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受托人的意见
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在再保险

原告: 养老金领取者
被申请人: 雇主
ROD案例编号: 84-475——1987年12月15日

董事会:Joseph P. 康纳斯,老., Chairman; Paul R. 院长,受托人;
威廉·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, 受托人审查了有关根据雇主福利计划条款向养恤金领取者提供健康福利的争议的事实和情况.

背景事实

皇冠搏彩中心网站的记录显示，投诉人在煤炭行业的最后一次机密签约工作是1979年8月在被投诉人工作. The Complainant was awarded Social Security Disability Insurance (“SSDI”) benefits, 8月1日生效, 1979, 因为职业性尘肺病. 7月5日, 1985, 投诉人根据总共26年半的工作经历获得了1974年退伍军人管理局养老金计划递延既得养老金, 6月1日生效, 1985. The Complainant was advised by letter to contact his last signatory employer, 被申请人, concerning the provision of health benefits coverage as a 养老金领取者. 被告获得了该信函的副本.

The Complainant has stated that 被申请人 did not provide health benefits coverage for him until around August 1986. 申诉人说，他未付其配偶在1986年9月至1986年11月期间支付的医药费. The Complainant has stated that after these bills were incurred, his coverage was terminated. The Complainant contends that the medical bills should be paid by his last employer, 被申请人.

被投诉人声称投诉人自愿终止与被投诉人的雇佣关系，而他当时并非无法工作. The Respondent alleges that the Complainant was employed with Banner Coal and Land Company, 另一签署雇主, 在他于八月离职后, 1979. 支持其立场, 被申请人 has submitted (1) a letter from the Workers’ Compensation Fund indicating that the Complainant is receiving a permanent partial disability award (versus a total disability award); (2) an affidavit signed by the general manager of 被申请人 stating that the Complainant was recalled to work in less dusty areas in July and September 1982 and July 1983; (3) an affidavit signed by a senior Employee of 被申请人 stating that he was sent to notify the Complainant of recall; and (4) an affidavit signed by a former employee of Banner Coal and Land Company stating that the Complainant worked regularly for Banner Coal and Land Company from February 1980 to June 1981. The Respondent claims that it is not the Complainant’s last signatory employer, 因此, it is not responsible for providing the Complainant’s health benefits coverage as a 养老金领取者. 被投诉人还声称其资不抵债, 因此, health benefits should be provided under the 1974 Benefit Plan and Trust. 被告已陈述, at the time the Complainant’s outstanding medical bills were incurred, it had agreed to provide coverage for the Complainant under its benefit plan for salaried employees. 被投诉人表示，它同意提供这种保险是为了帮助当时失业且没有保险的投诉人.

Banner Coal and Land的工资部门已向皇冠搏彩中心网站提交了一份声明，表明他们没有投诉人被雇用为机密雇员的记录. No hours were reported to the Funds by Banner Coal and Land for the Complainant. 除了, the Complainant’s union dues record indicates that the Complainant’s last working union dues were for August 1979, when the Complainant was last employed by 被申请人; dues were paid until April 1987 in an unemployed status. The Complainant has submitted a copy of his W-2 form for 1979 showing wages from employment with 被申请人. He has stated that 被申请人 is his last employer and that this is the last W-2 form he has received.

争端

Whether 被申请人 is responsible for providing health benefits coverage for the Complainant as a 养老金领取者.

双方立场

投诉人的立场:被投诉人负责为投诉人提供作为养老金领取者的健康福利.

Position of 被申请人: The Respondent is not the Complainant’s last signatory employer; therefore, it is not responsible for providing the Complainant’s health benefits coverage as a 养老金领取者. 此外, 被申请人 is insolvent and financially unable to provide such coverage.

相关的规定

Article XX(c)(3)(i) of the National Bituminous Coal Wage Agreement of 1984 provides in pertinent part:

(3)(i) Each signatory 雇主 shall establish and maintain an Employee benefit plan to provide, 通过保险公司实施, health and other non-pension benefits for its Employees covered by this Agreement as well as pensioners, 1974年养恤金计划和信托皇冠搏彩中心网站, whose last signatory classified employment was with such 雇主. 雇主根据该等计划向其合格参与人提供的福利应在本协议有效期内由该雇主按该等计划规定的水平予以保证.

