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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: 93- 97 - 2000年3月17日

受托人: A. 弗兰克·邓纳姆，迈克尔·H. 霍兰德，唐纳德·E. 皮尔斯,小., 艾略特一. 西格尔.

The Trustees have reviewed the facts 和 circumstances of this dispute concerning the provision of benefits under the terms 雇主福利计划的成员.

背景事实

原告, 谁的出生日期是五月十二日, 1945, was employed by the Respondent in a classified position until October 7, 1992, 当他被解雇的时候. 原告 received 健康的延续 benefits coverage as a laid off employee through October 31, 1993. Following his employment with the Respondent, the Complainant was employed in the coal construction industry until August 4, 1995.

原告 applied for Social Security Disability Insurance (“SSDI”) benefits. His application was approved on appeal by an Administrative Law Judge on June 25, 1997, with a disability onset date of August 4, 1995.

根据皇冠搏彩中心网站组织的记录, the Complainant will be eligible upon attaining age 55 to receive a 1974 Pension Plan pension based on 26 years of credited signatory service.

原告 states that the Respondent has refused to provide health benefits coverage for him as a disabled 员工.

争端

Is the Respondent required to provide health benefits coverage for the Complainant as a disabled 员工?

双方立场

Position of the 原告: The Respondent is required to provide health benefits coverage for the Complainant as a disabled 员工.

Position of the 被申请人: The Respondent is not required to provide health benefits coverage for the Complainant because he does not meet the eligibility requirements for a disabled 员工 under 第二条丙. 1993年雇主福利计划.

相关的规定

Article I (1), (2), 和 (4) 雇主福利计划的成员 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 1993, as amended from time to time 和 any successor agreement.

(4) “员工” 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. (1)雇主福利计划 provides:

第二条资格

C. 残疾员工

In addition to disabled Pensioners who are receiving pension benefits 和 are therefore entitled to receive health benefits under section B of this Article II, health benefits under Article III shall also be provided to any 员工 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, 和

(b) 没有达到55岁，并且

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

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

第三条D. (1)(a) 雇主福利计划的成员 provides:

第三条待遇

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 和 accidental death 和 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
2,000 hours 6 months
少于500小时 30天

讨论

根据第二条C款. 雇主福利计划的成员, an 员工 is eligible for health benefits coverage as a disabled 员工 if he meets the following requirements: (a) has completed 20 years of credited service, including the required number of years of signatory service; (b) has not attained age 55; (c) became disabled after December 6, 1974 while in classified employment with the 雇主; 和 (d) is eligible for Social Security Disability Insurance benefits. 原告 clearly satisfies the requirements of 第二条丙. (1) (a)、(b)及(d). The issue here is whether the Complainant became disabled while in classified employment with the Respondent.

原告 ceased working for the Respondent on October 7, 1992, due to a layoff. Based on his hours worked in the 24 consecutive calendar month period prior to his layoff, the Complainant was eligible for continuation of coverage through October 31, 1993. An 员工 who becomes eligible for SSDI benefits while on layoff is entitled to health benefits coverage as a disabled 员工 under 第二条丙. (1). See RODs 166, 81-488, 81-653, 和 88-378.

原告 was awarded SSDI benefits for a period of disability commencing on August 4, 1995. Because the Complainant’s disability did not begin while he was receiving continued benefits coverage as a laid-off 员工, he does not meet the requirement of having become disabled while in classified employment with the Respondent. 相应的, the Complainant is not eligible for health benefits coverage as a disabled 员工 under 第二条丙. (1)雇主福利计划.

受托人的意见

The Respondent is not required to provide health benefits coverage for the Complainant as a disabled 员工.