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受托人的意见
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在再保险

投诉: 残疾员工
被申请人: 雇主
ROD案例编号: 84-663——1988年9月14日

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

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 和 circumstances of this dispute concerning the provision of health benefits coverage for disabled Employees 根据雇主福利计划的条款.

背景事实

The Complainants are two disabled Employees who sustained compensable injuries while performing classified work for the Respondent. 投诉人之一, 谁的出生日期是六月九日, 1929, 他在4月20日停止工作时57岁, 1987, 因为他受伤了. 另一投诉人, 谁的生日是12月14日, 1929, 他在5月12日停止工作时57岁, 1987, 因为他受伤了. 因为他们受伤了, 申诉人无法返回工作岗位，正在领取工人赔偿.

申诉人说，答辩人于1988年5月31日终止了他们的医疗福利. The Complainants claim that the Respondent is responsible for providing their health benefits coverage as disabled Employees beyond May 31, 1988, 符合1984年全国烟煤工资协议(“工资协议”)第十一条的规定. The Complainants state that they have not severed their employment with the Respondent 和 anticipate returning to work.

The Respondent states that it provided continued benefits coverage for the Complainants through May 31, 1988, 根据第三条. D. (1)(b)雇主福利计划. Because each of the Complainants was eligible to receive a pension under the 1974 Pension Plan at the time of his disability, the Respondent contends that they are not entitled to any additional period of health benefits coverage as disabled Employees under 第二条. C. (2)计划. The Respondent states that the Complainants’ reference to Article XI of the Wage Agreement is irrelevant since that provision addresses eligibility for Sickness 和 Accident Benefits, 没有持续的医疗保险.

争端

Whether the Respondent is responsible for providing health benefits coverage for the Complainants as disabled Employees beyond May 31, 1988.

双方立场

Position of the 投诉: The Respondent is responsible for providing health benefits coverage for the Complainants as disabled Employees beyond May 31, 1988, 符合1984年工资协定第十一条的规定.

Position of the 被申请人: Because each of the Complainants was eligible for a 1974 Pension Plan pension at the time of his disability, 他们在5月31日之后就没有资格享受医疗保险了, 1988年第2条规定的残疾雇员. C. (2)雇主福利计划.

相关的规定

雇主福利计划第I(1)、(2)、(4)条规定:

第一条-定义

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1984年《官方网站》, 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.

第二条. C. 雇主福利计划第(1)、(2)、(3)条规定:

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 paragraph B of this 第二条, 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年的记名服务, 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) 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 残疾 Insurance Benefits under Title II of the Social Security Act or its successor;

(2) Becomes totally disabled due to a compensable disability within four years of the date the Employee would be eligible to receive a pension under the 1974 Pension Plan or any successor thereto, as long as the Employee continues to be so disabled during the period for which Workers’ Compensation payments (Workers’ Compensation does not include Federal Black Lung Benefits) are applicable; or

(3) 是接收还是会接收?, 正确应用后, 有资格根据工资协议领取疾病和事故福利.

第三条D. 雇主福利计划的(1)(a)、(b)及(d)项规定:

第三条-福利

D. 一般规定

(1) 续保

(a) 裁员

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

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

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

(d) 最大续保范围

在任何情况下，(a)条款的任何组合均不得, (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

The Complainants in this case contend that they are entitled to health benefits coverage as disabled Employees beyond May 31, 1988, 当该覆盖被答辩人终止时. 残疾雇员享受健康福利的资格由第2条规定.C. 和第三. D. (1) (b)雇主福利计划.

第二条. C. (1) of the 雇主 Benefit Plan provides health benefits coverage to a disabled Employee who satisfies the requirements specified therein, 其中一项规定雇员未满55岁. 因为申诉人在55岁以上时致残, 根据这一规定，他们没有资格享受医疗福利.

第二条. C. (2)计划 provides health benefits coverage for an Employee who “becomes totally disabled due to a compensable disability within four years of the date the Employee would be eligible to receive a pension under the 1974 Pension Plan.“受托人以前曾解释过第二条. C. (2) ROD 84-507(附件副本), holding that coverage under that provision is limited to disabled Employees who are not yet eligible for a 1974 Pension Plan pension.

The 1974 Pension Plan provides that pension benefits are to be provided to “[a]ny participant who (a) has at least 10 years of signatory service… 和 (b) has attained the age of 55 years…” 因为申诉人在55岁以上时致残 和 each had at least 10 years of signatory service, 他们在残疾时有资格领取1974年养老金计划的养老金. 相应的, the Complainants are not entitled to health benefits coverage as disabled Employees under 第二条丙. (2)雇主福利计划.

第二条丙. (3) of the Plan provides health benefits coverage for a disabled Employee who is receiving or would be eligible to receive Sickness 和 Accident (“S&A) 1984年工资协议第11条规定的福利. 第三条D. (1)(b) of the Plan also provides continued benefits coverage for an Employee who ceases work because of disability for the greater of (i) the period of eligibility for S&A福利，或(ii)第III D条规定的基于工作小时数的期间. (1) (a). 根据工资协议第十一条, 获得疾病和意外福利金的资格限制在最多52周. 此外，本计划根据第三条限制持续福利的覆盖范围. D. (1) (a)以该月的结余加上最后一次工作日期起计的12个月为限. 由于投诉人于四月二十日因残疾停止工作, 1987年和5月12日, 1987, 和 the Respondent provided continued health benefits coverage for both of the Complainants through May 31, 1988, the Respondent has fulfilled its obligation to the Complainants as disabled Employees by providing the maximum period of continued benefits coverage for which they qualify 根据雇主福利计划的条款.

受托人的意见

The Respondent is not responsible for providing health benefits coverage for the Complainants as disabled Employees beyond May 31, 1988, 根据雇主福利计划的条款.