Motor Vehicle Accidents/Subrogation
Documents Related to Motor Vehicle Accidents & Subrogation
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The Fund often pays Benefits to treat injuries or illnesses caused by third parties. In such situations, the members or dependents may obtain compensation from the third parties; for example, through a lawsuit or workers’ compensation claim. If so, the member or dependent must use part of the third party recovery to reimburse the Fund for some of the Benefits paid to treat the injury or illness.
The Fund’s right to compensation from third-party recoveries is called “Subrogation.” Every Plan in the Fund has a section on Subrogation that sets forth the rules that govern third-party recoveries. If you seek compensation for an injury or illness subject to the Fund’s Subrogation rights, you and your lawyer must comply with the Subrogation rules applicable to your Plan. The Plan’s subrogation rights come into play when a third party causes you to suffer an injury or illness and the Plan pays Benefits to you as a result of that accident or illness. In that event, to the fullest extent permitted by law, the Plan requires you to reimburse the Plan for those Benefits from any Recovery that arises from the accident or injury. Please refer to the Explanation of Subrogation Policy and Subrogation agreement.
Important: Cooperating with the Subrogation Program offers many advantages including the promise of fair treatment. Attempting to sidestep the Subrogation Program incurs significant risks for the members and their lawyers.
In accordance with Plan provisions, the Fund will only cover medical expenses on a subrogated basis once the maximum liability has been paid by the motor vehicle insurance carrier. In other words, the Fund will consider the payment of medical expenses only after Benefits from the automobile insurance carrier have been exhausted.
In addition, the Fund will not provide coverage for short-term disability Benefits (except for the first 5 days of missed work) for injuries sustained in a motor vehicle accident. The only time the Fund will pay more than 5 days of short-term disability Benefits is when written proof is submitted verifying that the state in which you reside does not allow you to purchase wage loss protection from your motor vehicle insurance carrier. The state of Pennsylvania allows residents to purchase wage loss protection. It is recommended that you contact your motor vehicle insurance carrier to evaluate the extent to which you are covered for wage loss Benefits resulting from a motor vehicle accident. Check with your motor vehicle insurance carrier to ensure that your policy carries at least the minimum coverage required by the state in which you reside.
Do not wait until you have an accident to find out you have no wage loss coverage under your policy. Payment for the first 5 days of short-term disability Benefits does not apply to motorcycle accidents. There are no short-term disability Benefits payable for injuries sustained as a result of a motorcycle accident.