If the Welfare Fund pays benefits to or for you, your Dependent, your estate or your Dependent’s estate as a result of an accident, Injury, or Sickness for which any third party is or may be liable, the Fund has a right to be reimbursed from any settlement, judgment, insurance proceeds, no-fault automobile insurance payments, or other recovery for any and all benefits paid in connection with such Injury and Sickness up to the amount of recovery.
In addition, the Fund will have a first equitable lien and constructive trust upon any such recovery in the amount of all benefits paid up to the amount of your recovery, regardless of how the recovery is allocated or structured. You must hold any such recovery in constructive trust for the benefit of the Fund. The Fund’s right of reimbursement is from the first dollar you receive. The enforcement of this right does not require that you be made whole or otherwise receive your full claim from the third party, unless the Fund agrees in writing to a reduction of its claim.
You, your Dependent or estate must sign the Fund’s written Reimbursement Agreement Form acknowledging the Fund’s rights under this provision. The Fund may withhold benefits until such agreement is signed. If the Fund pays a claim in the absence of a Reimbursement Agreement, or pays a claim in error, that payment will not waive, compromise, diminish, release, or prejudice any right the Plan has to reimbursement or a lien.
You, your Dependent or estate must immediately inform the Fund in writing of any legal action or any recovery that arises subsequent to the payment of benefits by the Fund. You, your Dependent or estate must cooperate fully with the Fund in connection with the exercise of its rights under this provision and must do nothing to prejudice such rights.
The Common Fund Doctrine will not apply to any recovery, and the Fund will not pay fees or costs incurred in connection with any sum recovered unless the Fund has agreed in writing to pay a portion of those fees or costs. The amount recoverable by the Fund includes any and all amounts paid by the Plan in relation to your Sickness or Injury, all administrative fees and expenses related to the claim ( such as PPO access fees) and the Fund’s costs and reasonable attorneys’ fees (even for appeals) regardless of the amount of your actual recovery. The Plan’s reimbursement and lien rights apply, without regard to state law limitations on liens against workers’ compensation recoveries.
The Fund may, at its option, initiate legal action to secure and protect its rights under this provision.
In the event that reimbursement is not made as provided above, the Fund has the right to withhold any future benefits that you, your Dependent or estate may be entitled to receive until the Fund has been reimbursed. In the event that you, your Dependent or estate fails to timely inform the Fund of any recovery, the Fund will have a right of reimbursement from you, your Dependent or estate for any and all benefits paid and for costs of suit, including payment of reasonable attorney fees, regardless of the amount of the actual recovery. The Fund Office may also suspend your benefits after giving you a 30-day notice of suspension, if the Fund Office learns that you have received a recovery without making reimbursement to the Fund and if you are not engaged in good faith negotiations to settle the Fund’s right to reimbursement.