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受托人的意见
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In Re

原告: 残疾员工
被申请人: 雇主
ROD案例编号: 1982年4月27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 (“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 health coverage for a disabled individual by the 雇主 under the terms of the 雇主’s Benefit plan and hereby render their opinion on the matter.

背景事实

原告, 谁的生日是6月12日, 1929, 自7月15日起为雇主从事机密工作, 1970, 至十二月十二日, 1971. 1978年12月，申诉人工作的矿井被关闭. Although the Complainant did not return to work, he was not officially laid off until April 10, 1979. 当时, 他已经完成了超过20年的荣誉服务, including the required number of years of signatory service for pension eligibility.

申诉人已工作超过2年,000 hours for the 雇主 during the 24 month period immediately prior to his last day worked. 因此，根据第三条. 雇主计划的e1 (a), he was eligible for 健康的延续 and other non-pension benefits for the balance of December 1978, 到12月31日, 1979.

12月20日, 1950, the Complainant was involved in a mine accident which required the amputation of his right foot two inches above his ankle. He was awarded a 45% permanent partial disability award from the State Workmen’s Compensation Funds. He later suffered two compensable injuries in 1971 and 1972 while working for the 雇主. He was granted a 10% permanent partial disability award for these injuries.

After he ceased work the Complainant applied for Social Security Disability Insurance (“SSDI”) benefits. 他的申请获得批准，于1979年5月3日生效.

原告 also submitted an application for health coverage for disabled miners to the UMWA Health and Retirement Funds. 6月24日, 1980, he was advised that he satisfies the UMWA 1974 pension plan requirements for a pension, 除了年龄, and that he should contact the 雇主 as he may be eligible for health coverage under the terms of the 雇主’s plan.

The 雇主 refuses to provide health coverage for the Complainant.

争端

Is the 雇主 responsible for the provision of health coverage under 第二条. C(1) of the 雇主’s plan for the Complainant, who became disabled during his period of lay-off?

各方立场

Position of the 原告: 原告 states that he has met all the requirements of 第二条. C(1) and is, therefore, entitled to health coverage from the 雇主.

Position of the 雇主: 原告 does not meet the requirements under 第二条. Section C(1) or (2) of the 雇主’s Plan for the following reasons: (1) he did not become disabled while employed by the 雇主; (2) he did not draw any S & A benefits and was not drawing Workmen’s Compensation benefits prior to his lay-off in April, 1979; (3) he was 49 at the time of lay-off. 因此，他没有资格享受医疗保险.

相关的规定

第二条. C(1) and (2) of the 雇主’s Plan which provides, in pertinent part:

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 第二条, health benefits under 第三条 shall be provided to any Employee who:

(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,

(b)未满55岁

(c) became disabled after December 6, 1974, 在被雇主分类雇佣期间, and

(d) is eligible for Social Security Disability 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 he would be eligible to receive a pension under the 1974 Pension Plan or any successor thereto, as long as he continued to be so disabled and during the period for which Workmen’s Compensation payments (Workmen’s Compensation does not include Federal Black Lung Benefits) are applicable….

第三条. 雇主福利计划的E(1)(a)项规定:

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, life, and accidental death and dismemberment insurance coverage is as follows:

工作时数 保险期限
的雇主 继续从
24公历月 最后工作日期
前一段时间
最近工作日期

2000小时以上 月结余
加12个月

500或更多但更少 月结余超过2000小时 加6个月

少于500小时 30天

讨论

根据第二条. 雇主计划的C(1)项, an Employee is eligible for health coverage 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, 在被雇主分类雇佣期间; and (d) is eligible for Social Security Disability Insurance Benefits. 投诉人显然符合

(a)、(b)和(d)的要求. 争论的焦点是他是否在12月6日之后残疾, 1974, 在被雇主分类雇佣期间.

The information in the file indicates that the Complainant satisfies this requirement. 原告 was eligible for continued health benefits from December 13, 1978, 到12月31日, 1979. 因此, 5月3日, 1979, the date listed on his SSDI award as the date on which his total disability began, 他有资格继续享受保险. Moreover, as of that date, the Complainant would be considered an Employee in classified employment. 因此，他符合第二条的要求. 雇主计划的C(1)(C)项.

受托人的意见

The Trustees are of the opinion that the 雇主 is responsible for providing health coverage for the Employee and his dependents under 第二条. 雇主计划的C(1)项.