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受托人的意见
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在再保险

原告: 员工
被申请人: 雇主
ROD案例编号: 1982年6月29日

Board of Trustees: Harrison Combs, Chairman; John J. O’Connell, Trustee; Paul R. 迪恩,受托人.

Pursuant to Article IX of the United Mine Workers of America 1950 Benefit Plan and Trust, and under the authority of an exemption granted by the United States Department of Labor, the Trustees have reviewed the facts and circumstances of this dispute concerning the provision of health and other non-pension benefit coverage for a disabled 员工 by the 雇主 under the terms of the 雇主’s Benefit Plan and hereby render their opinion on the matter.

背景事实

员工, 谁28岁, sustained a compensable injury while at work for the 雇主 on December 17, 1979. He was off from work due to the injury through December 19, 1980, when he sustained severe permanent injuries in an automobile accident. The 雇主 provided health and non-pension benefit coverage for the 员工 for a period of 12个月 following his last work date, 到12月31日, 1980.

争端

Is the 雇主 responsible for coverage after December 31, 1980?

双方立场

Position of the 员工’s Representative: 员工 should have benefit coverage for one year subsequent to a termination of his employment and not from the last day worked because of his compensable injury.

Position of the 雇主: The 雇主 has provided benefit coverage for the 员工 as required by the Plan.

相关的规定

第三条. E. (1) (a), (b), (d) of the 雇主’s Plan which provides:

(1) Continuation of Coverage

(a) 裁员

If an employee ceases work because of layoff, 健康的延续, 视力保健, life and accidental death and dismemberment insurance coverage is as follows:

Number of Hours 工作 for the
雇主 in the 24 Calendar Month Period of Coverage
Period Prior to the Date Last Continuation From the Date
工作 最后的工作

2000小时以上 月加余额
12个月

500 or more but less than 月加余额
2000小时 8个月

少于500小时 30天

(b) 残疾

Except as otherwise provided.第二条, 部分C, if an 员工 ceases work because of disability, the 员工 will be eligible to continue health, 视力保健, life and accidental death and dismemberment insurance coverages while disabled for the greater of (i) the period of eligibility for sickness and Accident benefits, or (ii) the period as set forth in schedule (a) above.

(d) Maximum Continuation of Coverage

In no event shall any combination of the provisions (a), (b), or (c) above result in continuation of coverage beyond the balance of the month plus 12个月 from the date last worked.

讨论

第三条. E. (1) (a) of the 雇主’s Plan clearly provides that continuation of coverage commences following the “date last worked”. 此外, the 雇主’s Plan provides that the maximum continuation of coverage that an 雇主 is responsible to provide is the balance of the month plus 12个月 from the date last worked.
The Parties agree that the 员工 last worked for the 雇主 on December 17, 1979, when he sustained a compensable injury, and that the 雇主 provided the 员工 with continuation of coverage from December 18, 1979年至12月31日, 1980, the balance of the month from the date last worked plus 12个月. Therefore, no further benefit coverage is required.

受托人的意见

The Trustees are of the opinion that the 雇主 is not responsible for providing the 员工 with benefit coverage after December 31, 1980.