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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
连杆箱编号. 4. 1979年6月28日.

Board of Trustees: Julius Mullins, Chairman; John J. O’Connell, Trustee; Paul R. 迪恩,受托人.

Pursuant to Article IX of the United Mine Workers of America 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 about 员工’s eligibility for extended health and other non-pension benefits from an 雇主 and hereby render their opinion on the matter.

背景事实

员工 sustained a compensable back injury while lifting rock in the 雇主’s mine on August 23, 1977年，由于受伤，他离开了工作53周. 在8月23日之前的24个月内, 1977, 员工工作2年以上,000 hours.

员工 received Workmen’s Compensation for his August 1977人受伤 up to September 27, 1978年，并在8月23日提供了5%的永久部分和解, 1977人受伤. 员工, however, refused the settlement offer and returned the check accompanying the offer.

该员工已于8月30日复工, 1978年，8月30日和31日，9月1日和5日工作, 1978, 一名员工声称，他在9月5日工作时再次受伤, 1978年，从那以后就没有工作了, 没有医疗保险. 在9月5日之前的24个月内, 1978, 员工工作时间1,300 hours; he worked 32 of these hours after his return to work on August 30, 1978.

员工 filed a Workmen’s Compensation claim based on the alleged re-injury of September 5, 1978, 但这一索赔仍在审理中.

员工 was not paid Sickness and Accident Benefits because the Workmen’s Compensation claim, which will be the basis for the decision about whether 员工 is eligible for additional Sickness and Accident Benefits, 仍然待定.

问题或争议

Is the 雇主 required to provide health and other non-pension benefits to the 员工 and his eligible dependents based on the 员工’s work with the 雇主 during the period August 30, 1978年至9月5日, 1978?
如果是这样的话, for which period is the 员工 eligible for an extension of such benefits: (1) the 30天 following September 5, 1978, 或(2)九月余下的时间, 1978年和接下来的六个月?

双方立场

员工’s Position: 雇主 is required to provide health and other nonpension benefits to 员工 and his eligible dependents based on his period of work beginning August 30, 1978, 根据雇主计划的条款, 第三节, 文章花絮.(2)、(3)、(4)，自员工返回工作岗位之日起.

此外, 员工 is entitled to an extension of such benefits for the period September 5, 1978年至3月30日, 1979, 根据第3条, 文章花絮. 和第三条.(1)雇主计划, 自雇员于9月5日停止工作, 1978年因职业残疾，曾工作1年,在9月5日之前的24个月期间，雇主的工作时间为300小时, 1978.

雇主’s Position: 雇主 is not required to provide health and other non-pension benefits to the 员工 or his dependents for any periods because 员工 had been absent from work more than 12 months when he returned to work on August 30, 1978 and he worked only four days thereafter when he stopped working again because of a disability for which maximum Sickness and Accident Benefits have been allowed.

在另一种情况下, if 员工 is determined to be eligible for such benefits based on his work for the 雇主 from August 30, 1978年至9月5日, 1978, 员工’s eligibility can be extended for a maximum of 30天 following September 5, 自1978年起，雇员在7天内只工作了32小时. 员工已经使用了另一个1,从9月5日开始工作了268个小时, 1976年至8月23日, 从1977年到8月23日的失业期间, 1977年和8月30日, 1978.

雇主计划的有关规定

第2条第3节部分规定:

A. 员工

第11条规定的福利应提供给下列任何员工:

* * * *

(2) is on layoff or disabled from the 雇主 and had continued eligibility as of March 27, 1978, for coverage under the United Mine Workers of America 1974 Benefit Plan (“prior Plan”) as a laid-off or disabled employee. Coverage for such laid-off or disabled 员工 shall not continue beyond the date when they would no longer have been eligible for such coverage under the provisions of the prior Plan.

(3) 除非上文第(2)段另有规定, any 员工 of the 雇主 who is not actively at work* for the 雇主 on March 27, 1978, will not be eligible for coverage under the Plan until he returns to active employment with the 雇主…

(4) A new 员工 will eligible for health benefits from the first day worked with the 雇主.

第三条第3节部分规定:

E. 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, 视力保健, 人寿、意外死亡和肢解保险的保险范围如下:

工作时数
在保险期限内的雇主
月前 由日期开始延续
到上次工作的日期 最后的工作

2000小时以上 月余额加上12个月

500或更多但更少 月加余额
2000小时以上 6个月

少于500小时 30天

(b) 残疾

除第二条另有规定外, 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, 视力保健, 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.

讨论

在8月23日之前的24个月内, 1977, 员工工作2年以上,000 hours and on that basis would have been eligible for continued 1974 Benefit Plan coverage for 12 months, 到8月31日, 1978. 他在8月23日获得了工人赔偿, 1977人受伤, 因此, 员工 was eligible for up to 52 weeks of continued benefits coverage beginning August 24, 1977 based on his eligibility for Sickness and Accident Benefits as a result of the mine accident.

当雇员于8月30日返回工作岗位时, 1978 his continued eligibility for benefits coverage had expired under both of the alternatives set forth above. 当雇员于8月30日返回工作岗位时, 1978, he became eligible for benefits as an employee returning to active work 根据第3条, 文章花絮.(2)雇主计划. Since the 员工 did return to work after the original period of his entitlement had expired, his eligibility for continued benefits is based only upon the number of hours he worked after the expiration of that period. 因此, 因为该员工在8月30日返回工作岗位后只工作了32个小时, 1978, his eligibility for health and other non-pension benefit coverage continued for 30天 from September 5, 1978, 根据第3条的附表, 文章IIIE.员工计划的(1)(a)项.

受托人的意见

The Trustees are of the opinion that the 雇主 is required to provide health and other non-pension benefits to the 员工 and his eligible dependents for the period August 30, 1978年至10月4日, 1978, 受计划规定的限制, 根据1978年的NBCWA, XX条, 节(C).

In the event that the 员工 is determined to be entitled to additional Sickness and Accident Benefit eligibility based on the alleged mine injury of September 5, 1979, the 员工 will be eligible for benefit coverage while receiving or eligible to receive such Sickness and Accident Benefits.

然而, since that determination apparently rests upon the decision in a pending Workmen’s Compensation claim, 受托人没有根据就这一争端的这一方面发表意见.