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.