2. you cease to be an Eligible Employee (such as, but not limited to, due to cessation of full-time employment or lay off);
3.
the date of your death; or
4.
you make a material misrepresentation to obtain benefits.
CLAIMS, SUBROGATION AND REIMBURSEMENT RIGHTS
When must you submit a claim? You must give the Claims Administrator proof of claim no later than 30 days after your Disability starts. You must give the Claims Administrator proof of continued Disability and regular treatment by a Physician within two weeks of the date such proof is requested. When are claims paid? When the Claims Administrator receives satisfactory proof of claim, and your claim for Disability benefits is approved, benefits will begin on the following regularly scheduled payroll date. What constitutes proof of claim? In order for a claim to be processed, the Claims Administrator must receive your application for benefits, as well as sufficient medical evidence in support of your claim. Such evidence may consist of records from your Physician, narrative reports, x-rays and any other medical records, as well as evidence that you continue to be under the appropriate care and treatment of a Physician. The Employer may require that you see a doctor selected by the Claims Administrator for an independent evaluation. Approval of a claim for benefits and the continuation of benefits are subject to your cooperation in submitting to such an examination. When may the Employer require repayment of benefits? The Employer has the right to recover any and all payments made due to fraud, any error made in processing the claim and receipt of Other Income. You (or your estate) is required to make these reimbursements in full and your receipt of Weekly Benefits is contingent on your agreeing to so reimburse the Employer. In addition, the Employer may reduce or withhold future benefit payments to recover such overpayments. The Employer also has the right to recover any amount of collection or legal costs incurred in the recovery of such overpayments. What happens if my injury was caused by a third party? The Plan has what is called right of subrogation and a right of reimbursement and recovery. When another party is legally responsible or agrees to compensate you for a disability for which you To whom are benefits paid? All benefits are payable to you. There are no survivor benefits. The Employer or Claims Administrator also may require a signed statement identifying all Other Income benefits.
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