Part 7 – Other Party Liability (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 77 Member Cooperation You must give Blue Cross Blue Shield HMO Blue information and help. This means you must complete and sign all necessary documents to help Blue Cross Blue Shield HMO Blue get this money back. This also means that you must give Blue Cross Blue Shield HMO Blue timely notice of all significant steps during negotiation, litigation, or settlement with any third party (such as filing a claim or lawsuit, initiation of settlement discussions, agreement to a settlement in principle, etc.) and before settling any claim arising out of injuries you sustained by an act or omission of another person(s) for which Blue Cross Blue Shield HMO Blue paid benefits. You must not do anything that might limit Blue Cross Blue Shield HMO Blue’s right to full reimbursement. Workers’ Compensation No benefits are provided for health care services that are furnished to treat an illness or injury that Blue Cross Blue Shield HMO Blue determines was work related. This is the case even if you have an agreement with the workers’ compensation carrier that releases them from paying for the claims. All employers provide their employees with workers’ compensation or similar insurance. This is done to protect employees in case of a work-related illness or injury. All health care claims for a work-related illness or injury must be billed to the employer’s workers’ compensation carrier. It is up to you to use the workers’ compensation insurance. If Blue Cross Blue Shield HMO Blue pays for any work-related health care services, Blue Cross Blue Shield HMO Blue has the right to get paid back from the party that legally must pay for the health care claims. Blue Cross Blue Shield HMO Blue also has the right, where possible, to reverse payments made to providers. If you have recovered any benefits from a workers’ compensation insurer (or from an employer liability plan), Blue Cross Blue Shield HMO Blue has the right to recover from you the amount of benefits it has paid for your health care services. This is the case even if:  the workers’ compensation benefits are in dispute or are made by means of a settlement or compromise;  no final determination is made that an injury or illness was sustained in the course of or resulted from your employment;  the amount of workers’ compensation due to medical or health care is not agreed upon or defined by you or the workers’ compensation carrier; or  the medical or health care benefits are specifically excluded from the workers’ compensation settlement or compromise. If Blue Cross Blue Shield HMO Blue is billed in error for these services, you must promptly call or write to the Blue Cross Blue Shield HMO Blue customer service office.