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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: 1980年12月18日

Board of Trustees: Harrison Combs, 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 concerning the provision of health and other non-pension benefits to an injured 员工 by the 雇主 and hereby render their opinion on the matter.

背景事实

The 员工 sustained an injury while working for the 雇主 on February 26, 1979, 还没有回去工作. 作为事故的结果, the 员工 became eligible for and continues to receive Workmen’s Compensation benefits. 另外, the 雇主 provided continued coverage of health and other non-pension benefits under the 雇主’s Plan. 2月27日, 1980, the 员工 was advised by the 雇主 that such benefits would be terminated as of March 1, 1980.

The 员工 submitted an application for a Disability Pension to the UMWA Health and Retirement Funds on April 22, 1980. That application was denied inasmuch as he had not yet been awarded Social Security disability benefits. The 员工 has recently received a Social Security disability award, 然而, and his application for a Disability Pension is under reconsideration.

争端

Is the 雇主 responsible for the provision of health and other non-pension benefits for the 员工 after February 29, 1980? 如果有，是什么时期?

各方立场

原告: The 员工 is entitled to health and non-pension benefit coverage by the 雇主 for as long as he remains disabled or receives Workmen’s Compensation benefits.

被申请人: The 雇主 has not stated his position.

国家有关规定

o Article III E(1)(a),(b) of the 雇主’s Plan which provides:

E. 一般规定

(1)续保
(a)裁员

If an employee ceases work because of lay off, 健康的延续, 视力保健, life and accidental death and dismemberment insurance coverage is as follows:

Numbers of Hours Worked for the Period of Coverage
雇主在24个日历月内 继续
Period Prior to the Date Last Worked Date Last Worked

- 2000小时或更长时间 月余额加上12个月
- 500或以上但不超过 月结余
2000小时 加6个月
- 30天内少于500小时

(b) Disability – Except as otherwise provided in Article II, 部分C, if an 员工 ceases work because of disability, the 员工 will be eligible to continue health, 视力保健, life and accidental death and dismemberment insurance coverages 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.

o Article XI (c) of the National Bituminous Coal Wage Agreement of 1978 (“Wage Agreement”) which provides:

(c) Commencement and Duration of Benefits

Sickness and Accident Benefits shall begin with the first day of disability resulting from an accident ….

Benefits for disability resulting from an accident, 要么上班，要么下班, shall be payable for a maximum of 52 weeks, regardless of the length of the 雇主’s classified employment with the 雇主 at the time of the accident.

讨论

The 员工 ceased work because of disability resulting from an accident in February, 1979. Under Article III (E)(1)(b) of the 雇主’s Plan, the 员工 was entitled to continuation of coverage for the greater of (1) the period of eligibility for Sickness and Accident (“S&A”) benefits, or (2) tie period set forth in Article III (E)(l)(a). 在任何一个标准下, the maximum period of eligibility for continued coverage is the balance of the month plus 12 months. The 雇主 provided continued coverage for that maximum period ending February 29, 1980. 相应的, 根据第III (E)(1)(b)条, the 雇主 was no longer responsible for providing continued coverage after that date.

雇员可以, 然而, regain his eligibility to receive health and other non-pension benefits under the 雇主’s Plan if his application for a Disability Pension is approved. Such coverage would be retroactive to the effective date of the pension. 直到做出决定, 然而, the 雇主 is under no obligation to provide coverage to the 员工.

受托人的意见

The Trustees are of the opinion that the 雇主 is not responsible for the provision of benefits for the 员工 beyond February 29, 1980. The 雇主 would again be responsible for coverage, 然而, if the 员工 is awarded a Disability Pension.