Miscellaneous Provisions
Assignability
Except as applicable law may otherwise require, no amount
payable at any time hereunder shall be subject in any manner
to alienation by anticipation, sale, transfer, assignment,
bankruptcy, pledge, attachment, charge or encumbrance of any
kind, and any attempt to alienate any amount, whether
presently or hereafter payable shall be void, provided that
benefits payable at any time may be used to make direct
payments to health care providers upon written authorization
of the participant. The Fund shall not be liable for or
subject to the debts or liabilities of any person entitled
to any amount payable through the Welfare Fund, or any part
thereof.
Filing Of Information
Each eligible participant, qualifying dependent or other
interested person shall file with the Welfare Fund such
pertinent information as requested, including proof or
continued proof of eligibility or dependency, and in such a
manner and form as the Fund may specify or provide. Failure
to file the requested information will result in the
suspension of entitlement to any benefits hereunder until
such time as said information is filed by the covered person
or on behalf of the covered person.
Misstatements
In the event of any misstatement of fact(s) affecting
coverage and/or benefits under the Welfare Fund, the true
facts will be used to determine the proper coverage and the
participant and qualifying dependent will be liable to repay
the Fund for any excess coverage or benefits provided on the
basis of the misstatement.
Overpayments
If a covered person has been paid benefits by the Welfare
Fund that either should not have been paid or are in excess
of the benefits that should have been paid, the Fund may
cause the deduction of the amount of such excess or improper
payment from any subsequent benefits payable to such covered
person or other present or future amounts payable to such
person, or recover such amount by any other legal method
that the Fund, in its sole discretion, shall determine. Each
covered person hereby authorizes the deduction of such
excess payment for such benefits or other present or future
compensation payments.
Payment To Other Than Participant
If it is determined that any person to whom benefits are
payable is unable to care for personal affairs; is a minor;
or has died, then any payment due the participant or his/her
estate may be paid to the duly appointed legal
representative, spouse, child, other relative or an
institution maintaining or having custody of such person
otherwise entitled to payment. In such a case, the Fund may,
at its discretion, hold any such payments until a legal
representative is appointed. Any such payment shall be a
complete discharge of the liabilities of the Fund Office.
Privacy Provision
The following constitutes the Welfare Fund’s general
policy regarding privacy:
1) Any information collected by the Welfare Fund will be
treated as confidential except for certain specific
disclosures. Those exceptions are as follows:
- Information required to administer benefit programs
or to process a claim for benefits.
- Information relative to duplicate coverage.
- Information to be disclosed to determine whether
medical services were reasonable and necessary.
- Information needed to comply with legal or
regulatory requirements.
2) Any information which is on file with the Welfare Fund
shall be available to the participant except as follows:
- If the information relates to civil or criminal
proceedings.
- If such is of a medical nature, the information may
be available only through the covered person’s
physician.
3) The participant may request that any personal
information be corrected, amended or deleted.
Right Of Information
For the purpose of determining the applicability of and
implementing the terms of these benefits, the Welfare Fund
may, without the consent of or notice to any person, release
or obtain any information necessary to determine
acceptability of any potential or current covered person who
benefits from the Fund’s coverage. In so acting, the Welfare
Fund shall be free from any liability that may arise with
regard to such action. Any covered person claiming benefits
shall furnish to the Welfare Fund information which may be
necessary to implement this provision.
Subrogation
Subrogation means the Plan’s right to pursue the covered
person’s claims for covered medical expenses that become the
responsibility of a third party or other insurer. This
subrogation right allows the Welfare Fund to pursue any
claim which the covered person has against any third party
or other insurer, whether or not the covered person chooses
to pursue that claim. The Fund may make a claim directly
against the third party or other insurer, but in any event,
the Fund has a lien on any amount recovered by the covered
person whether or not designated as payment for medical
expenses. The covered person automatically assigns to the
Fund any rights against any third party or other insurer
when this provision applies and must repay the benefits paid
on his or her behalf out of the recovery made from the third
party or other insurer. The Fund will have priority over any
funds paid by the third party or other insurer to a covered
person relative to the injury or illness, including a
priority over any claim for non-medical or dental charges,
attorney fees, or other costs and expenses. The Welfare
Fund’s subrogation and recovery rights, as well as the
rights assigned to it, are limited to the extent to which
the Fund has made, or will make, payments for covered
medical expenses as well as any costs and fees associated
with the enforcement of its rights. The covered person will
execute and deliver all required instruments and papers as
well as doing whatever else is needed to secure the Fund’s
right of subrogation as a condition to having the Welfare
Fund make payments. In addition, the covered person will do
nothing to prejudice the right of the Fund to subrogate
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