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受托人的意见
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In Re

Complainant: 残疾员工
Respondent: Employer
ROD Case No: 84-618——1988年6月6日

董事会:Joseph P. Connors, Sr., Chairman; Paul R. Dean, Trustee; William B. Jordan, Trustee; William Miller, Trustee; Donald E. Pierce, Jr., Trustee.

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 a disabled Employee under the terms of the Employer Benefit Plan.

Background Facts

The Complainant was employed in a classified position with Henry C Coal Company until August 26, 1986, 当他的膝盖受伤时. 因为他受伤了, the Complainant was awarded Workers’ Compensation and he did not return to work with Henry C Coal Company. 申诉人说，10月24日对他的膝盖进行了手术, 1986年和11月5日, 1986.

投诉人受雇于被投诉人, 哈曼矿业公司, from January 26, 1987年至6月25日, 1987, 当他停止工作去做另一次膝盖手术时. Funds’ records indicate that the Complainant worked 964 hours for the Respondent in the 24-month period prior to June 25, 1987. The Respondent provided continued health benefits coverage for the Complainant until February 1, 1988.

The Complainant states that a disabled Employee is entitled to continued health benefits coverage during his period of eligibility for Sickness and Accident (“S&A”) benefits. He therefore contends that the Respondent is responsible for providing his continued health benefits coverage for 52 weeks beginning June 25, 1987, since an Employee whose disability results from an accident is eligible for 52 weeks of S&根据工资协议的条款获得福利.

被投诉人认为投诉人没有资格获得S&A benefits from the Respondent because the Complainant’s disability occurred during his employment with a previous

他的雇主亨利C煤炭公司. The Respondent states that the Complainant has received the maximum continuation of coverage under the terms of the Employer Benefit Plan.

Dispute

Whether the Respondent is responsible for providing health benefits coverage for the Complainant beyond February 1, 1988.

双方立场

Position of the Complainant: The Respondent is responsible for providing continued health benefits coverage for the Complainant for 52 weeks, beginning June 25, 1987, 他上次约会成功了.

Position of the Respondent: The Complainant has received the maximum continuation of coverage for which he is eligible under the terms of the Employer Benefit Plan.

相关的规定

Article XI, Section (b) of the National Bituminous Coal Wage Agreement of 1984 provides in pertinent part:

(b)资格

Benefits shall not be payable in the event that the Employee’s employment had been terminated, or if he was laid off or was granted a leave of absence prior to his disability, or in the event that his disability is the direct result of an injury suffered prior to his employment with the Employer or while the Employee is engaged in employment other than classified employment with his Employer.

雇主福利计划第I(1)、(2)、(4)条规定:

第一条-定义

下列术语具有本协议规定的含义:

(1) “雇主”指(“雇主名称”).

(2) “工资协议”指1984年《皇冠搏彩中心》, 如不时修订及任何后续协议.

(4) “雇员”系指为雇主从事保密工作的人员, 有资格获得本协议项下的福利.

Article II G. (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 Pensioners 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.

Article III D. 雇主福利计划的(1)(a)和(b)条款规定:

第三条-福利

D. 一般规定

(1) 续保

(a) Layoff

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
在雇员之前 续保期
Date Last Worked 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 月余额加上6个月
2,000 hours

少于500小时 30 days

(b) Disability

第二条另有规定的除外, section 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.

Discussion

根据第三条. D. (1)(b)雇主福利计划, the Employer is required to provide continued health benefits coverage to a disabled Employee for the greater of (i) the period of eligibility for Sickness and Accident benefits, or (ii) the period of eligibility based on the number of hours worked for the Employer during the 24-month period prior to his date last worked.

1984年《皇冠搏彩中心网站》第11条规定&A benefits shall not be payable in the event that an Employee’s disability is the direct result of an injury suffered prior to his employment with the Employer. It is undisputed by the parties that the Complainant’s disability is the result of an injury he sustained prior to his employment with the Respondent. 因此，投诉人不符合S&A benefits from the Respondent and his eligibility for continued health benefits coverage must be based on the number of hours worked for the Respondent in the 24-month period prior to June 25, 1987, 根据第三条. D. (1)(b)雇主福利计划. Inasmuch as the Complainant worked 964 hours for the Respondent during that period, he was eligible for continued health benefits coverage from the Respondent for the balance of June 1987 plus 6 months. The Respondent has fulfilled its obligation to the Complainant by providing continued health benefits coverage until February 1, 1988.

受托人的意见

The Respondent is not responsible for providing any additional period of continued health benefits coverage for the Complainant under the terms of the Employer Benefit Plan.