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OPINION OF TRUSTEES
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In Re

Complainant: Disabled Employee
Respondent: Employer
ROD Case No: 81-713 – March 20, 1987

Board of Trustees: Joseph P. Connors, Sr., Chairman; Paul R. Dean, Trustee;
William B. Jordan, Trustee; William Miller, Trustee; Donald E. Pierce, Jr., Trustee.

根据美国煤矿工人联合会(“UMWA”)1950年福利计划和信托的第九条, 并根据美国劳工部授予的豁免授权, the Trustees have reviewed the facts and circumstances of this dispute concerning the provision of health benefits coverage for a disabled Employee under the terms of the Employer Benefit Plan.

Background Facts

投诉人最后一次为被投诉人工作是在1983年12月23日. 他后来因尘肺病和肺气肿而无法重返工作岗位. 皇冠搏彩中心网站的记录显示，申诉人从1月1日起领取疾病和事故津贴, 1984 through January 17, 1984.

The Complainant filed for Social Security Disability Insurance (“SSDI”) benefits under Title II of the Social Security Act on February 28, 1984. 他的申请于1984年10月30日获得批准，并于1984年1月5日生效.

On November 9, 1984, the Complainant filed an application for pension benefits under the UMWA 1974 Pension Plan to establish his eligibility for health benefits coverage as a disabled Employee. On September 16, 1985, the Funds acknowledged that when he reached age 55 he would be eligible to receive a pension based on 26-3/4 years of classified service, 他有资格领取SSDI福利, 而且他是在为某签字雇主从事机密工作期间致残的. Accordingly, 他被告知，他可能有资格从他的上一个雇主那里获得医疗福利.

The Complainant states that the Respondent claims to be out of business and has not provided his health benefits coverage as a disabled Employee. 申诉人问，被投诉人是否负责支付其医疗福利. In the alternative, 投诉人询问1974年福利计划和信托是否可以提供此类福利.

被告是1981年全国烟煤工资协议(“工资协议”)的签署人, which expired on September 30, 1984. 被告没有签署1984年的工资协议. The Respondent has failed to respond to repeated inquiries by Funds’ staff requesting its position in this dispute.

Dispute

Whether the Respondent is responsible for providing health benefits to the Complainant as a disabled Employee.

Positions of the Parties

Position of the Complainant: The Complainant asks whether the Respondent or the 1974 Benefit Plan and Trust is responsible for the provision of his health benefits coverage as provided by the Employer Benefit Plan.

被投诉人的立场:被投诉人未说明其在该争议中的立场.

Pertinent Provisions

1981年《皇冠搏彩中心网站》第20 (c)(3)(i)条规定:

(3)(i)各签署雇主应建立并维持员工福利计划，以提供, 通过保险公司实施, health and other non-pension benefits for its Employees covered by this Agreement as well as pensioners, under the 1974 Pension Plan.和信托，其最后签署人的分类工作是与该雇主. The benefits provided by the Employer to its eligible Participants pursuant to such plans shall be guaranteed during the term of this Agreement by that Employer at levels set forth in such plans. Such plans shall also include that each signatory Employer continue to make the death benefit payments in pay status as of December 5, 1977, for deceased Employees and pensioners under the 1974 Pension Plan whose last signatory classified employment was with such Employer, in the same manner and in the same amounts as previously provided for in the 1974 Benefit Plan and Trust. The plans established pursuant to this subsection are incorporated by reference and made a part of this Agreement, and the terms and conditions under which the health and other non- pension benefits will be provided under such plans are as to be set forth in such plans.

雇主福利计划第I(1)、(2)、(4)条规定:

Article I – Definitions

下列术语具有本协议规定的含义:

(1) “雇主”指(雇主名称).

(2) “工资协议”指1981年《皇冠搏彩中心》, 如不时修订及任何后续协议.

(4) “雇员”系指为雇主从事保密工作的人员, 有资格获得本协议项下的福利.

