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OPINION OF TRUSTEES
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In Re

Complainant: Surviving Spouse
Respondent: Employer
ROD Case No: 84-339 – September 30, 1987

Board of Trustees: Joseph P. Connors, Sr., Chairman; Paul R. Dean, Trustee; William B. Jordan Trustee; William Miller, Trustee; Donald E. Pierce, Jr., 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, 并根据美国劳工部授予的豁免授权, the Trustees have reviewed the facts and circumstances of this dispute concerning the provision of benefits coverage for a disabled Employee and his surviving spouse under the terms of the Employer Benefit Plan.

Background Facts

The Complainant’s husband performed classified work for the Respondent from June 1984 until September 20, 1985, when he ceased work due to illness. 他再也没能重返工作岗位，并于1986年9月8日死于肺癌. 根据投诉人提交的皇冠搏彩中心网站记录和工资单, her husband had worked 2,076 hours for.答辩人在紧接上一次工作日期之前的24个月内工作.

The representative for the Complainant has stated that the Respondent provided continued benefits coverage for the Complainant and her husband until June 26, 1986, 当申诉人丈夫的疾病和事故津贴被终止时. 该代表指称，被告拒绝在该日期之后提供福利, claiming that the Complainant’s husband had not worked sufficient hours in the 24-month period prior to his date last worked to qualify for any additional period of continued coverage. Information submitted to the Funds by the insurance carrier indicates that health benefits coverage was provided through December 31, 1986; however, the Complainant has stated that medical expenses incurred prior to her husband’s death have not been paid. The Complainant has indicated that her attempts to contact the Respondent regarding those charges have been unsuccessful. 申诉人还说，人寿保险赔偿金没有得到支付. 代表争辩说，申诉人的丈夫工作超过2年,在9月20日之前的24个月里，总共工作了000小时, 1985; therefore, 他有权在死亡之日之前继续领取福利金, September 8, 1986, 投诉人有权根据雇主福利计划获得人寿保险福利.

皇冠搏彩中心网站已确定被申请人已不再营业, effective December 31, 1986, and the Complainant has been advised by letter that she and her eligible dependents may qualify for health benefits coverage pursuant to Article II E. 1974年UMWA福利计划和信托，1987年1月1日生效.

Dispute

Is the Respondent responsible for payment of the Complainant’s husband’s medical expenses incurred prior to his death on September 8, 1986, 以及向投诉人提供人寿保险福利?

Positions of the Parties

投诉人职位:投诉人丈夫工作时间超过2年,在9月20日前的24个月期间内，给予被投诉人000小时, 1985, 当他因为残疾而停止工作时. Therefore, 被告负责从9月20日起继续其福利保障, 1985 until his death on September 8, 1986, 投诉人有权获得人身保险赔偿.

被投诉人的立场:被投诉人未能表明其在该争议中的立场

Pertinent Provisions

雇主福利计划第I(1)、(2)、(4)条规定:

Article I – Definitions

下列术语具有本协议规定的含义:

(1) “Employer” means (Employer’s Name).

(2) “工资协议”指1984年《皇冠搏彩中心》, 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, eligible to receive benefits hereunder.

Article II A. (1), C. (3) and E. (3)雇主福利计划规定:

Article II – Eligibility

根据第三条有资格领取健康津贴的人员如下:

A. Active Employees

第III条规定的福利应提供给下列任何员工:

(1) 在工资协议生效之日为雇主积极工作*;

C. Disabled Employees

In addition to disabled Pensioners who are receiving pension benefits and are therefore entitled to receive health benefits under paragraph B of this Article II, 第3条规定的健康福利也应提供给下列任何雇员:

(3) Is receiving or would, upon proper application, 有资格根据工资协议领取疾病和事故福利.

Life and accidental death and dismemberment insurance shall also be provided to Employees described in (3) above.

