Trustee Actions
To All Employees and Dependents:
This Notice is to inform you of recent Trustee actions in regard to the following:
- routine physical exam increase
- clarification of initial and reinstatement of eligibility provisions
- revised subrogation language
Routine Physical Exam Increase
(Employees and Spouses in All Classes)
Routine physical examinations performed through the Health Dynamics Preferred Provider Preventive Care Program will continue to be covered in full, up to the maximum amount approved by Trustees. Trustees recently approved a fee increase for the Health Dynamics Program from $452 to $465. To align with the amount payable for the Health Dynamics Program, we are pleased to announce that the benefit for routine physical examinations under Comprehensive Major Medical Benefits for the employee and spouse will increase from $452 to $465 per person per calendar year effective January 1, 2003.
Clarification of Initial and Reinstatement of Eligibility Provisions
(All Classes)
For Bargaining Unit Employees, Non-Bargaining Unit Employees, and Alumni, we want to clarify that you and your dependents become initially eligible on the first day of the second month following the month in which you have worked and are credited with 500 hours of contributions at the prevailing contribution rate, provided such contributions are credited within 12 consecutive months.
If you have had a break in eligibility of one or more months, your eligibility will be reinstated for a period of three months beginning on the later of:
- the first day of the third month following the month in which you have worked and are credited with contributions for 450 hours in not more than 12 consecutive months since your hours were used for eligibility or self-contribution
- the first day of the month following at least a one-month break in eligibility.
- OR -
After a break in eligibility of at least 12 consecutive months, the rules for initial eligibility will apply.
Revised Subrogation Language
(All Classes)
We mentioned to you in your recent Fund newsletter that the Plan's Subrogation/Reimbursement language has been amended. The language now reads as follows:
Whenever the Wisconsin Carpenters' Health Fund has been or is providing medical, hospital, dental, vision, or disability benefits ("e;Benefits"e;) as a result of the occurrence of an injury, sickness, or death which results in a possible recovery of indemnity from any party, including an insurer (including uninsurance and underinsurance coverage), the Fund may make a claim or maintain an action against such party.
By virtue of accepting such Benefits as a result of the occurrence of an injury, sickness, or death which results in a possible recovery of indemnity from any party, including an insurer (including uninsurance and underinsurance), the eligible person assigns to the Fund the right to make a claim against such party to the extent of the amount of such Benefits.
An eligible person must not do anything after the loss for which the Benefits were provided to prejudice the Fund's right of recovery. An eligible person must promptly advise the Administrative Manager of this Fund in writing whenever a claim against any party is made by or on behalf of the eligible person with respect to any loss for which Benefits were, or are being, received from the Fund.
The recipient of Benefits has an obligation to provide the Fund or its designee with the names and addresses of all potential parties and their insurers, adjusters, and claim numbers, as well as accident reports and any other information the Fund requests. If the information requested is not provided, the Fund in its discretion may withhold future benefit obligations pending receipt of the requested information.
The eligible person or the Fund may make a claim against a party or commence an action against a party and will join the other as provided under Section 803.3 of the Wisconsin Statutes or applicable state or federal law. Each will have an equal voice in the prosecution of such claim or action.
The proceeds from any settlement or judgment in any claim made against any party will be allocated as follows:
- First, a sum sufficient to fully reimburse the Fund for all Benefits advanced will be paid to the Fund. No court costs nor attorneys' fees may be deducted from the Fund's recovery without prior expressed written consent of the Fund. This right will not be defeated by any so-called "e;Fund Doctrine"e; or "e;Common Fund Doctrine"e; or "e;Attorneys' Fund Doctrine"e; or any other similar doctrine or theory.
- Any remainder will be paid to the eligible person on whose behalf claim is made.
- The Fund will receive a credit, up to the full amount of any remainder paid to the recipient of Benefits pursuant to the prior paragraph (2), to apply against any future Benefit obligations arising out of the injury, sickness, or death which was the subject of the claim which resulted in the settlement or judgment.
The aforesaid allocation of proceeds will be paid from the first dollar of any proceeds received and will have a priority over competing claims regardless of whether the total amount of the recovery of the eligible person, or those claiming under him, is less than the actual loss suffered, or less than the amount necessary to make the eligible person, or those claiming under him, whole. The Fund's rights will not be defeated or reduced by the application of any so-called "e;Made-Whole Doctrine,"e; "e;Garrity Doctrine,"e; "e;Rimes Doctrine,"e; or any doctrine purporting to defeat the Fund's rights by allocating the proceeds exclusively, or in part, to non-medical expense damages.
Furthermore, such allocation will apply to claims of dependents of eligible employees covered by the Fund, regardless of whether such recipient was legally responsible for expenses of treatment.
In the event an eligible person makes a recovery in a claim from any party and the proceeds are not allocated in accordance with the prior paragraphs, the Trustees will have the right to make a claim for reimbursement, including but not limited to claims for restitution, unjust enrichment, or a constructive trust over any recovery by the eligible person, to the extent of the Fund's expenditures, whether the recovery is paid to, or in the possession of, the eligible person, the eligible person's attorney, or any other individual or entity, or to take a credit on future Fund obligations to the eligible person to the extent of such Benefits. Such credit will not be limited to future obligations of the Fund to the actual recipient of such Benefits but also may be taken against any future obligations to the eligible employee or any of his dependents.
Accordingly, language in the General Exclusions also has been amended to state the following:
- Take a credit against future claims of the eligible person to the amount of the Fund's expenditures of such expense
- Initiate legal proceedings to recover the Fund's expenditures
- Exercise the Fund's right to reimbursement, including but not limited to claims for restitution, unjust enrichment, or a constructive trust over any recovery by the eligible person, to the extent of the Fund's expenditures, whether the recovery is paid to, or in the possession of, the eligible person, the eligible person's attorney, or any other individual or entity.
- OR -
Please keep this Notice in your Summary Plan Description for future reference. If you have any questions about this information, feel free to contact the Fund Office.
Yours very truly,
THE BOARD OF TRUSTEES
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