MMC Benefits Handbook
Right of Recovery/Subrogation
Unless otherwise stated in the applicable insurance policy/evidence of coverage or benefits booklet/summary, any benefits under the Marsh & McLennan Companies Health & Welfare Benefits Program, Marsh & McLennan Companies Group Benefits Plan and Marsh & McLennan Companies Retiree Reimbursement Account (the "Plans") will be subject to the reimbursement and subrogation rules below. This section applies to your eligible dependents the same as it applies to you.
Reimbursement to Plans if You Recover Payment for an Injury or Illness
This section applies if you or your legal representative, estate or heirs recover money or other property for an injury, sickness or other condition, or if you have made, or in the future may make, such a recovery, including a recovery from any insurance carrier.
The Plans will not cover either the reasonable value of the services to treat such an injury, sickness, or other condition or the treatment of such an injury, sickness, or other condition. These benefits are specifically excluded.
The Plans may, however, advance moneys or provide benefits for such an injury, sickness, or other condition, and, if so, you must promptly convey moneys or other property from any settlement, arbitration award, verdict, insurance payment , or other recovery from any party to the Plans in the amount of moneys or of the benefits advanced or provided by the Plans to you, regardless of whether or not (1) you have been fully compensated or made whole for your loss, (2) liability is admitted by you or any other party, or (3) your recovery is itemized or specified as a recovery for medical expenses incurred.
If a recovery is made, the Plans shall have first priority in payment over you or any other party to receive reimbursement of the moneys and value of the other benefits advanced on your behalf. This reimbursement shall be from any recovery made by you and includes, but is not limited to, uninsured and underinsured motorist coverage, any no-fault insurance, medical payment coverage (auto, homeowners, or otherwise), workers' compensation settlement, compromises or awards, other group insurance (including student plans), and direct recoveries from liable parties.
You must assign to the Plans any benefits you may have under any automobile policy or other coverage, to the extent of the Plans' claim for reimbursement. You must sign and deliver, at the request of the Plans or its agents, any documents needed to effect such assignment of benefits.
You must cooperate with the Plans and its agents and shall sign and deliver such documents as the Plans or its agents reasonably request to protect the Plans' right of reimbursement, provide any relevant information, and take such actions as the Plan or its agents reasonably request to assist the Plans making a full recovery of the reasonable value of the moneys or other benefits provided.
You shall not take any action that prejudices the Plans' rights of reimbursement and consents to the right of the Plans, by and through its agent, to impress an equitable lien or constructive trust on the proceeds of any recovery to enforce the Plans' rights under this section, and/or to set off from any future benefits otherwise payable under the Plans the value of moneys and other benefits advanced under this section to the extent not recovered by the Plans.
The Plans shall be responsible only for those legal fees and expenses to which it agrees in writing. You shall not incur any expenses on behalf of the Plans in pursuit of the Plans' rights. Specifically, no court costs or attorney's fees may be deducted from the Plans' recovery without the express written consent of the Plan. Any so-called "Fund Doctrine," "Common Fund Doctrine," "Attorney's Fund Doctrine," or other equitable defenses shall not defeat this right.
The Plans shall recover the full amount of moneys and the value of the benefits advanced and paid hereunder, without regard to any claim or fault on the part of any beneficiary of yours, whether under comparative negligence or otherwise.
Plans' Right to Subrogation
This section applies if another party is, or may be considered, liable for your injury, sickness, or other condition (including insurance carriers who are financially liable).
The Plans will not cover either the reasonable value of the services to treat such an injury, sickness, or other condition or the treatment of such an injury, sickness, or other condition. These benefits are specifically excluded.
The Plans may, however, advance moneys or provide benefits for such an injury, sickness, or other condition, and, if so, the Plans are subrogated to all of your rights against any party liable for your injury, sickness, or other condition, or who is or may be liable for the payment for the medical treatment of such injury, sickness, or other condition (including any insurance carrier), in the amount of moneys or value of other benefits advanced or provided by the Plans to you. The Plans may assert this right independently of you. This right includes, but is not limited to, your rights under uninsured and underinsured motorist coverage, any no-fault insurance, medical payment coverage (auto, homeowners, or otherwise), workers' compensation coverage, or other insurance. The Plans are not obligated in any way to pursue this right independently or on your behalf, but may choose to pursue its rights to reimbursement under the Plans, at its sole discretion.
You are obligated to cooperate with the Plans and its agents to protect the Plans' subrogation rights. Your obligations include, but are not limited to, providing the Plan or its agents with any relevant information requested by them, signing and delivering such documents as the Plans or its agents reasonably request to enforce the Plans' subrogation right, and obtaining the consent of the Plans or its agents before releasing any party from liability for payment of medical expenses.
If you enter into litigation or settlement negotiations relating to your injury, sickness or other condition, you must not prejudice, in any way, the subrogation rights of the Plans under this section. If you fail to cooperate as provided in this section, including executing any documents required in this section, the Plans may, in addition to remedies provided elsewhere in the Plans and/or under the law, set off from any future benefits otherwise payable under the Plans the money and value of other benefits advanced under this section to the extent not recovered by the Plans.
The costs of legal representation of the Plans in matters related to subrogation shall be borne solely by the Plans. The costs of your legal representation shall be borne solely by you.
Equitable Lien
By accepting any benefits advanced by the Plans under this section, you acknowledge that any proceeds of settlement or judgment, including your claim to such proceeds held by another person or held by you, are being held for the benefit of the Plans under these provisions. If the Plans advance moneys or provide benefits for an injury, sickness, or other conditions, and you recover moneys or benefits from a third party in the amount of the moneys or benefits advanced, the Plans have an equitable lien in connection with any such payments. Failure to hold such received funds in trust, and in a separate, identifiable account, will be deemed a breach of your fiduciary duty to the Plans.
Notice
You specifically agree to notify the Plans in writing whenever benefits are paid under the Plans that arise out of any injury, sickness, or other condition that provides or may provide the Plans subrogation or reimbursement rights. Furthermore, you specifically agree to notify the Plans: (1) within 30 days of the date any notice is given by any party, including an attorney, of its intent to pursue or investigate a claim to recover damages or obtain compensation due to an injury, sickness, or other condition; or (2) within 30 days of the date any party, including an attorney, undertakes, pursues, or investigates a claim to recover damages or obtain compensation due to an injury, sickness, other condition.
Waiver
The Plan Administrator in its sole and absolute discretion may waive or modify any or all of the provisions of this rule.