Health and Welfare Summary Plan Description

 
  • Health and Welfare SPD / Article XIII / Miscellaneous Provisions >>

13.9 Loss of Benefits and Other Consequences.

Under some circumstances, including without limitation those circumstances set forth in this section, a Covered Individual may lose benefits, have payments delayed, or become liable to the Plan.

  1. Inadequate or Improper Evidence. The Board has the power to deny, suspend or discontinue benefits to a Participant who fails to submit, at the request of the Plan Office, information or proof reasonably required to administer the Plan.
  2. Prohibited Employment in the Electrical Industry. If after your retirement you engage in prohibited employment as described in Sections 3.1(c)(2) or 4.7(a), your entitlement to Plan benefits will be suspended.
  3. No or Incomplete Enrollment.No benefits are payable with respect to a Covered Individual until the Covered Individual is properly and timely enrolled in the Plan.
  4. Providing Incomplete or False Information. If a Covered Individual fails to provide requested information or gives false information to verify disability, age, beneficiary information, marital status or other vital information, payment of benefits may be delayed or go unpaid. If a Covered Individual makes a false statement to the Plan or other official regarding the payment of benefits or other issues related to the Plan, he will be liable to the Plan for any benefits paid in reliance on such false statements or information, and any attorney fees and costs incurred in effecting recovery or which were incurred as a result of the false statement or information, and reasonable interest charges. The Plan may deduct any such fees, costs and interest charges from any benefits otherwise payable with respect to the Covered Individual.
  5. Subrogation and Related Claims. The Plan may recover any amount it pays for claims for which a Covered Individual received payment under a court judgment, settlement agreement, insurance payment or any other form of payments from a third party, including any payment received from an insurance company. (See also Section 8.13.)