Opinion of Trustees
Resolution of 争端
情况下没有. 84-422
第1页
______________________________________________________________________________
OPINION OF TRUSTEES
______________________________________________________________________________
在再保险
Complainants: Laid-off Employee
Respondent: Employer
ROD 情况下没有: 84-422 – 1989年7月25日
Board of Trustees: Joseph P. 康纳斯,老., Chairman; Paul R. Dean, Trustee; William Miller,
Trustee; Donald E. 皮尔斯,小., Trustee; Thomas H. Saggau, Trustee.
Pursuant to Article IX of the United Mine Workers of America (“UMWA”) 1950 福利计划
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 benefits coverage for a laid-off Employee under the terms of the Employer
福利计划.
Background Facts
The Complainant was employed in a classified position by the Respondent from August 18, 1986
until December 29, 1986, when the Complainant was laid off. Funds’ records indicate that the
Complainant worked over 500 hours for the Respondent during the 24-month period prior to the
Complainant’s date last worked. The Respondent provided health benefits coverage for the
Complainant through the Bituminous Industry Trust/Business 保险 Trust (“BIT”) and
California Life 保险. The Complainant has submitted copies of unpaid bills for medical
services rendered between September 14, 1986 and February 19, 1987. A representative for
California Life 保险 states that the Complainant’s medical bills have been approved for
payment, but it is awaiting the settlement of the carrier’s bankruptcy. Information indicates that
both BIT and California Life 保险 ceased paying health benefits claims for services
rendered prior to April 30, 1987 due to the insolvency of BIT and California Life 保险.
争端
Whether the Respondent or the UMWA 1974 福利计划 and Trust is required to pay the
Complainant’s medical bills that are unpaid due to the insolvency of BIT and California Life
保险.
Positions of the Parties
Position of the Complainant: The Complainant asks whether the Respondent or the UMWA 1974
福利计划 and Trust is required to pay his medical bills that are unpaid due to the insolvency
of BIT and California Life 保险.
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Position of the Respondent: The Respondent has not replied to repeated correspondence from
Funds’ staff requesting its position in this dispute.
Pertinent Provisions
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage Agreement of 1984 provides
in pertinent part:
(3)(i) Each signatory Employer shall establish and maintain an
Employee benefit plan to provide, implemented through an
insurance carrier(s), health and other non-pension benefits for its
Employees covered by this Agreement as well as pensioners, under
the 1974 Pension Plan and Trust, whose last signatory classified
employment was with such Employer. The benefits provided by
the Employer to its eligible Participants pursuant to such plans
shall be guaranteed during the term of this Agreement by that
Employer at levels set forth in such plans.
Article I (1), (2) and (4) of the Employer 福利计划 provide:
Article I – Definitions
The following terms shall have the meanings herein set forth:
(1) “Employer” means (Employer’s Name).
(2) “Wage Agreement” means the National Bituminous Coal Wage
Agreement of 1984, as amended from time to time and any successor
协议.
(4) “Employee” shall mean a person working in a classified job for the
Employer, eligible to receive benefits hereunder.
第二条A款. (4) of the Employer 福利计划 provides:
第二条 – Eligibility
A. Active Employees
(4) A new Employee will be eligible for health benefits from the first day
worked with the Employer.
第三条D. (1)(a) of the Employer 福利计划 provides:
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D. General Provisions
(1) Continuation of Coverage
(一)裁员
If an Employee ceases work because of layoff, continuation of health, life
and accidental death and dismemberment insurance coverage is as
如下:
Number of Hours Worked for
the Employer in the 24
Consecutive Calendar Month
Period Immediately Prior to Period of Coverage
the Employee’s Date Continuation from the
Last Worked Date Last Worked
2,000 or more hours Balance of month plus
12个月
500 or more but less than Balance of month plus
2,000 hours 6 months
Less than 500 hours 30 days
讨论
Article XX Section (c)(3)(i) of the 1984 Wage Agreement requires an Employer to provide an
Employer 福利计划,…implemented through an insurance carrier(s), [for] health and other
non-pension benefits….” It further requires that, “…benefits provided by the Employer to its
eligible Participants pursuant to such plans shall be guaranteed during the term of this
Agreement by that Employer at levels set forth in such plans.”
第二条. A. of the Employer 福利计划 provides health benefits coverage to an active
employee working in a classified job for a signatory Employer. In addition, 第二条I. D. (1)(a)
provides continued benefits coverage for a laid-off Employee for a defined period based upon
the number of hours worked for the Employer during the 24-month period immediately prior to
the date last worked. Because the Complainant had worked for the Respondent for more than
500 hours in the 24-month period immediately prior to his layoff, the Respondent continued to
be responsible for the Complainant’s health benefits for the balance of the month in which the
Complainant last worked plus six months, or through June 30, 1987.
The Respondent implemented its Employer 福利计划 through an employer trust fund and
insurance carrier. The employer trust fund and the carrier subsequently became insolvent.
Implementation of a plan through a carrier, in and of itself, does not relieve the Respondent of its
primary obligation to provide benefits pursuant to the Wage Agreement. 因为
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Complainant was eligible for health benefits coverage from the Respondent at the time the
medical charges in question were incurred, the Respondent is responsible for payment of those
charges under the terms of the Employer 福利计划.
The Complainant has asked in the alternative whether benefits might be provided by the 1974
福利计划 and Trust. Under that Plan, a beneficiary may be entitled to coverage if his last
signatory employer is “no longer in business.” However, a “no longer in business” determination
is made according to established procedures separate from the ROD process.
Opinion of the Trustees
The Respondent is responsible for payment of the covered medical charges incurred by the
Complainant and his eligible dependents during the Complainant’s employment wish the
Respondent and during his period of eligibility for continued benefits coverage consistent with
the terms of the Wage Agreement and the Employer 福利计划.