The Welfare Fund does not cover any claims for work-related Injuries or Sicknesses. However, if the Industrial Commission initially determines that your Injury or Illness did not arise in the course of your employment, and you comply with the reimbursement agreement provisions of the Plan, which are outlined in the section beginning in Reimbursement Policies and Procedures, the Plan may cover such claims, provided you do the following:
- You must promptly notify the Fund Office in the manner designated by the Fund Office that you have filed a workers’ compensation claim.
- The Fund Office must verify that the benefit claims have been denied or disputed and are not being paid by the workers’ compensation carrier pending resolution of the workers’ compensation proceeding, and that such benefits are provided under the Fund. You must promptly inform the Plan Administrator or its designee in writing of all material developments with respect to your workers’ compensation proceeding, and you must submit all benefit claims within six months of the decision in your workers’ compensation case.
- The Fund will conditionally pay the covered benefit claims/expenses not paid by workers’ compensation. The Plan will not pay Weekly Accident and Sickness Disability benefits for any period in which you are receiving workers’ compensation benefits.
- The Fund’s reimbursement provisions will control how the Plan provides coverage of any Plan benefits, rather than the terms of any workers’ compensation settlement. You may contact the Fund Office or review the Reimbursement Policies and Procedures.
- You must comply with all applicable reimbursement provisions outlined in the next section, including completion of the Fund’s Reimbursement Agreement.