E. 已故雇员或退休人员的尚存配偶及受养人

Health benefits under Article III shall be provided to (i) any unmarried surviving spouse (who was living with or being supported by the Employee or Pensioner immediately prior to the Employee’s or Pensioner s death) and (ii) such spouse’s unmarried surviving dependent children as defined in subparagraphs (2) and (5) of paragraph D, of an Employee or Pensioner who died:

(3) At a time when such Employee or Pensioner is entitled to receive health benefits pursuant to paragraph A, B, or C of this Article II, provided that (i) if such Employee or Pensioner died prior to the effective date of the Wage Agreement and the spouse is not eligible for a Surviving Spouse’s benefit, then only for the period that the spouse is eligible to receive death benefits in installment payments pursuant to paragraph C of Article III, or (ii) if such Employee or Pensioner died on or after the effective date of the Wage Agreement and the spouse is not eligible for a Surviving Spouse’s benefit and life insurance benefits or death benefits are payable in a lump sum, then only for 60 months following the month of the death of such Employee or only for 22 months following the month of death of such Pensioner. 如果人寿保险赔偿金不支付, health benefits shall be provided only to the end of the month in which the Employee or Pensioner died.

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*积极工作的雇员包括在9月30日积极工作的雇主雇员, 1984, and who returns to active work with the Employer two weeks after the effective date of the Wage Agreement.

Article III B. (1) (a) and D. 雇主福利计划的(1)(a)、(b)及(d)项规定:

Article III – Benefits

B. 人寿及意外死亡及伤残保险

(1) Active Employees

公司将为员工提供人身、意外死亡和伤残保险, as described in Article II, Sections A and C(3), 按照以下时间表:

(a) 雇员因暴力以外的原因死亡, external and accidental means, life insurance in the amount of $30,000美元将支付给雇员的指定受益人.

D. General Provisions

(1) Continuation of Coverage

(a) Layoff

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

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

2,000 or more hours Balance of month plus
12 months
500 or more but less than Balance of month plus
2,000 hours 6 months
Less than 500 hours 30 days

(b) Disability

第二条另有规定的除外, section C, 雇员因残疾而停止工作, 雇员将有资格继续保持健康, 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.

(d) Maximum Continuation of Coverage

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 months from the date last worked.

Discussion

Under Article III D. (1)(b) of the Employer Benefit Plan, 雇主必须提供持续的健康, life and accidental death and dismemberment coverage for a disabled Employee for the greater of his period of eligibility for Sickness and Accident benefits or his period of eligibility based on the number of hours worked during the 24-month period prior to his date last worked. Funds’ records and the evidence submitted by the Complainant indicate that the Complainant’s husband worked 2,在9月20日之前的24个月期间内，答辩人的工作时间为076小时, 1985, his date last worked. Accordingly, 申诉人的丈夫有权继续保持健康, life and accidental death and dismemberment coverage for the balance of September 1985 plus twelve months the maximum period allowable under Article III D. (I)(d). 因为申诉人的丈夫于9月8日死亡, 1986, the Respondent is responsible for payment of any covered medical expenses incurred by him through that date and 向投诉人支付人寿保险赔偿金.

Furthermore, Article II E. (3)(ii) of the Employer Benefit Plan requires a signatory Employer to provide health benefits to the unmarried surviving spouse of an Employee and to her eligible dependents for a 60-month period, 如该雇员在工资协议生效日期后死亡, 如果未亡配偶没有资格领取未亡配偶福利, 如果人寿保险或死亡赔偿金一次性支付给未亡配偶. 因为投诉人符合这些要求, the Respondent is responsible for the provision of health benefits coverage for the Complainant and her eligible dependents from September 1986 through December 31, 1986, 根据第II条E款被确定不再营业的日期. 1974年UMWA福利计划和信托皇冠搏彩中心网站.

Opinion of the Trustees

The Respondent is responsible for payment of the Complainant’s husband’s covered medical expenses incurred through September 8, 1986, 向投诉人支付人寿保险赔偿金, and for the provision of health benefits coverage for the Complainant and her eligible dependents through December 31, 1986.