Payment of Benefits for Compensated Injuries

For the purposes of this provision, "compensated incident" shall mean any occurrence taking place at any time or over a period of time from which any settlement, award or recovery is or was granted to an eligible individual. It includes a single act, or a number of acts occurring over a period of time which result in injury to the eligible individual (such as, but not limited to, continued exposure to a harmful agent, prolonged misdiagnosis of a condition, etc.).

Notwithstanding any provision of the Plan to the contrary, no benefit shall be payable under the Plan for any covered expense which arises out of or is attributable to a compensated incident, either directly or indirectly, unless and until the total of benefits payable under the Plan's terms for all claims related to that incident equals or exceeds the total amount of compensation paid from another source. In determining the total amount paid by another source, the Plan will include amounts paid for medical services provided or rendered as a result of or in connection with any injury, sickness, accident, or condition arising out of or related to the compensated incident, whether the compensation is in the form of a judgment, settlement, or otherwise, and however such compensation is described or designated.

This provision shall apply irrespective of the designation or description of such compensation or recovery (i.e., loss, punitive damages, pain and suffering, medical expenses, attorneys' fees, costs, etc.). For the purpose of this provision, any and all compensation and recovery shall first be applied to compensation for medical expenses.

This provision shall apply regardless of who institutes the action against another source and regardless of who pays the compensation or recovery to the eligible individual, and whether recovery is in the form of a judgment, settlement or otherwise, and whether the eligible individual is an eligible employee or an eligible dependent, or a legally competent or incompetent person, or a representative of any such person.

The determination of whether a covered expense is within the purview of treatment and/or service attributable to a compensated incident is a question of fact which shall be determined by the Trustees in their sole discretion.

The eligible individual (or, in the case of an incompetent eligible individual, his or her representative), shall assist and cooperate with representatives designated by the Trustees in making a determination as to whether the treatment and/or service can be attributable to the compensated incident. The eligible individual (or, in the case of an incompetent eligible individual, his or her representative) shall sign any and all necessary documents, releases and waivers reasonably requested by the Trustees or their representatives in making their determinations of whether the treatment and/or service can be attributable to the compensated incident. No benefit shall be payable for any covered expense incurred in the treatment of a condition or injury which may be attributable to a compensated incident, whenever incurred, to or on behalf of an eligible individual during any period of time during which the eligible individual or, if applicable, the representative, fails or refuses to render reasonable aid, or sign any document, waiver or release reasonably related to furthering the intent of this provision.

This provision shall in no way affect or otherwise diminish the Plan's right to subrogation or recovery under a repayment agreement for medical expenses incurred prior to, or if applicable, subsequent to, the eligible individual's recovery.

This provision shall not be deemed waived by reason of satisfaction or release of the Plan's claim or lien under the Plan's subrogation rights without the express written agreement by the Trustees of such waiver. Any purported waiver of this provision by an eligible individual (or, in the case of an incompetent eligible individual, his or her representative) shall be null and void insofar as it applies to the Plan or Trustees or to any benefits claimed to be due and owing under the Plan.