illness or injury, the Participant and/or Eligible Dependent (collectively “you”) agree:

• that the Fund has established an equitable lien on any recovery received by you (or your dependent, legal representative or agent);
• to notify any third party responsible for your illness or injury of the Plan’s right to reimbursement for any claims related to your illness or injury;
• to hold any reimbursement or recovery received by you (or your dependent, legal representative or agent) in trust on behalf of the Fund to cover all benefits paid by the Fund with respect to such illness or injury, and to reimburse the Fund promptly for the benefits paid, even if you are not fully compensated (“made whole”) for your loss;
• that the Fund has the right of first reimbursement against any recovery or other proceeds of any claim against the other person (whether or not the participant or dependent is made whole) and that the Fund’s claim has first priority over all other claims and rights;
• to reimburse the Fund in full up to the total amount of all benefits paid by the Fund in connection with the illness or injury from any recovery received from a third party, regardless of whether the recovery is specifically identified as a reimbursement of medical expenses. All recoveries from a third party, whether by lawsuit, settlement, insurance or otherwise, must be turned over to the Fund (and prior to turnover to hold in constructive trust) as reimbursement up to the full amount of the benefits paid;
• that the Fund’s claim is not subject to reduction for attorney’s fees or costs under the “common fund” doctrine or otherwise;
• that, in the event that you elect not to pursue your claim(s) against a third party, the Fund shall be equitably subrogated to your right of recovery and may pursue your claims;
  to assign, upon the Fund’s request, any right or cause of action you may have to the Fund;
  not to take or omit to take any action to prejudice the Fund's ability to recover the benefits paid and to cooperate with the Fund in doing what is reasonably necessary, in the sole discretion of the Fund, to assist the Fund in obtaining reimbursement;
• to cooperate in doing what is necessary, in the sole discretion of the Fund, to assist the Fund in recovering the benefits paid or in pursuing any recovery;
• to forward any recovery to the Fund or to notify the Fund as to why you are unable to do so within ten days of disbursement by the third party; and
• to the entry of judgment against you and, if applicable, your dependent, in any court for the amount of benefits paid on your behalf with respect to the illness or injury to the extent of any recovery or proceeds that were not turned over as required and for the Fund’s cost of collection, including but not limited to the Fund’s attorneys’ fees and costs.

No benefits will be payable for charges and expenses which are excluded from coverage under any other provision of the Plans. The Fund may enforce its right to reimbursement by filing a lawsuit, recouping the amount owed from a Participant's or an Eligible Dependent's future benefit payments (regardless of whether benefits have been assigned by a participant or Eligible Dependent to a doctor, hospital or other provider), or any other remedy available to the Fund.

By accepting benefits (whether the payment of such benefits is made to you, your covered dependent or on your or your covered dependent's behalf to any provider) from the Fund, you and your covered dependents agree that a court proceeding with respect to these provisions may be brought in such court of competent jurisdiction as the Fund may elect. By accepting such benefits, you and your covered dependents (and your or your covered dependent's representatives, agents, assigns, guardians estates, heirs or beneficiaries) hereby submit to each such jurisdiction, waiving whatever rights may correspond to you or your covered dependents (or your or your covered dependent's representative, agent, assign, guardian, estate, heir or beneficiary) by reason of your or your covered dependents' (or their) present or future domicile.

The Fund may need additional facts or information to properly apply the coordination of benefits, subrogation or right of recovery provisions. By filing a claim for benefits under the Fund, you and your covered dependents authorize the Fund to obtain, and the other plan(s) and your or your covered dependent's representative, agent, assign, guardian, estate, heir or beneficiary to release, such information as the Fund deems necessary for the enforcement or administration of the Fund's coordination of benefits, subrogation or right of recovery provisions.

The Fund may permit you to turn over less than the full amount of benefits paid and recovered as it determines in its sole discretion. Any reduction of the Fund’s claim is subject to prior written approval by the Fund.