Article II C. 雇主福利计划的(1)(a)、(b)、(c)及(d)项规定:

Article II – Eligibility

根据第三条有资格领取健康津贴的人员如下:

C. Disabled Employees

In addition to disabled Pensioners who are receiving pension benefits and are therefore entitled to receive health benefits under paragraph B of this Article II, 第3条规定的健康福利也应提供给下列任何雇员:

(1) (a) 已完成20年的信用服务, 包括根据第IV条C所规定的签字服务年数. (6) 1974年养老金计划或其继任者的任何相应条款，以及

(b) has not attained age 55, and

(c) 1974年12月6日以后在雇主的分类雇佣中致残，并且

(d) is eligible for Social Security Disability Insurance Benefits under Title II of the Social Security Act or its successor;

Article III D. 雇主福利计划的(1)(a)和(b)条款规定:

Article III – Benefits

D. General Provisions

(1) Continuation of Coverage

(a) Layoff

如果雇员因裁员而停止工作, continuation of health, 人寿、意外死亡和肢解保险的保险范围如下:

Number of Hours Worked for the
Employer in the 24 Consecutive
Calendar Month period Immediately
prior to the Employee’s Date Last Period of Coverage Continuation
Worked from the Date Last Worked
_________________________________ ________________________________

2,000 or more hours Balance of month plus 12 months

500 or more but less than Balance of month plus 6 months
2,000 hours

Less than 500 hours 30 days

(b) Disability

第二条另有规定的除外, Section C, 雇员因残疾而停止工作, 雇员将有资格继续保持健康, life and accidental death and dismemberment insurance coverage while disabled for the greater of (i) the period of eligibility for Sickness and Accident benefits, 或(ii)上述(a)项附表所列期间.

Discussion

Article XX Section (c)(3)(i) of the 1981 Wage Agreement requires a signatory Employer to establish and maintain an Employer Benefit Plan to provide health and other non-pension benefits to its Employees. The Wage Agreement stipulates that benefits provided by the Employer pursuant to such plans shall be guaranteed during the term of the Agreement.

Article II C. (1) of the Employer Benefit plan provides health benefits coverage to a disabled Employee who has completed at least 20 years of credited service, has not attained age 55, became disabled after December 6, 1974, 在被雇主分类雇佣期间, 并有资格领取社会保障残疾保险. 投诉人已建立26-3/4年的信用签名服务，年龄未满55岁. He received an SSDI award, effective January 5, 1984, 在他欺骗的一段时间里，疾病和意外从沮丧中获益. 这个裁决确定他是在12月6日之后残疾的, 1974年在被告的机密工作中. Based on these facts, 申诉人符合第二条丙款规定的健康福利的资格要求. (1) of the plan. Accordingly, the Respondent is responsible for providing his health benefits coverage as a disabled Employee effective January 5, 1984.

The issue here is whether the Respondent is contractually obligated to provide such coverage beyond the expiration of the 1981 Wage Agreement when the Respondent did not sign the 1984 Wage Agreement. 美国联邦第四巡回上诉法院，位于华盛顿特区. 美国煤矿工人联合会，等. v. Royal Coal Co., 768 F. 2d 588, 592 (4th Cir. 1985) and Dist. 17、美国煤矿工人联合会等. v Allied Cor . etc., 765 F. 2d 412, (en banc), as ruled that an Employer’s contractual obligation to provide health benefits to its retirees does not extend beyond the expiration of the Wage Agreement. 投诉人享有与退休人员相同的资格, and his right to benefits is based on the fact that he has accrued the same number of years of service required of a retiree to qualify for benefits. Accordingly, 投诉人应被视为雇主福利计划下的退休人员.

The Complainant has also asked in the alternative whether coverage might be provided under the 1974 Benefit Plan and Trust. Under that Plan, a beneficiary is entitled to coverage only if it is determined that the beneficiary’s last Employer is “no longer in business.” Such determination is made by the Trustees under established procedures separate from the ROD procedure.

Opinion of the Trustees

The Respondent is responsible for providing health benefits coverage for the Complainant as a disabled Employee, effective January 5, 1984, 到1981年工资协议于9月30日到期为止, 1984. Given the `controlling language of the applicable Wage Agreement and Plan documents and in light of the Fourth Circuit’s decisions, the Respondent is not responsible for providing health benefits to the Complainant following the expiration of the 1981 Wage Agreement.