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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: 88-381 - 1991年5月8日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean, Trustee; William Miller, Trustee; Donald E. 皮尔斯,小., Trustee; Thomas H. Saggau,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 benefits coverage for a disabled Employee under the terms of the 雇主 Benefit Plan.
背景事实
10月2日, 1990, the Complainant was working in a classified position for the Respondent when he sustained a work-related injury. 因为他受伤了, 投诉人已于十月三日停止工作, 1990 and was awarded Workers’ Compensation benefits. Funds’ records indicate that the Complainant worked over 2000小时 for the Respondent during the 24-month period immediately prior to his date last worked.
The Complainant states that the Respondent has failed to provide his health benefits coverage as a disabled Employee. According to information provided to the Funds, the Complainant’s health benefits coverage was cancel led November 30, 1990 when the Respondent laid off its Employees and ceased operations. The Complainant contends that the Respondent is required to pay his outstanding medical bills and to provide coverage for the remainder of his period of eligibility under the 雇主 Benefit Plan.
争端
Whether the Respondent is responsible for providing health benefits coverage for the Complainant beyond November 30, 1990.
双方立场
Position of the 原告: The Respondent is responsible for providing health benefits coverage for the Complainant beyond November 30, 1990.
Position of the 被申请人: The Respondent has not responded to repeated correspondence from Funds’ staff requesting 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”指(雇主名称).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1988, 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, 有资格获得本协议项下的福利.
第二条丙. (3) of the 雇主 Benefit Plan provides:
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:
(3) 是接收还是会接收?, 正确应用后, be eligible to receive Sickness and Accident Benefits pursuant to the Wage Agreement.
Life and accidental death and dismemberment insurance shall also be provided to Employees described in (3) above.
第三条D. (1) (a), (b) and (d) of the 雇主 Benefit provide:
第三条-福利
D. 一般规定
(1) 续保
(a) 裁员
If an Employee ceases work because of layoff, 健康的延续, life and accidental death and dismemberment Insurance coverage is as follows:
工作时数
24 .雇主
连续日历月
紧接前一时期 保险期限
雇员入职日期 继续
最后的工作 最近工作日期
2000小时以上 月加余额
12个月
500或更多，但少于 月加余额
2000小时 6个月
少于500小时 30天
(b) 残疾
Except as otherwise provided in Article II, 部分C, if an Employee ceases work because of disability, the Employee will be eligible to continue health, life and accidental death and dismemberment coverage while disabled for the greater of (I) the period of eligibility for Sickness and Accident benefits, or (ii) the period as set forth in the schedule in (a) above.
(d) 最大续保范围
In no event shall any combination of the provisions of (a), (b), (c), (e) or (g) above result in continuation of coverage beyond the balance of the month plus 12个月 from the date last worked.
讨论
第二条丙. (3) of the 雇主 Benefit Plan provides health benefits coverage for a disabled Employee who is receiving or would be eligible to receive Sickness and Accident Benefits pursuant to the Wage Agreement. 此外，第三条D. (1) (b) provides that an Employee who ceases work because of disability will be eligible to continue health, life and accidental death and dismemberment coverage while disabled for the greater of (I) the period of eligibility for Sickness and Accident benefits, or (ii) the period based on the number of hours worked as set forth in 第三条D. (1) (a). Inasmuch as the Complainant ceased work because of disability and had worked over 2000小时 for the Respondent during the 24-month period prior to his date last worked, 10月3日, 1990, the Respondent is responsible for providing continued benefits coverage for the Complainant, 在1990年10月以后的12个月, the maximum period allowable under Article III. D., provided the Complainant remains disabled.
受托人的意见
The Respondent is responsible for providing health benefits coverage for the Complainant and his eligible dependents for the remainder of his period of eligibility beyond November 30, 1990年至10月31日, 1991, consistent with the terms of the 雇主 Benefit Plan.