受托人的意见
争议的解决
情况下没有. 84-584
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______________________________________________________________________________
受托人的意见
______________________________________________________________________________
在再保险
原告:员工
被申请人:雇主
ROD案例编号:84-584 - 1988年3月28日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean,受托人; William B. 约旦,
Trustee; 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 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 under the terms of the Employer 福利计划.
背景事实
的 Complainant has worked for the Respondent in a classified position since March 1979. 的
Respondent contracted with an Employer association to provide health benefits coverage to its
Employees, the Complainant included, until April 30, 1985. 雇主协会
subsequently ceased paying health benefits claims and filed a Petition for Relief under Chapter
破产法第11条. 的 Complainant has submitted copies of unpaid bills for medical
services incurred on March 5 and March 27, 1985. 的 Complainant contends that he should not
你负责支付这些账单.
的 Respondent has provided health benefits coverage for the Complainant through different
自1985年5月1日起成为保险公司. 的 Respondent has stated that since it provided health
benefits coverage for the Complainant through the Employer association, the Employer
association is responsible for payment of the Complainant’s outstanding medical bills.
争端
Is the Respondent responsible for payment of the outstanding medical bills incurred by the
1985年3月的投诉人?
双方立场
Position of the Complainant: 的 Respondent is responsible for payment of the medical bills
incurred by the 1985年3月的投诉人.
受托人的意见
争议的解决
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Position of the Respondent: 的 Respondent provided the Complainant with health benefits
通过雇主协会投保. 雇主协会 is therefore responsible
for payment of the outstanding medical bills incurred by the Complainant.
相关的规定
Article XX Section (c)(3)(i) of the National Bituminous Coal Wage 协议 of 1984
在有关部分规定:
第(c)节1974计划和信托
(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 协议 as well as
pensioners, under the 1974 Pension Plan and Trust, whose last signatory
classified employment was with such Employer. 提供的好处
Employer to its eligible Participants pursuant to such plans shall be guaranteed
during the term of this 协议 by that Employer at levels set forth in such
计划……
Article I (1), (2), and (4) of the Employer 福利计划 provide:
第一条-定义
的 following terms shall have the meanings herein set forth:
(1)“雇主”指(雇主名称).
(2) “Wage 协议” means the National Bituminous Coal Wage
协议 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. (1) of the Employer 福利计划 provides:
第二条-资格
的 persons eligible to receive the health benefits pursuant to Article III are as follows:
A. 积极的员工
Benefits under Article III shall be provided to any Employee who:
受托人的意见
争议的解决
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正在积极地工作
for the Employer on the effective date of the Wage
协议;
____________
*
Actively at work includes an Employee of the Employer who was actively at work on
September 30, 1984, and who returns to active work with the Employer two weeks after the
工资协议生效日期.
讨论
Article XX Section (c)(3)(i) of the 1984 Wage 协议 requires Employers to provide an
Employee benefit plan… “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 协议 by that
Employer at levels set forth in such plans.”
第二条A款. of the Employer 福利计划 provides health benefits coverage to active Employees
working in classified jobs for a signatory Employer. 本案的被告
implemented its Employer 福利计划 until April 30, 1985 through an Employer association
后来破产了吗. Implementation of a plan, in and of itself, does not
relieve the Respondent of its primary obligation to provide benefits pursuant to the Wage
协议. Inasmuch as the Complainant was eligible for health benefits coverage from the
Respondent as an active Employee at the time his outstanding medical charges were incurred,
the Respondent is responsible for payment of those charges under the terms of the Employer
福利计划.
受托人的意见
的 Respondent is responsible for payment of covered medical expenses incurred by the
1985年3月的投诉人, consistent with the terms of the Employer 福利计划.