RIGHT OF RECOVERY

This Plan does not cover any injury for which a third party may be liable or legally responsible, by reason of negligence, an intentional act or breach of any legal obligation on the part of that third party.

If any service is provided or medical claims paid in connection to any injury caused by a third party, and you or your eligible dependents receive reimbursement from or on behalf of a third party or from uninsured motorist coverage, the Plan is entitled to recover the full amount of benefits paid under the Plan for such services, up to the gross amount recovered by you or your eligible dependents. Upon settlement of the claim against the third party, insurance company or uninsured motorist coverage, you will pay or cause to be paid to the Plan all amounts to which it is entitled, in accordance with this paragraph. If you or your eligible dependents receive a settlement or judgment from a third party in an amount which is less than you anticipated, this in no way affects the Plan’s right to recover the full amount for claims paid on you or your eligible dependents behalf.

The Plan has a right to first reimbursement of any recovery from a third party or any uninsured motorist coverage, even if you or your eligible dependents are not otherwise made whole and without regard to how your recovery is categorized. An automatic lien will arise in favor of the Plan on all funds recovered from a third party insurer. This lien shall remain in effect until the Plan is reimbursed. The participant and/or eligible dependent are prohibited from commingling the recovered funds with other assets or alienating or spending the recovered funds until the Plan has been reimbursed for the benefits paid on his or her behalf. The assets recovered are owed to the Plan and you and/or your eligible dependents shall be obligated to pay them over to the Plan. The Plan shall be entitled to enforce this requirement by way of equitable restitution or constructive trust, or any other remedy permitted by law.

You or your eligible dependents must complete and sign an Agreement to Reimburse in such a form or forms as the Plan may require BEFORE any benefits are paid. If you or your eligible dependents refuse to sign an Agreement to Reimburse, or any other such agreement the Plan may require, you and/or your eligible dependents shall not be eligible for benefits under the Plan for medical claims related to this injury.

If the Plan pays benefits on you or your eligible dependents’ behalf and you and/or your eligible dependents recover any process from or on behalf of a third party or from uninsured motorist coverage, and you do not reimburse the Plan, you and your eligible dependents will be ineligible for future Plan benefit payments until the Plan has withheld an amount equal to the amount which has not been reimbursed.