Refund of Overpayments and Subrogation
Refund to The Plan of Overpayment of Benefits If Plan benefits are paid in error to any Plan participant or provider of service, the Plan reserves the right to have the overpayment refunded.
If any participant or provider of service does not promptly refund an overpayment to the Plan upon request, the Plan reserves the right to reduce any future benefit payments until the full amount of the overpayment is recovered.
Subrogation - Third Party Liability As a condition to receiving medical benefits under the Plan, participants agree to transfer to the Plan their rights to recover damages in full for such benefits when the injury or illness occurs through the act or omission of another person. The Plan participant agrees to execute or cause to be executed any and all documents required by the Plan, including a Subrogation Reimbursement Agreement, and to execute or cause to be executed any documents on behalf of minor dependents covered by the Plan. In the event the dependent is a minor, Chancery Court approval of such Subrogation Reimbursement Agreement must be obtained prior to the payment of any benefits.
Alternatively, if a Plan participant receives any recovery, by way of judgment, settlement, or otherwise, from another person or business entity, the Plan participant agrees to reimburse the Plan in full, in first priority, for any medical expenses paid by it (i.e., the Plan shall be first reimbursed fully to the extent of any and all benefits paid by it from any monies received, with the balance, if any, retained by the Plan participant).
The obligation to reimburse the Plan, in full, in first priority, exists regardless of whether the settlement or judgment specifically designates the recovery, or a portion thereof, as including medical expenses.
The Plan’s right of full recovery, either by way of subrogation or right of reimbursement, may be from funds the Plan participant or legal representative of the Plan participant receives or is entitled to receive from any third party or the insured’s own uninsured/underinsured or medical payment motorist insurance.
The Plan may enforce reimbursement or subrogation rights by requiring the Plan participant or legal representative of the Plan participant to assert a claim to any of the foregoing coverage to which he may be entitled.
The Plan will not contribute to any attorney fees or costs associated with the Plan participant’s recovery efforts.
In the event any hospital, medical, and related service or benefit is provided for, or any payment is made or credit is extended to a Plan participant for injuries or illnesses resulting from an act or