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受托人的意见
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在再保险

原告: 未亡配偶
被申请人: 雇主
ROD案例编号: 84-351——1987年4月9日

董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean,受托人; William B. Jordan,受托人; William Miller,受托人; Donald E. 皮尔斯,小.,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 benefits coverage for the surviving spouse of an Employee under the terms of the 雇主 Benefit Plan.

背景事实

The Complainant is the surviving spouse of an Employee who worked in a classified position for the Respondent from May 1959 through July 13, 1984. 7月13日, 1984, the Complainant’s husband became disabled due to a work-related injury and was unable to return to work. 他工作了超过2小时,000 hours for the Respondent in the 24-month period prior to July 13, 1984, 并且有资格获得疾病和意外保险(“S”)&A)福利，为期52周. The Respondent provided the Complainant’s husband with health benefits until his death on September 11, 1986. The Complainant’s husband was subsequently awarded a Normal Retirement pension for the period from January 1985, 在他62岁那年的第二个月, 到1986年9月.

申诉人声称她有权获得30美元的赔偿,1万美元的人寿保险赔偿金. The Respondent claims that the Complainant’s husband was entitled to life insurance coverage as a disabled Employee for the period for which he was eligible for S&A福利，或到1985年7月12日. The Respondent claims that because the Complainant’s husband was not entitled to life insurance coverage as a disabled Employee at the time of his death, 申诉人的妻子无权得到30美元,000英镑人寿保险津贴.

争端

Whether the Respondent is responsible for providing the Complainant a $30,000英镑人寿保险津贴.

双方立场

Position of the 原告: The Respondent is responsible for providing her with a $30,000英镑人寿保险津贴.

Position of the 被申请人: The Complainant’s husband was entitled to life insurance coverage as a disabled Employee during the period for which he was eligible for Sickness and Accident benefits, 或到7月12日, 1985. 由于申诉人的丈夫于9月11日死亡, 1986, after his entitlement to life insurance coverage as a disabled Employee had ceased, 投诉人无权获得30美元的赔偿,000英镑人寿保险津贴.

相关的规定

Article I (1), (2), (4) and (5) of the 雇主 Benefit Plan provide:

第一条-定义

下列术语具有本协议规定的含义:

(1) “雇主”指(煤炭公司名称).

(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1984, 如不时修订及任何后续协议.

(4) “Employee” shall mean a person working in a classified job for the 雇主, 有资格获得本协议项下的福利.

(5) “养老金领取者”系指领取养老金的任何人, other than (i) a deferred vested pension based on less than 20 years of credited service, or (ii) a pension based in whole or in part on years of service credited under the terms of Article II G of the 1974 Pension Plan, 或其任何继承者的任何相应段落, 根据1974年退休金计划(或其任何后续计划), 谁的最后一次机密签署工作是在雇主处, 以本计划第二条B款的规定为准.

第二条丙. (3)雇主福利计划规定:

第二条-资格

The persons eligible to receive the health benefits pursuant to Article III are as follows:

C. 残疾员工

In addition to disabled 养老金领取者 who are receiving pension benefits and are therefore entitled to receive health benefits under paragraph B of this Article II, health benefits under Article III shall also be provided to any Employee who:

(3) 是接收还是会接收?, 正确应用后, be eligible to receive Sickness and Accident Benefits pursuant to the Wage Agreement.

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

第三条B. (2) (a)规定:

第三条-福利

B. 人寿及意外死亡及伤残保险

(2) 养老金领取者

在领取养老金的人去世后, 如第二条所述, 部分B, life insurance shall be paid in lump sum to the Pensioner’s named beneficiary in the following amounts:

(a) $2,500 if such Pensioner had Dependents at the time of death …

第三条D. 雇主福利计划的(1)(a)和(b)条款规定:

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

工作小时数
连续24年的雇主
日历月期间
在雇员的最后日期之前 续保期
工作 从上次工作日期开始

2000小时以上 月余额加上12个月
500或更多，但少于
2000小时 月余额加上6个月
少于500小时 30天

(b) 残疾

第二条另有规定的除外, 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, life and accidental death and dismemberment 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

第二条丙. (3) of the 雇主 Benefit Plan provides health benefits coverage and accidental life and dismemberment insurance to disabled Employees who are eligible for Sickness and Accident (“S&”)福利. 此外，第三条D. (1)(b) provides that an Employee who ceases work because of disability will receive continuation of life and accidental death and dismemberment coverage for the greater of the period of eligibility for S&第III条D款规定的福利或期间. (1)(a). 根据第三条D款. (1)(a), continuation of such coverage is based on the number of hours worked by the Employee during the 24-month period prior to the date last worked.

The Complainant’s husband worked over 2000 hours for the Respondent in the 24-month period prior to July 13, 1984年，有资格获得S&从1984年7月13日起的52周. 根据第三条D款. (1) the Complainant’s husband was entitled to continued life and accidental death and dismemberment insurance as a disabled Employee through July 31, 1985. Inasmuch as the Complainant’s husband was not eligible to receive life and accidental death and dismemberment insurance as a disabled Employee at the time he died on September 11, 1986, 投诉人没有资格获得30美元的赔偿,000英镑人寿保险津贴.

根据第三条B款. (2) (a), 在领取养老金的人去世后, a $2,500 lump-sum life insurance benefit shall be paid to the named beneficiary, 如果该养恤金领取者在死亡时有受抚养人. Inasmuch as the Complainant’s husband was a Pensioner effective January 1985, 并在9月11日去世时有一名家属, 1986, 投诉人有资格获得2美元的赔偿,500 lump-sum death benefit from the Respondent as the surviving spouse of a Pensioner.

受托人的意见

The Respondent is not responsible for providing the Complainant a $30,000英镑人寿保险津贴. 被投诉人负责向投诉人提供$2,500 life insurance benefit as the surviving spouse of a Pensioner.