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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: 84-607——1989年5月23日
董事会:Joseph P. 康纳斯,老., Chairman; Paul R. Dean, Trustee; William Miller, Trustee; Donald E. 皮尔斯,小., Trustee; Thomas H. Saggau,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
投诉人最后一次在煤炭行业工作是在4月20日, 1982, when he was injured in a work-related accident. 由于这次受伤, the Complainant has been unable to return to work, and he was awarded Social Security Disability Insurance (“SSDI”) benefits, 4月20日生效, 1982.
As a part of 被申请人’s hiring process, the Complainant had been required to provide information regarding his medical history. 申诉人在其就业申请表和体格检查表中指出，他从未因工伤而提出工人赔偿要求，也没有收到工人赔偿福利. After the Complainant injured his back on April 20, 1982, 被投诉人发现投诉人此前曾提出多宗涉及其他雇主的工伤赔偿要求，而投诉人在受雇于被投诉人之前曾因背部受伤而获得永久性部分残疾赔偿. 10月12日, 1982, 被投诉人通知投诉人，他因伪造就业申请及体格检查表格而被停职. The Complainant’s discharge was subsequently upheld by an arbitration decision rendered December 15, 1982.
The Complainant was subsequently awarded a 1974年退休金计划 Minimum Disability pension, 5月1日生效, 1982. The Complainant was advised to contact his last signatory employer, 被申请人, concerning his eligibility for 健康 benefits coverage as a 养老金领取者. 申诉人的代表说，被投诉人拒绝为申诉人提供医疗保险.
The Respondent contends that it is not responsible for providing 健康 benefits coverage for the Complainant as a 养老金领取者 because the Complainant did not “retire” from employment with 被申请人; rather, 他出院了. The Respondent claims that if an Employee is discharged for just cause, 他丧失了所有的条款, 条件, 权利, benefits and privileges associated with his employment. The Respondent contends that under 第三条 D(1) of the 雇主 Benefit Plan, discharge results in immediate and total termination of an Employee’s 健康 benefits coverage. 答辩人还争辩说，《官方网站》中没有任何规定要求它为因正当理由被解雇的养恤金领取者提供健康福利.
争端
被投诉人是否负责为投诉人提供作为养恤金领取者的健康福利.
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.
被投诉人的立场:投诉人并没有从被投诉人的雇佣中退休，当他因正当理由被解雇时，他丧失了作为雇员的所有现在和将来的权利. 因此, 被投诉人不负责为投诉人作为养恤金领取者提供健康福利.
相关的规定
1981年和1984年《官方网站》第20 (c)(3)(i)条有关部分规定:
(3)(i) Each signatory 雇主 shall establish and maintain an Employee benefit plan to provide, implemented through an insurance carrier(s), 本协议所涵盖的雇员以及领取养老金者的健康和其他非养老金福利, under the 1974 Pension Plan and Trust, 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 1981 and 1984 雇主 Benefit Plans provide:
第一条-定义
The following terms shall have the meanings herein set forth:
(1) “雇主” means (雇主’s Name).
(2) “Wage Agreement” means the National Bituminous Coal Wage Agreement of 1981 [1984], as amended from time to time and any successor agreement.
(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, or any corresponding paragraph of any successor thereto, under the 1974 Pension Plan (or any successor thereto), whose last classified signatory employment was with the 雇主, subject to the provisions of 第二条乙 of this Plan.
第二条乙. (1) of the 1981 and 1984 雇主 Benefit Plans provides:
第二条-资格
The persons eligible to receive 健康 benefits pursuant to 第三条 are as follows:
B. 养老金领取者
根据本办法第三条向养恤金领取人提供的健康津贴和人寿保险如下:
(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) 6月7日, 1981年10月1日, 1984], shall be eligible for coverage as a 养老金领取者 under, and subject to all other provisions of this Plan. Notwithstanding (i) and (ii) of the definition of 养老金领取者 in Article I(5) of this Plan, 在12月5日符合1974年福利计划下领取养老金资格的任何此类养老金领取者, 1977, shall be eligible for such benefits, subject to all other provisions of this Plan.
第三条. D. (1)(e) of the 1981 雇主 Benefit Plan provides:
(e) 辞职或解雇
If an Employee quits or is discharged, 健康, 人身、意外死亡和肢解保险自最后工作日期起终止.
讨论
1981年和1984年《官方网站》第XX(c)(3)(i)条要求签署雇主建立和维持雇主福利计划，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. 第二条. B. (1)雇主福利计划规定，根据1974年养老金计划领取养老金的任何个人, 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 健康 benefits coverage under the 雇主 Benefit Plan. 已经审查了投诉人养老金档案中的证据，并确认了皇冠搏彩中心网站关于投诉人有权根据1974年养老金计划获得最低残疾养老金的原始决定. 根据养老金档案, the Complainant’s last day of signatory classified employment was on April 20, 1982年与被告. Inasmuch as the Complainant was awarded a 1974年退休金计划 Minimum Disability pension, 5月1日生效, 1982, the Complainant is entitled to 健康 benefits coverage from his last signatory employer.
被投诉人声称，申诉人从被投诉人获得健康福利的权利因其于12月15日出院而终止, 1982, in accordance with 第三条. D. (1)(e) of the 雇主 Benefit Plan. The continuation of coverage provisions of 第三条. D. (1)本计划的规定仅适用于雇员，因此不适用于投诉人作为养恤金领取者享受健康福利的资格. 此外, 1981年和1984年《官方网站》第20 (c)(3)(i)条明确规定，签署雇主必须向最后为该雇主从事分类工作的养恤金领取者提供健康和其他非养恤金福利. 鉴于投诉人最后一次为被投诉人进行保密签字工作是在四月二十日, 1982, and he is receiving a 1974年退休金计划 Minimum Disability pension, he is a 养老金领取者 within the meaning of 第二条乙. and is entitled to 健康 benefits coverage provided by 被申请人, 5月1日生效, 1982.
受托人的意见
被投诉人负责为投诉人作为养恤金领取者提供医疗保险, 5月1日生效, 1982, under the terms of the 雇主 Benefit Plan.