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

第一条-定义

The following terms shall have the meanings herein set forth:

(1) “雇主”指(雇主名称).

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

(5) “养老金领取者” shall mean any person who is receiving a pension, other than (i) a deferred vested pension based on less than 20 years of credited service, 或(ii)全部或部分根据1974年养恤金计划第ii G条的规定记入的服务年数的养恤金, 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), whose last classified signatory employment was with the 雇主, 以本计划第二条B款的规定为准.

第二条乙. (1)雇主福利计划规定:

第二条-资格

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

B. 养老金领取者

Health benefits and life insurance under Article III hereof shall be provided to 养老金领取者 as follows:

(1) Any 养老金领取者 who is not again employed in classified signatory employment subsequent to

(a) such 养老金领取者’s initial date of retirement under the 1974 Pension Plan, and

(b) 10月1日, 1984, 都有资格作为养老金领取者享受以下的保险, 并受本计划所有其他条款的约束. Notwithstanding (i) and (ii) of the definition of 养老金领取者 in Article I(5) of this Plan, any such 养老金领取者 who was eligible for benefits under the 1974 Benefit Plan as a 养老金领取者 on December 5, 1977, 都有资格享受这些福利, 受本计划所有其他条文规限.

讨论

1984年《皇冠搏彩中心网站》第XX(c)(3)(i)条要求签署雇主建立并维持雇主福利计划，为最后签署者分类就业于该雇主的养恤金领取者提供健康和其他非养恤金福利. 工资协议规定，在本协议有效期内，雇主根据该计划提供的福利应按该计划规定的水平得到保证.

第二条乙. of the 雇主 Benefit Plan establishes that an individual who is receiving a pension under the 1974 Pension Plan, 但以少于二十(20)年的累计服务年限为基础的递延既得退休金，或以第II条G项下的全部或部分累计服务年限为基础的退休金除外. of the 1974 Plan, is eligible for health benefits coverage under the 雇主 Benefit Plan. Inasmuch as the Complainant was awarded a 1974年退休金计划 Deferred Vested pension 6月1日生效, 1985, 基于26年半的信用服务, the Complainant meets the eligibility requirements of 第二条乙. and is entitled to health benefits coverage from his last signatory employer.

The issue here is whether the Complainant’s last signatory classified employment was with 被申请人. 被投诉人提交的证据支持其指控，即投诉人在被投诉人终止雇佣时并非完全残疾, and that he later refused recall to employment with 被申请人. 然而, 该等证据不足以证明投诉人曾受雇于Banner Coal and Land Company担任机密职位, 另一签署雇主, 在他受雇于答辩人之后. 此外, 被投诉人提交的由一名前班纳煤地公司雇员签署的宣誓书，并没有指明投诉人据称在1980年和1981年为班纳煤地公司所从事的工作类型. 本案中提交的其他证据表明，申诉人没有被Banner Coal and Land作为机密雇员雇用的记录，他最后一次缴纳工会会费是在1979年8月. 此外, Banner Coal and Land Company did not report any hours of service to the Funds for the Complainant, 根据工资协议条款的要求. 鉴于所提交的证据不足以证明投诉人在受雇于被投诉人后受雇于Banner Coal and Land Company担任机密职位, the Trustees conclude that the Complainant’s last signatory classified employment was with 被申请人. 因此, 被投诉人负责为投诉人作为养恤金领取者及其合格家属提供医疗保险, 6月1日生效, 1985. 被投诉人声称其资不抵债，在经济上无法提供健康福利，但这并不能免除其根据《皇冠搏彩中心网站》提供这种福利的义务.

被投诉人建议，申诉人的健康福利应由1974年福利计划和信托皇冠搏彩中心网站提供. 根据该计划, a beneficiary is entitled to coverage only if it is determined that the beneficiary’s last 雇主 is “no longer in business.” Such determination is made by the Trustees under established procedures separate from the ROD procedure.

受托人的意见

被投诉人有责任根据雇主福利计划的条款为投诉人及其合格的受抚养人提供医疗保险, 6月1日生效, 1985.