Third Party Liability

No Benefits are payable under this Policy if an Employee has the right to recover money from a third party or their insurer as compensation for Injury or Sickness.  However, if liability has not yet been determined, or for any other reason recovery from the third party or their insurer has not been received, then an Employee may apply to use an advance payment in an amount equal to the benefits to which the Employee would otherwise have been entitled if not for the existence of this provision.

No advance payment shall be made by Us unless the Employee would, if not for the existence of this provision, be eligible to receive Benefits and the Employee agrees in writing:

1. to take all necessary action to recover from the third party the total of the amounts advanced by Us.
2. to direct the third party, their insurer, or the Employee’s lawyer to pay to Us from any judgment or settlement obtained from or on behalf of the third party an amount equal to the total amount of money advanced by Us.
3. that any judgment or settlement obtained from or on behalf of the third party that does not specify an amount for wage loss shall be deemed to include wage loss in an amount equal to the amounts advanced by Us.
4. to pay all legal fees incurred in pursuing any claim against the third party.
5. to enter into a Reimbursement Agreement with Us establishing the terms and conditions for repayment of the amounts advanced by Us.
6. to repay to Us the full amount advanced to the Employee in the event the claim against the third party is abandoned or settled without Our written consent.
7. to irrevocably authorize the third party, or their insurer, to release to Us all information in their possession relating to the Employee’s claim including full particulars of any settlement or judgment.
8. to authorize the third party’s insurer to pay directly to Us from any settlement of judgment an amount equal to the amount advanced by Us.

If the Employee fails to comply with subparagraphs 1 to 8 above, then We may terminate the advance payment.

An Employee may make no further claims for Benefits arising out of any Injury or Sickness for which monies are paid by or on behalf of a third party after the Employee has entered into a settlement with or obtained judgment against the third party.

Newly added for 2020:

Notwithstanding the foregoing, if the Employee has the right to recover any money from a third party or their insurer as compensation for Injury or Sickness arising out of a motor vehicle accident (a “Motor Vehicle Accident”), We may pay Benefits to the Employee. If We pay any Benefits to the Employee in relation to a Motor Vehicle Accident, the provisions of the British Columbia Insurance (Motor Vehicle) Act, and all amendments and regulations thereto, shall apply, and in receiving any Benefits paid by Us, the Employee’s overall right to recover from a third party or their insurer as compensation for a Motor Vehicle Accident may be reduced by the amount of any Benefits paid by Us.