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OPINION OF TRUSTEES
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In Re

Complainant: Disabled Employee
Respondent: Employer
ROD Case No: 81-494 – December 17, 1984

Board of Trustees: Harrison Combs, Chairman; Joseph P. Brennan, Trustee; William Miller, Trustee; Paul R. Dean, Trustee.

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, and under the authority of an exemption granted by the United.States Department of Labor, 受托人审查了有关雇主根据雇主福利计划条款为残疾雇员提供健康福利的争议的事实和情况，并在此就此事发表意见.

Background Facts

投诉人在煤炭行业的最后一次机密签约工作是在9月21日为答辩人工作, 1978, when he ceased his employment due to illness. 答辩人所报告的工作时数显示，他的工作时数超过2小时,在紧接答辩人最后一次工作日期之前的24个月期间内的000小时. He received Sickness and Accident (S&A) benefits during the period September 28, 3978, to November 28, 1978. Effective June 1, 1979, six months after his S&A benefits terminated, 他有资格根据标题II获得社会保障残疾保险福利(“SSDI”). On April 21, 1980, 被投诉人终止了投诉人在雇主福利计划下的福利保障(雇主计划).

申诉人于12月19日根据1974年UMWA养恤金计划提出养恤金福利申请, 1980, to establish his eligibility for health benefits as a disabled miner. On November 13, 1981, 他的申请被拒绝了，因为他没有提交20年保密服务的证据，而且在他有资格领取1974年计划养恤金之日起的四年内，他没有完全残疾. 1984年4月，皇冠搏彩中心网站收到了关于他的工作经历的进一步资料. On July 5, 1984年，他从信中得知皇冠搏彩中心网站审查了他的工作经历, on the basis of his 20 years of credited service, combined with his age (under 55), and evidence that he was awarded SSDI benefits, 已经确定，他可能有资格作为残疾矿工享受医疗福利. He was advised to contact his last signatory employer, the Respondent, which also received a copy of that letter.

On August 17, 1984, 被投诉人恢复了投诉人在雇主计划下的福利保障. The Complainant’s Representative has stated, however, 被投诉人拒绝为投诉人提供1980年4月至1984年8月期间的追溯赔偿.

Dispute

在1980年4月医疗福利终止后的一段时间内，被投诉人是否负责为申诉人及其合格家属提供医疗福利, through the date of reinstatement in August 1984?

Position of the Parties

申诉人的立场:申诉人要求恢复其医疗福利，溯及终止该保险之日.

被申请人的立场:被申请人声明其没有适用的国家烟煤工资协议的副本, therefore, 不知道是否负责向投诉人提供保险.

Pertinent Provisions

Article I. (1), (2), (4), and (9) of the Employer Benefit Plans provide:

Article I – Definitions

The following terms shall have the meanings herein set forth:

1. “Employer” means (name of company).

2. “工资协议”指1981年《皇冠搏彩中心》, as amended from time to time and any successor agreement….

4. “雇员”系指为雇主从事保密工作的有资格享受本协议项下福利的人员。.

9. “签字服务”应与美国联合煤矿工人1974年养老金计划(“1974年养老金计划”)或其任何后续计划中赋予该术语的含义相同.

Article II. C. (1) of the Employer Benefit Plans provides:

Article II – Eligibility

C. Disabled Employees

除了领取养恤金福利并因此有权根据本条B款领取健康福利的残疾养恤金领取人之外, 第3条规定的健康福利也应提供给下列任何雇员:

(1) (a) Has completed 20 years of credited service, including the
根据1974年养恤金计划第IV C(6)条或其任何后续的任何相应款规定的签署人服务年数, and

(b) has not attained age 55, and

(c) 1974年12月6日以后在雇主的分类雇佣中致残，并且

(d) 符合领取《皇冠搏彩中心网站》第二章或其后续章节规定的社会保障残疾保险福利的资格;

Article III D (1) (a) and (b) of the Employer Benefit Plans provide:

D. General Provisions

(1) Continuation of Coverage

(a) Layoff

If an Employee ceases work because of layoff, continuation of health, 人寿、意外死亡和肢解的保险范围如下:

Number of Hours Worked for the
Employer in the 24 Consecutive
Calendar Month Period Immediately Period of Coverage Continua-
Prior to the Employee’s tion from the Last
Date Last Worked Date Last Worked

2,000 or more hours Balance of month plus 12 months

500 or more but less than Balance of month plus 6 months
2,000 hours

Less than 500 hours 30 days

(b) Disability

Except as otherwise provided in Article II, section C, if an Employee ceases work because of disability, the Employee will be eligible to continue health, 残疾时的人寿、意外死亡和肢解保险，以(i)有资格领取疾病和意外福利金的期间较长者为准, or (ii) the period as set forth in the schedule in (a) above.

Discussion

Under Article II.C.(1) of the Employer Benefit Plans, 如果个人符合服务养恤金资格要求，他就有资格享受福利, except for age, under the UMWA 1974 Pension Plan, became disabled after December 6, 1974, while in classified employment with the Employer, 并且符合社会保障法第二章规定的SSDI福利.

投诉人符合1974年退休金计划的服务退休金资格要求，且未满55岁. He received an SSDI award effective June 1, 1979年，根据他在受雇于答辩人的机密工作期间所患疾病造成的残疾. 因此，他也符合12月6日以后残疾的要求, 1974 while in classified employment with the Employer.

Based on the facts, 投诉人符合雇主计划第II条C(1)款福利覆盖的资格要求. Consequently, 投诉人有资格以残疾雇员的身份享受雇主计划下的福利. The Respondent provided such coverage for the Complainant through April 21, 1980, and reinstated coverage effective August 17, 1984. Therefore, 答辩人负责为4月22日的额外中间期提供保险, 1980 through August 16, 1984.

Opinion of the Trustees

被投诉人负责在4月22日期间为投诉人及其合资格受养人提供福利, 1980 through August 16, 1984.