instruments and documents as We determine are necessary to secure the right of recovery. Right to Receive and Release Information We, without consent or notice to You, may obtain information from and release information to any other Plan with respect to You in order to coordinate Your benefits pursuant to this section. You must provide Us with any information We request in order to coordinate Your benefits pursuant to this section. This request may occur in connection with a submitted claim; if so, You will be advised that the "other coverage" information, (including an Explanation of Benefits paid under the Primary Plan) is required before the claim will be processed for payment. If no response is received within 55 days of the request, the claim will be closed. If the requested information is subsequently received, the claim will be processed.
or on behalf of the Covered Person which is binding on any attorney or other party who represents the Covered Person whether or not an agent of the Covered Person or of any insurance company or other financially responsible party against whom a Covered Person may have a claim provided said attorney, insurance carrier or other party has been notified by Us or Our agents; • agrees that this lien shall constitute a charge against the proceeds of any recovery and We shall be entitled to assert a security interest thereon; • agrees to hold the proceeds of any recovery in trust for Our benefit to the extent of any payment made by Us. Additional Terms • No adult Covered Person may assign any rights that the Covered Person may have to recover dental expenses from any third party or other person or entity to any Dependent child without Our prior express written consent. Our right to recover shall apply to decedents’, minors’, and incompetent or disabled persons’ settlements or recoveries. • No Covered Person shall make any settlement, which specifically reduces or excludes, or attempts to reduce or exclude, the benefits provided by the plan. • Our right of recovery shall be a prior lien against any proceeds recovered by the Covered Person. This right of recovery shall not be defeated nor reduced by the application of any so-called “Made-Whole Doctrine”, “Rimes Doctrine”, or any other such doctrine purporting to defeat Our recovery rights by allocating the proceeds exclusively to non-dental expense damages. • No Covered Person shall incur any expenses on behalf of the plan in pursuit of the plan’s rights. Specifically; no court costs, attorneys' fees, or other representatives' fees may be deducted from the plan’s recovery without Our prior express written consent. This right shall not be defeated by any so-called “Fund Doctrine”, “Common Fund Doctrine”, or “Attorney’s Fund Doctrine”. • We shall recover the full amount of benefits provided under the plan without regard to any claim of fault on the part of any Covered Person, whether under comparative negligence or otherwise. • We hereby disavow all equitable defenses in the pursuit of Our right of recovery. Our recovery rights are neither affected nor diminished by equitable defenses. • In the event that a Covered Person fails or refuses to honor his obligations under the plan, We shall be entitled to recover any costs incurred in enforcing the terms of the Policy including, but not limited to, attorney’s fees, litigation, court costs, and other expenses. We shall also be
HCDFB-COB113
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Expenses For Which A Third Party May Be Responsible This plan does not cover: • Expenses incurred by You or Your Dependent(s) for which another party may be responsible as a result of having caused or contributed to an injury or sickness. • Expenses incurred by You or Your Dependent(s) to the extent any payment is received either directly or indirectly from a third party tortfeasor or as a result of a settlement, judgment or arbitration award in connection with any automobile medical, automobile no-fault, uninsured or underinsured motorist, homeowners, workers' compensation, government insurance (other than Medicaid), or similar type of insurance or coverage. The coverage under this plan is secondary to any automobile no-fault or similar coverage. Right of Reimbursement If a Covered Person incurs expenses for Covered Dental Services for which another party may be responsible or for which the Covered Person may receive payment as described above, We will be granted a right of reimbursement, to the extent of the benefits provided by Us, from the proceeds of any recovery whether by settlement, judgment, or otherwise. Lien of the Plan By accepting benefits under this plan, a Covered Person: • grants a lien and assigns to Us an amount equal to the benefits paid under this plan against any recovery made by
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