A Subrogation Contract is essential when an insurance company or other entity seeks to recover payments made to an insured party from a responsible third party. This document is commonly used across the United States when an insurer has compensated its policyholder for a loss and wishes to pursue reimbursement from the party that caused the loss. The contract must carefully consider state-specific insurance laws, federal regulations like ERISA and Medicare Secondary Payer Act, and relevant common law principles. It typically includes detailed provisions about the scope of subrogation rights, cooperation requirements, and recovery distribution mechanisms.
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1. Parties: Identification of subrogating party and subrogated party
2. Background: Description of original claim, payment, and basis for subrogation
3. Definitions: Key terms used in the agreement including 'Claim', 'Recovery', 'Subrogation Rights'
4. Grant of Subrogation Rights: Express transfer of rights from subrogor to subrogee
5. Scope of Rights: Extent and limitations of subrogation rights being transferred
6. Cooperation Obligations: Parties' duties to assist in pursuing claims
7. Distribution of Recoveries: How recovered amounts will be allocated
1. Attorney Representation: Terms regarding legal representation in pursuing claims when legal action is anticipated
2. Confidentiality: Provisions for maintaining confidentiality of claim details when sensitive information is involved
3. Medicare Compliance: Specific provisions for Medicare compliance when Medicare interests are involved
1. Schedule A - Claim Details: Detailed description of original claim and payments made
2. Schedule B - Recovery Allocation: Formula or methodology for distributing recoveries
3. Schedule C - Required Documentation: List of documents needed to support subrogation claim
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