E. SUBROGATION AND REIMBURSEMENT OF BENEFITS ADVANCED FOR WHICH A THIRD PARTY IS RESPONSIBLE

1. Agreement by Acceptance of Benefits. By accepting benefits from the Plan for any condition for which a third party may be legally responsible, you agree that:
   
   1. the Plan is automatically assigned your right to sue the third party to the extent it is responsible for those benefits;
   
   
   2. the Plan may intervene at any time in any lawsuit (or other proceeding) you bring against the third party in connection with the event that contributed to your condition;
   
   
   3. you will reimburse the Plan from any amounts you recover from the third party relating to your condition to the extent of your benefits; and
   
   
   4. the Plan has an automatic lien upon any amounts you recover from the third party to the extent of your benefits.
   
   
   This subsection generally applies to any no-fault insurance recovery (such as workers’ compensation), and any proceeding brought against a third party for its negligent acts or omissions.
2. Conditions to Receipt of Benefits. As a condition to your receipt of Plan benefits and to any further eligibility under the Plan, you agree to:
   
   1. notify the Plan within 30 days of commencing any lawsuit (or other proceeding) against a third party for damages or other remedy on account of a condition for which Plan benefits may be paid, including the important facts and background of the lawsuit;
   2. furnish any information or assistance and execute any documents that the Plan may reasonably require to enforce its rights under this subsection; and
   3. take no action that may prejudice or interfere with the Plan's rights under this subsection.
   
   
3. Subrogation. Subrogation is the right of the Plan to step in the shoes of a Covered Person to pursue directly an action against a third party who may have injured that Covered Person (such as in an automobile accident) for recovery of medical benefits paid by the Plan.
   
   To the extent the Plan pays any benefits on your behalf, it is subrogated to all related recovery rights you may have against any third party or under any no-fault insurance coverage, regardless of whether you obtain a full or partial recovery from the third party and without offset for any costs you may incur pursuing a claim against the third party. The Plan’s subrogation right (i) takes priority over any right of recovery you hold against the third party arising out of the event that caused the Plan to pay your benefits, (ii) is for the full amount of your benefits paid by the Plan and (iii) applies whether or not you receive (or are entitled to receive) a full or only a partial recovery from the third party. You may not release any third party from its responsibility for any Plan benefits provided to you without the written approval of the Plan. If you pursue a claim against any third party, you agree to include any subrogated interest of the Plan in that claim. If you do not, the Plan is presumed to be included in that claim. If you do not pursue a claim against a third party in which the Plan has a subrogation right, the Plan may independently pursue or settle the claim.
4. Reimbursement. Reimbursement is the Plan’s right to pursue an action against a Covered Person who has already recovered on claim for health benefits against the third party.
   
   To the extent you recover from a third party on a claim that resulted in a payment of Plan benefits for which the third party is responsible, you will use the recovery to reimburse the Plan up to the amount of the medical benefits paid by the Plan. This Plan reimbursement right applies (i) first priority, (ii) without offset for any costs you incur to obtain the recovery, (iii) whether or not you received a full or partial recovery and (iv) whether or not you have been “made whole” by reason of the recovery. If you are paid any money or property by a third party as a recovery for a claim described in this subsection, you agree to hold any such amounts in trust for the Plan’s benefit. If you do not reimburse the Plan as required in this subsection, you will be personally liable for all costs associated with the Plan’s attempt to recover from you. You also agree to assist the Plan fully (including the timely execution of appropriate documents) to allow the Plan to enforce its reimbursement rights. Unless expressly agreed otherwise, the Plan is not responsible for any fees or costs you may incur should you pursue a claim against a third party. The Plan’s reimbursement rights hereunder are not subject to offset for any costs you incur pursuing a claim against the third party.
   
5. Other Matters


1. You Must Provide Claim Information. When you submit a claim to the Plan, you must complete appropriate forms, including a form requesting:




1. how the injury or illness occurred;


2. the identity of any potentially responsible third parties, including their insurer, adjusters and claim numbers;


3. any accident report; and


4. an assignment of your interest in any third party recovery relating to your claim to the extent the Plan has a subrogated interest.


2. Recovery by Plan. The Plan may offset any future benefit payments to you in the amount of any outstanding lien. If the Plan pays your benefits and, for whatever reason, benefits were not covered under the Plan, the Plan may recover those payments in any lawful manner, including offsetting any future benefit payments to either you or your Dependents.


3. Make Whole Doctrine. The Plan does not apply the “make whole” doctrine applied by some state courts, and that might otherwise require that you be “made whole” before the Plan may benefit from its subrogation or reimbursement rights.