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受托人的意见
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在再保险

原告: 残疾员工
被申请人: 雇主
ROD案例编号: 84-407——1987年6月18日

董事会:Joseph P. 康纳斯老., Chairman; Paul R. 院长，受托人. Jordan,受托人; William Miller,受托人; Donald E. 皮尔斯,小.,受托人.

Pursuant to Article IX of the United Mine Workers of America (“UMWA”) 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 benefits coverage under the terms of the 雇主 Benefit Plan.

背景事实

原告, 44岁, was employed in a classified position with 被申请人 until he became disabled because of coronary artery disease on November 5, 1985. The Respondent provided the Complainant with continued health benefits coverage through September 30, 1986, 当这种保险终止时. 6月20日, 1986, the Complainant was awarded Social Security Disability Insurance (SSDI) benefits, 11月5日生效, 1985. 在1月30日的信中, 1987, the Complainant was notified by the Funds that because he was working in a classified job for a signatory 雇主 when he became disabled, is eligible to receive SSDI benefits and will be eligible upon attaining age 55 to receive a pension based on at least 20 years of credited service, he may be eligible for health benefits as a disabled Employee. 原告 was advised by the Funds to contact his last signatory 雇主, 被申请人, 确定他的资格.

The representative for the Complainant has submitted outstanding bills for medical services and prescriptions provided to the Complainant between October 30, 1986年和2月9日, 1987. 原告’s representative contends that 被申请人 is responsible for the provision of health benefits for the Complainant as a disabled Employee.

争端

Whether 被申请人 is responsible for providing the Complainant with health benefits as a disabled Employee.

双方立场

Position of the 原告: The Respondent is responsible for providing his health benefits as a disabled Employee.

Position of 被申请人: The Respondent has not replied to repeated correspondence regarding its position in this dispute.

相关的规定

Article I (1), (2) and (4) of the 雇主 Benefit Plan provide:

第一条-定义

The following terms shall have the meanings herein set forth:

(1) “雇主” means (name of coal company).

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1984, as amended from time to time and any successor agreement.

(4) “Employee” shall mean a person working in a classified job for the 雇主, eligible to receive benefits hereunder.

第二条丙. (1) (a), (b), (c) and (d) of the 雇主 Benefit Plan provide:

第二条-资格

The persons eligible to receive the health benefits pursuant to Article III are as follows:

C. 残疾员工

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 health benefits under Article III shall also be provided to any Employee who:

(1) (a) Has completed 20 years of credited service, including the required number of years of signatory service pursuant to Article IV C. (6) of the 1974 Pension Plan or any corresponding paragraph of any successor thereto, and

(b) 没有达到55岁，并且

(c) became disabled after December 6, 1974 while in classified employment with the 雇主, and

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

讨论

根据第二条C款. (1)雇主福利计划, a disabled Employee is entitled to health benefits coverage if he has not attained age 55; satisfies the 20-year service pension eligibility requirement under the 1974 Pension Plan, including the required number of signatory service years; became disabled after December 6, 1974, while in classified employment with the 雇主; and is eligible for Social Security Disability Insurance benefits under Title II of the Social Security Act. Inasmuch as the Complainant meets the foregoing eligibility requirements of 第二条丙. (1)雇主福利计划, he is entitled to health benefits coverage from 被申请人, 11月5日生效, 1985.

受托人的意见

The Respondent is responsible for providing the Complainant with health benefits as a disabled Employee.